Behavioral symptoms and sleep problems in children with anxiety disorder.
Iwadare Yoshitaka,Kamei Yuichi,Usami Masahide,Ushijima Hirokage,Tanaka Tetsuya,Watanabe Kyota,Kodaira Masaki,Saito Kazuhiko
Pediatrics international : official journal of the Japan Pediatric Society
BACKGROUND:Sleep disorders are frequently associated with childhood behavioral problems and mental illnesses such as anxiety disorder. To identify promising behavioral targets for pediatric anxiety disorder therapy, we investigated the associations between specific sleep and behavioral problems. METHODS:We conducted retrospective reviews of 105 patients aged 4-12 years who met the DSM-IV criteria for primary diagnosis of generalized anxiety disorder (n = 33), separation anxiety disorder (n = 23), social phobia (n = 21), or obsessive compulsive disorder (n = 28). Sleep problems were evaluated using the Children's Sleep Habits Questionnaire (CSHQ) and behavioral problems by the Spence Children's Anxiety Scale, Oppositional Defiant Behavior Inventory (ODBI), and Depression Self-Rating Scale for Children. RESULTS:Depressive behavior was weakly correlated with CSHQ subscores for sleep onset delay and night waking but not with total sleep disturbance. Anxiety was correlated with bedtime resistance, night waking, and total sleep disturbance score. Oppositional defiance was correlated with bedtime resistance, daytime sleepiness, sleep onset delay, and most strongly with total sleep disturbance. On multiple regression analysis ODBI score had the strongest positive association with total sleep disturbance and the strongest negative association with total sleep duration. CONCLUSIONS:Sleep problems in children with anxiety disorders are closely related to anxiety and oppositional defiant symptoms.
Sleep disturbances in treatment-seeking OCD-patients: Changes after concentrated exposure treatment.
Nordahl Håkon,Havnen Audun,Hansen Bjarne,Öst Lars-Göran,Kvale Gerd
Scandinavian journal of psychology
Research indicates that patients with Obsessive Compulsive Disorder (OCD) frequently suffer from comorbid sleep difficulties, and that these difficulties often are not clinically recognized and diagnosed. There has been limited research investigating if comorbid sleep difficulties impair treatment outcome for OCD and if the sleep difficulties change following OCD-treatment. Thirty-six patients with obsessive compulsive disorder underwent concentrated exposure treatment delivered in a group over four consecutive days and were assessed with measures of OCD, depressive symptoms and sleep disturbance at three different time points (pre, post and 6 months follow-up). The sample was characterized by a high degree of comorbidity with other psychiatric disorders. At pre-treatment nearly 70% of the patients reported sleep difficulties indicative of primary insomnia. The results showed that patients had large reductions of OCD-symptoms as well as significant improvements in sleep disturbance assessed after treatment, and that these improvements were maintained at follow-up. Sleep disturbance did not impair treatment outcome, on the contrary patients with higher degree of sleep disturbance at pre-treatment had better outcome on OCD-symptoms after treatment. The results indicated that the majority of the OCD sample suffered from sleep disturbances and that these sleep disturbances were significantly reduced following adequate treatment of OCD without specific sleep interventions. However, a proportion of the patients suffered from residual symptoms of insomnia after treatment.
Sleep disturbance and obsessive-compulsive symptoms: Results from the national comorbidity survey replication.
Cox Rebecca C,Olatunji Bunmi O
Journal of psychiatric research
A small body of developing research has found evidence for sleep disturbance in obsessive-compulsive disorder (OCD) and links between sleep disturbance and obsessive-compulsive symptoms (OCS) in unselected samples. However, the link between sleep disturbance and OCS is yet to be examined in a nationally representative sample. Furthermore, the extent to which the link between sleep disturbance and OCS is accounted for by symptoms of depression remains unclear. To address this gap in the literature, the present study examined the relationship between sleep disturbance and OCS in a nationally representative sample. Participants were assessed in the National Comorbidity Survey Replication (NCS-R; n = 2073). Consistent with predictions, results revealed that individuals with sleep disturbance reported increased OCS severity compared to individuals without sleep disturbance. Further, sleep disturbance severity was associated with OCS severity, even when controlling for depression (and other anxiety-related disorders). This study is the first to link sleep disturbance and OCS in a nationally representative sample, and these findings highlight the unique role of sleep disturbance in the experience of OCS. Future research is necessary to delineate specific mechanisms that may account for this relationship.
