[Sleep architecture in schizophrenia patients]. / Sizofreni Hastalarinda Uyku Yapisi

OBJECTIVE: Sleep disorders are a common and important part of schizophrenia's clinical Picture; however, the number of polysomnography-based studies of schizophrenia is limited and there is a lack of consensus regarding a specific sleep pattern in schizophrenia patients. As such, the aim of the present study was to investigate the sleep architecture in non-medicated schizophrenia patients. METHOD: The study included 13 adult male inpatients with schizophrenia, undifferentiated type, (based on DSM-IV-TR criteria) and an age- and sex-matched group of normal controls. The participants were studied during 2 consecutive nights in the sleep laboratory. The Brief Psychiatric Rating Scale (BPRS), Scale for Negative Symptoms (SANS), and Scale for Positive Symptoms (SAPS) were used for clinical assessment. Polysomnographic recordings obtained on the second night were used for analysis. RESULTS: Compared to the controls, the schizophrenic patients had less total sleep time, lower sleep efficiency, longer sleep latency, more awakenings, and increased duration of awakenings after falling asleep. In terms of sleep architecture, the schizophrenia patients showed no evidence of abnormal-slow wave sleep, but the percentage of REM sleep was reduced. REM sleep measures, including REM latency and density, did not significantly differ between the 2 groups. Based on correlation analysis between the sleep parameters and clinical symptoms, slow-wave sleep was inversely correlated with formal thought disorder. CONCLUSION: The findings indicate that in addition to decreased REM sleep time, disturbances in sleep initiation and maintenance were prominent in the non-medicated schizophrenia patients. The correlation between decreased decreased REM sleep and, slow-wave sleep, and formal thought disorder we observed in the patients might have been related to the underlying pathophysiology of schizophrenia.

Patient adherence and efficacy of quetiapine treatment in schizophrenia: results of a multicentre, naturalistic 6-month follow-up study.

The aim of the study was to evaluate the adherence and efficacy of quetiapine treatment in a 6-month, multicentre, noninterventional naturalistic design. Overall, 710 schizophrenia patients using quetiapine or who had switched to quetiapine were included. The continuation rate for quetiapine treatment during 6-month follow-up period was 69%. Adherence improved with each subsequent visit for continued patients, 92.9% at the second visit to 96.1% at the last. Treatment adherence was correlated to improvement of symptoms, though not significantly. Patients having lower clinical global impression severity scores at the beginning were twice as likely to improve compared with patients with higher clinical global impression scores. Schizophrenia patients with antisocial behaviour problems had two and a half times higher drop-out rates. In conclusion, this naturalistic study showed that adherence to quetiapine treatment was high, and treatment was effective in schizophrenia patients during long-term treatment. Remission of symptoms in schizophrenia is much related to severity of symptoms at baseline, treatment adherence and characteristics of patients such as antisocial behavioural patterns.

Polysomnography in patients with post-traumatic stress disorder.

AIMS: The purpose of the present study was to investigate sleep structure in post-traumatic stress disorder (PTSD) patients with and without any psychiatric comorbidities. The relationship between sleep variables and measurements of clinical symptom severity were also investigated. METHODS: Sleep patterns of 24 non-medicated male PTSD patients and 16 age- and sex-matched normal controls were investigated on polysomnography on two consecutive nights. Six PTSD-only patients and 15 PTSD patients with major depressive disorder (MDD) were also compared to normal controls. Sleep variables were correlated with PTSD symptoms. RESULTS: Compared to the normal controls, the PTSD patients with MDD had difficulty initiating sleep, poor sleep efficiency, decreased total sleep time, decreased slow wave sleep (SWS), and a reduced rapid eye movement (REM) sleep latency. The PTSD patients without any comorbid psychiatric disorders had moderately significant disturbances of sleep continuity, and decreased SWS, but no abnormalities of REM sleep. REM sleep latency was inversely proportional to the severity of startle response. SWS was found to be inversely correlated with the severity of psychogenic amnesia. CONCLUSIONS: PTSD patients have disturbance of sleep continuity, and SWS deficit, without the impact of comorbid depression on sleep. The relationship between SWS and the inability to recall an important aspect of trauma may indicate the role of sleep in the consolidation of traumatic memories. The relationship between the severity of the startle response and REM latency may suggest that REM sleep physiology shares common substrates with the symptoms of PTSD.

Effectiveness of psychoeducation intervention on post-traumatic stress disorder and coping styles of earthquake survivors.

