Ultradian cycles in mice: definitions and links with REMS and NREMS.

Sleep can be organized in two quite different ways across homeothermic species: either in one block (monophasic), or in several bouts across the 24 h (polyphasic). Yet, the main relationships between variables, as well as regulating mechanisms, are likely to be similar. Correlations and theories on sleep regulation should thus be examined on both types of sleepers. In previous studies on monophasic humans, we have shown preferential links between the number of ultradian cycles and the rapid eye movement sleep (REMS) time, rather than with its counterpart non-rapid eye movement sleep (NREMS). Here, the sleep of 26 polyphasic mice was examined, both to better describe the NREMS distribution, which is far more complex than in humans, and to replicate the analyses performed on humans. As in humans, the strongest links with the number of cycles were with REMS. Links were not significant with NREMS taken as a whole, although positive correlations were found with the NREMS immediately preceding REMS episodes and inversely significant with the residue. This convergence between monophasic and polyphasic patterns supports the central role played by REMS in sleep alternation.

[Chronic fatigue syndrome: psychiatric perspectives]. / Le syndrome de fatigue chronique: aspects psychiatriques.

Chronic fatigue syndrome (CFS) is a common illness of unknown etiology and pathogenesis characterized by severe disabling fatigue and a variety of musculoskeletal, neurocognitive, mood symptoms and sleep disorders lasting at least six months. A significant proportion of patients fulfilling operative criteria for a diagnosis of CFS will also meet criteria for a psychiatric disorder such as depression, somatization or anxiety disorders. Premorbid lifestyle may play a predisposing, and/or perpetuating role in CFS. Some patients improve with time but most remain functionally impaired for several years. A variety of interventions have been used in the treatment and management of CFS. Interventions which have shown promising results include cognitive behavioural therapy and graded exercise therapy. Antidepressants can be useful particularly in the case of comorbid affective disorders. Development of good therapeutic doctor-patient alliance with empathic care is central to the effective management of CFS. In this article we overview the nature and definition of CFS. The prevalence, the prognosis and the psychopathological issues are presented. The management of this controversial syndrome is discussed.

[Sleep apnea syndrome : multidisciplinary management. Apropos of a preliminary experience]. / Syndrome d'apnées du sommeil: prise en charge multidisciplinaire. A propos d'une expérience préliminaire.

The authors describe a multidisciplinary approach for patients with sleep apnea syndrome. During the first year 40 patients with obstructive sleep apnea documented by polysomnographic recordings were managed. Therapy proposed to the patient included weight loss and abstention from sedatives at night as sole treatment (n = 12) or, more often, combined with nasal and/or throat surgery (n = 21) or nasal continuous positive airway pressure (NCPAP) during sleep (n = 7). NCPAP was by far the most effective in reversing apneas but in view of its cost for the patient and its constraining aspects was proposed solely to those patients with the most severe apnea syndromes.

ACTH, cortisol and growth hormone 24-hour profiles in major depressive illness.

Circadian rhythms of ACTH, cortisol and growth hormone have been studied in eighteen major depressives (eight unipolar and ten bipolar) as well as in eight normal controls. Both unipolar and bipolar depressed patients secreted more growth hormone than normal men. This hypersecretion occurred during waking hours rather than during sleep. An early sleep GH increase was found in all but one of the normal men, but was absent in seven of the eight unipolar depressed patients, who had instead a presleep increase. No consistent disturbance of the temporal association between sleep onset and GH secretion was found in bipolar depressed patients. Both unipolar and bipolar depressed patients had higher 24 h mean cortisol levels than normal men, but no significant difference was found for 24 h ACTH levels. An early timing of the nadir of ACTH-cortisol secretion which was observed in our depressed patients also suggest that disorders of circadian time keeping may characterize major endogenous depression.

Sleep and neuroendocrine disturbances in catatonia. A case report.