The role of eveningness in obsessive-compulsive symptoms: Cross-sectional and prospective approaches.
Cox Rebecca C,Tuck Breanna,Olatunji Bunmi O
Journal of affective disorders
BACKGROUND:Eveningness may be defined as the tendency to be most active and alert during the evening. Previous research has linked eveningness with maladaptive psychological outcomes, and recent evidence has highlighted circadian dysregulation as a novel factor in psychopathology, including obsessive-compulsive disorder (OCD). However, limited research has examined the unique relationship between eveningness and OC symptoms. Two studies were conducted to thoroughly examine the links between eveningness and OC symptoms, while also considering the role of depression symptoms and sleep-related factors. METHODS:Using a cross-sectional approach, Study 1 examined the association between eveningness and OC symptoms when controlling for depression symptoms. Study 2 then employed a prospective approach to examine the extent to which the relationship between eveningness and change in OC symptoms over 4 months is mediated by change in sleep disturbance and total sleep time when controlling for depression symptoms. RESULTS:Results indicated that depression better accounts for the cross-sectional association between eveningness and OC symptoms. However, eveningness was found to be a more robust prospective predictor of change in OC symptoms in Study 2. Furthermore, sleep disturbance, but not total sleep time, partially mediated the relationship between eveningness and OC symptoms. LIMITATIONS:Single-method self-report approach, unselected sample, and lack of experimental manipulation. CONCLUSIONS:These findings suggest that eveningness may contribute to the development of OC symptoms over time, in part due to its effect on sleep disturbance. Future research examining the role of circadian dysregulation in OCD may uncover novel physiological mechanisms.
Circadian Rhythms in Obsessive-Compulsive Disorder: Recent Findings and Recommendations for Future Research.
Cox Rebecca C,Olatunji Bunmi O
Current psychiatry reports
PURPOSE OF REVIEW:Circadian rhythms are a topic of growing interest in mental health, particularly in obsessive-compulsive disorder. However, the consistency of this link has not been carefully examined. Thus, the present review integrates findings from the past 5 years in order to determine the strength of such a relationship and identify areas for clarification and extension. RECENT FINDINGS:Findings revealed inconsistent evidence for a link between circadian rhythms and OCD. Chronotype is unrelated to OCD symptoms in adolescents but predicts OCD symptoms in adults. Results on delayed sleep timing are equivocal. Circadian rhythm disorders predict OCD treatment outcome. Preliminary evidence implicates decreased light exposure and diurnal symptom variability in OCD. The relationship between circadian rhythms and OCD may vary by age, diagnostic status, and assessment method. Recent findings are limited by an overreliance on convenience samples and singular self-report methods. Recommendations for future research on the role of circadian rhythms in OCD are discussed.
Sleep in obsessive-compulsive disorder: a systematic review and meta-analysis.
Díaz-Román Amparo,Perestelo-Pérez Lilisbeth,Buela-Casal Gualberto
The aim of this study was to determine whether there are differences in sleep between people with and without obsessive-compulsive disorder (OCD), and, if so, whether such differences are associated with comorbid depressive symptoms or other conditioning factors. We conducted a search for articles published until March 2013 in PubMed, Web of Knowledge, PsycINFO, Scopus, Trip Database, Dissertation Abstracts, and OpenSIGLE. We retrieved 9658 records, which were assessed against the inclusion and quality criteria. Six studies were included in the review and four were included in the meta-analysis. They were all cross-sectional studies with medium methodological quality. All studies except one were polysomnographic. The total sample of the meta-analysis consisted of 111 patients with OCD and 141 controls. The synthesis of results showed differences in sleep between people with and without OCD. The presence of comorbid depression was a key issue in the amount and type of differences found. Nevertheless, in order to support these results, longitudinal studies should be conducted with larger sample sizes and different age ranges.
Eveningness is associated with poor sleep quality and negative affect in obsessive-compulsive disorder.