AIMS AND OBJECTIVES: The aim of the study was to examine the effectiveness of a psychoeducation intervention based on Peplau's approach, including problem-solving compared with intervention with medication on post-traumatic stress disorder (PTSD) symptoms and coping of earthquake survivors. BACKGROUND: Post-traumatic reactions and recovery are the result of complex interactions among biological, personal, cultural and environmental factors. Both psychosocial and psychopharmacological methods have been advised to treat PTSD. The general goal of treatment is to decrease the anxiety and to support these patients in regaining normal daily functions. DESIGN: The study used a pretest to posttest quasi-experimental design with three comparison groups. METHODS: The sample of the study included 51 survivors of the Marmara Earthquake who met diagnostic criteria for PTSD. Comparison groups were made up as psychoeducation only, medication only and psychoeducation with medication (PEM). Six semi-structured psychoeducation sessions were conducted individually. Patients in the 'medication only' group did not participate in these sessions. The Clinician Administered PTSD Scale, Hamilton Depression Scale and Coping Strategies Scale were used for the measurements. RESULTS: There was a significant difference between the 'PEM' group and the 'medication only' group with the first group showing greater relief of symptoms. Generally, there were no differences between the 'medication only' and 'psychoeducation only' groups. Avoidance as a coping strategy had significant positive correlations with PTSD and depression outcomes. CONCLUSIONS: Patients with PTSD seem to take more advantage from the combined treatment model. Nurses can help the patients with PTSD by teaching them to cope with the symptoms. RELEVANCE TO CLINICAL PRACTICE: The number and variety of catastrophic events in the world are increasing. Psychiatric nurses should therefore take responsibility regarding the effects of trauma and investigate the ways of working with people who experienced trauma in more detail and develop interventions based on scientific evidence.

Oscillatory responses representing differential auditory processing in sleep.

The goal of the study was to investigate the contribution of the delta and theta responses to the peaks on the event-related potential waveform and specifically to find the possible cognitive correlates of these oscillatory responses in rapid eye movements (REM) sleep and Stage 2 (spindle sleep), Stage 3 (light sleep) and Stage 4 (deep sleep; slow wave sleep) of non-REM sleep. Data on overnight sleep was acquired from 12 healthy, young adult, volunteer males; those on awake stage were obtained from 19 matched males. Brain activity was obtained in response to auditory stimuli (2000 Hz deviant and 1000 Hz standard stimuli: 65 dB, 10 ms r/f time, 50 ms duration) under passive oddball paradigm in sleep, active and passive oddball (OB-a, OB-p, respectively) paradigms in wakefulness. The effect of the experimental variables (stimulus type, sleep stage) was studied using 2 x 4 analysis of variance for repeated measures and stepwise multiple regression analysis. Overall, three types of configurations were obtained for the oscillatory responses which varied according to sleep stage and stimulus type: Large amplitude, differentiated delta and distinct theta response of long duration; distinct theta response with short duration; distinct delta response. As in wakefulness, the morphology of the time-domain peaks was found to be due to the superposition of the delta and theta responses. The configuration in REM resembled the responses to the OB-p paradigm and that NREM stages resembled the responses to the OB-a paradigm in wakefulness. Auditory information processing selectively varied according to sleep stages and took longer in sleep. Comparable peaks were obtained at longer latencies and later components appeared that did not exist under wakefulness. With respect to the long-duration theta activity, and greater differentiation between the deviant- and standard-elicited stimuli, Stage 2 appeared to represent the more effortful cognitive processing.

In restless legs syndrome, during changes in vigilance, the forced EEG shifts from alpha activity to delta or high alpha may lead to the altered states of dopamine receptor function and the symptoms.