Sleep EEG investigations were performed in a 31-year-old catatonic male patient before and after electroconvulsive therapy and 3 months after recovery. The dexamethasone suppression test was also performed longitudinally together with measurements of CSF 5-HIAA, HVA and 24-h urinary MHPG. A normal male control aged 32 was also investigated. Sleep analysis showed reduced REM latency and increased REM activity and density during the catatonic phase before treatment when compared to the age-matched control. REM latency remained shortened after recovery following ECT treatment and 3 months after recovery. Dexamethasone suppression test, abnormal before treatment normalized with clinical improvement during ECT. Urinary MHPG values were low in the catatonic state and did not change after ECT treatment. CSF HVA and 5-HIAA were also low in the pretreatment period and increased during the 3 months follow-up period. There results indicate that some cases of catatonic behavior may be linked to affective disorders.

Violent suicidal behavior and the thyrotropin-releasing hormone-thyroid-stimulating hormone test: a clinical outcome study.

A relation between abnormal response of thyroid-stimulating hormone (TSH) to thyrotropin-releasing hormone (TRH) and a personal history of violent suicidal behavior was observed in a sample of 60 depressive women. Patients with a blunted TSH response to TRH were also at greater risk for subsequent suicide. There was no relationship between TSH response to TRH and age, severity of depression and polarity of the illness.

Immediate and delayed alterations of adrenocorticotropin and cortisol nyctohemeral profiles after corticotropin-releasing factor in normal man.

Intravenous injections of 50 micrograms corticotropin-releasing factor (CRF) to four normal men at 0900 and 2300 h were followed by significant plasma ACTH and cortisol elevations, without changes in GH and PRL concentrations. The responses were more easily assessed late in the evening than in the morning, when they were superimposed upon the spontaneous hormonal variations. The initial hormonal response was always followed by a period of decreased hormonal values compared to control patterns. The normal pituitary-adrenal response to CRF was blunted or abolished by prior administration of dexamethasone. These data suggest that exogenous administration or CRF-induced endogenous production of glucocorticoids modulates the sensitivity of corticotropic cells to the action of CRF. Since normal ACTH and cortisol secretory episodes are likely to obscure the effects of CRF, stimulation tests for clinical purposes should be performed during the quiescent period, i.e. late in the evening.

General anesthesia after neuroleptic malignant syndrome.

The neuroleptic malignant syndrome (NMS) is an uncommon and potentially lethal complication of therapy with neuroleptics characterized by pallor, hyperthermia, and extrapyramidal signs (Delay and Deniker, 1968). Malignant hyperthermia (MH) is a rare but often fatal complication of general anesthesia characterized by hyperpyrexia and muscle rigidity, but not related to neuroleptic therapy. For both syndromes, NMS and MH, a common pathophysiology has been considered (Meltzer, 1973; Itoh, 1977; Caroff, 1980). These two syndromes may also be clinically indistinguishable from "acute lethal catatonia" characterized by fever, muscular hypertonicity, and stupor, first described by Stauder in 1934. We now report a case in whom NMS appeared following neuroleptic treatment for a psychotic depressive syndrome. After remission from the NMS, the patient underwent general anesthesia nine times for electroconvulsive therapy (ECT) without ill effect. This case supports the theory of distinct pathogenic mechanisms for both NMS and MH.

Thyrotrophin response to thyrotrophin-releasing hormone in unipolar and bipolar affective illness.

The plasma levels of thyrotrophin (TSH) and the response of this hormone to 200 microgram of thyrotrophin-releasing hormone (TRH) were studied in 27 unipolar and 24 bipolar depressive patients before and after amitriptyline treatment as well as in 42 normal controls. There was no significant difference in basal TSH levels between any of the groups studied according to diagnosis, menopausal status and antidepressant treatment. Before treatment, the TSH response to TRH was significantly lower in the unipolar and bipolar depressive patients than in normal controls. The TSH response to TRH did not differ significantly between the unipolar and bipolar depressives. When menopausal status was taken into account, the TSH response to TRH was significantly blunted in the unipolar postmenopausal patients when compared to postmenopausal controls. In the bipolar group, the premenopausal depressive patients had a significantly lower TSH response to TRH than premenopausal controls. After amitriptyline treatment, the TSH response to TRH, which was impaired before treatment in the bipolar premenopausal patients, improved significantly. However, no significant difference in the TSH response to TRH could be demonstrated after treatment in the unipolar postmenopausal patients in whom the TSH response was blunted before treatment. Our findings suggest that the differential TSH response to TRH in unipolar and bipolar patients may constitute biological markers of endocrine dysfunction in clinical subgroups of affective disorders.