RLS cases may carry a genetic vulnerability called EEG alpha activity gate dyscontrols which appear during changes in vigilance and generally during sleep. It is triggered by forced EEG shifts either from alpha activity to delta or high alpha. Expressions of alpha activity gate dyscontrols may have a gate effect that trigger a second vulnerability-dopamine receptor specific individual sensitivity (DRSIS) and this leads to a deficiency in dopamine transmissions at diencephalospinal dopamine system (DSDS). Due to altered gene expressions in states of dopamine receptor function, DRSIS EEGs and RLS symptoms may be interpreted as follows: A. Disinhibition state is alpha activity gate dyscontrols induced inhibition of DSDS inhibitory dopamine modulations. Dopaminergic disinhibitions inhibit inhibitory interneurons of sensory and motor nuclei neurons that are involved in RLS. These sleep sensitive inhibitory interneurons possibly have GABA-ergic functions in sleep. (I) DSDS thalamic neurons' disinhibitory effects in thalamus on GABA-ergic interneurons of: (a) Intralaminar nuclei non-discriminative sensation neurons at thalamocortical premotor network leading to symptom of "a sense of urgency to move" generally referenced to legs.(b) Reticular thalamic nucleus (RTN) neurons. At polysomnography,during NREM sleep, disinhibited RTN neurons show alpha activity gate dyscontrol 1. These are recurrent subtypes of CAP in alpha band (7-12 Hz) pointing a difficulty in shifting to subtypes of CAP in low delta bands (0.25-2.5 Hz) and sleep fragmentations.(II) Supraspinal disinhibitory projections from DSDS thalamic neurons on GABA-ergic interneurons of: (a) Sensory neurons at posterior horns of spinal cord leading to dysesthesias, generally referenced to legs.(b) Medullary-reticulospinal neurons and by way of independent spinal rhythm generators on motoneurons leading to periodic limb movements in sleep.B. Activation state is an increase in symptoms. Sensory intralaminar and motor pontin nuclei neurons are in fact excitatory but are disinhibited in RLS. Due to altered gene expression, these neurons begin to perceive 'disinhibition' as reduced inhibition. Their glutamate receptors may activate deficient dopamine transmissions on RTN leading to alpha activity gate dyscontrol 2. This implies a failure in preventing shifts to frequent subtypes of CAP in high alpha and low beta bands (12-13 Hz) resulting in an increase of sensorimotor symptoms and appearance of motor restlessness, behavioral arousals and insomnia. C. Inhibition state is spontaneous relief from sensorimotor symptoms. Short or long-term synaptic plasticities of dopamine receptors towards activations initiate negative feedbacks from inhibitory interneurons. They are supported by inhibitory dopamine modulations- alertness and some awareness generally with regular high alpha EEGs, supraspinal inhibitions and a reverse movement pattern of PLMS during standing up and continuing to walk.

Treatment of compulsive sexual behaviour with clomipramine and valproic acid.

The concepts of compulsive sexual behaviour or sexual addiction and treatment of the disorder have been argued over by many investigators. From a scientific point of view, both concepts are still not well established in psychiatric nomenclature. On the other hand, authors point out that compulsive sexual behaviour, obsessive-compulsive disorder and substance addiction show similarities in symptomatology and response to treatment. In this article, the case of a 21-year-old female exhibiting compulsive sexual behaviour since childhood who was treated with a combination of clomipramine and valproic acid is presented and discussed in the light of the relevant literature.

Evaluation of periodic leg movements and associated transcranial magnetic stimulation parameters in restless legs syndrome.

Restless legs syndrome (RLS), a sensorimotor disorder characterized by unpleasant sensations commonly localized in the legs, is frequently associated with periodic limb movements (PLMs) during sleep. We investigated the role of transcranial magnetic stimulation (TMS) and cortical silent period (CSP) duration as diagnostic and monitoring tools in 20 patients with primary RLS before and after 1 month of treatment and also studied 15 normal age- and gender-matched subjects. Polysomnographic assessment was undertaken and the PLM index determined in 17 of the 20 patients. We also studied the correlation between sleep efficiency index and CSP duration because of the increasing severity of the sleep disturbance and PLMs in patients with RLS. Our results demonstrate that the duration of the CSP was reduced in patients with RLS, and that dopaminergic treatment normalized this duration. There was no correlation between the PLM index and CSP duration. It may be speculated that PLMs and the CSP are due to different inhibitory mechanisms and they may be used separately as diagnostic and monitoring tools in patients with primary RLS.

Prevalence of insomnia symptoms: results from an urban district in Ankara, Turkey 1.

Objective. Characteristics of insomnia symptoms in Turkey are not well established. The goal of this study was to determine the prevalence of insomnia and related symptoms in an urban district of Turkey. Method. The study was carried out in Ankara, in an urban district with a population of 2665. Out of the 1332 people in the sample, 1034 in the 15-65 age range were included in the study. Interviews were conducted according to the "Sleep Disorders Assessment Questionnaire" developed by the researchers. The Insomnia Severity Index (ISI) was also given to the subjects with a sleep problem to measure the subjective quality and quantity of insomnia symptoms. Results and conclusion. A total of 29.4% of all participants reported a sleep problem, out of which 23.7% defined one or more of the insomnia symptoms which included difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), non-restorative sleep (NRS) and sleep deprivation (SD). Insomnia risk was found to be significantly increased with age, female sex, smoking and chronic medical illness. A total of 75.9% of participants who reported insomnia symptoms did not seek medical help for their complaint. According to the ISI, among the subjects with insomnia symptoms, 79 (32.2%) had subthreshold insomnia, 43 (17.6%) had clinical insomnia, 12 (4.9%) had severe clinical insomnia, while 88 (35.9%) did not score in the range indicating insomnia. The findings are discussed in the light of previous research and in relation to sociocultural factors emphasizing the need for public education on sleep disorders as medical conditions.