Simor Péter,Harsányi András,Csigó Kata,Miklós Gergely,Lázár Alpár Sándor,Demeter Gyula
Journal of behavioral addictions
Background Obsessive-compulsive disorder (OCD) is characterized by intrusive thoughts and repetitive behaviors that severely encumber daily functioning. OCD patients seem to exhibit sleep disturbances, especially delayed bedtimes that reflect disrupted circadian rhythmicity. Morningness-eveningness is a fundamental factor reflecting individual variations in diurnal preferences related to sleep and waking activities. Eveningness reflecting a delayed sleep-wake timing has repeatedly been associated with sleep problems and negative affect (NA). Therefore, the aim of this study was to examine the associations between morningness-eveningness, sleep complaints, and symptom severity in OCD patients and compared with a mixed psychiatric control group. Materials and methods The data of 49 OCD and 49 mixed psychiatric inpatients (with unipolar depression and anxiety disorders) were analyzed. Patients completed questionnaires regarding morningness-eveningness, sleep quality, nightmare frequency, depression, anxiety, and affective states. Obsessive and compulsive symptom severity was also assessed within the OCD group by clinician-rated scales. Results Eveningness preference was associated with impaired sleep quality and higher NA in OCD patients. In addition, impaired sleep quality showed a moderate correlation with anxiety and strong correlations with depressive symptoms and NA. Interestingly, in the mixed psychiatric group, eveningness was not linked to NA, and sleep quality also showed weaker associations with depressive symptoms and NA. Within the OCD group, eveningness preference was predictive of poorer sleep quality regardless the influence of depressive symptoms. Conclusion Our findings suggest that eveningness and sleep complaints are predictive of affective dysfunctions, and should be carefully considered in the evaluation and treatment of OCD patients.
A case of an unusual presentation of obsessive compulsive disorder in an adolescent.
Rohanachandra Yasodha Maheshi,Vipulanandan Santhrasulochana
Asian journal of psychiatry
Children and adolescents with Obsessive Compulsive Disorder (OCD) can present in atypical and unusual ways. We present the case of a 13 year old boy with an unusual presentation of OCD. He presented with irritability, aggression, poor sleep, reduced attention, hyperreligiosity, social withdrawal and disinhibition (i.e. inappropriately touching females) for 1 week and was found to have obsessional thoughts and impulses related to sex and the compulsion of seeking absolution from lord buddha. He was diagnosed as OCD after excluding organic causes, manic episode, acute psychotic episode, drug induced psychosis and sexual abuse. He initially responded to fluoxetine 20mg, olanzapine 2.5 and a short course of lorazepam. He was functioning well for 2 weeks and thus olanzapine and lorazapam were tailed off. A week later he presented with similar symptoms with the added symptoms of singing, masturbating in public and talking excessively to his mother about sex. He was found to have obsessional thoughts, impulses and images and the compulsions of reassurance seeking from his mother and seeking absolution from lord buddha. He responded to an increase in fluoxetine to 40mg and olanzapine 2.5mg. He has now remained in remission for 4 months with good functioning. This case shows that in contrast to adults, children may not recognize that their obsessional thoughts are irrational and may not be able to resist the obsessions as a result. It stresses the importance of being mindful of the atypical presentations of OCD in children to avoid misdiagnosis.
Microglia Gone Rogue: Impacts on Psychiatric Disorders across the Lifespan.
Tay Tuan Leng,Béchade Catherine,D'Andrea Ivana,St-Pierre Marie-Kim,Henry Mathilde S,Roumier Anne,Tremblay Marie-Eve
Frontiers in molecular neuroscience
Microglia are the predominant immune response cells and professional phagocytes of the central nervous system (CNS) that have been shown to be important for brain development and homeostasis. These cells present a broad spectrum of phenotypes across stages of the lifespan and especially in CNS diseases. Their prevalence in all neurological pathologies makes it pertinent to reexamine their distinct roles during steady-state and disease conditions. A major question in the field is determining whether the clustering and phenotypical transformation of microglial cells are leading causes of pathogenesis, or potentially neuroprotective responses to the onset of disease. The recent explosive growth in our understanding of the origin and homeostasis of microglia, uncovering their roles in shaping of the neural circuitry and synaptic plasticity, allows us to discuss their emerging functions in the contexts of cognitive control and psychiatric disorders. The distinct mesodermal origin and genetic signature of microglia in contrast to other neuroglial cells also make them an interesting target for the development of therapeutics. Here, we review the physiological roles of microglia, their contribution to the effects of environmental risk factors (e.g., maternal infection, early-life stress, dietary imbalance), and their impact on psychiatric disorders initiated during development (e.g., Nasu-Hakola disease (NHD), hereditary diffuse leukoencephaly with spheroids, Rett syndrome, autism spectrum disorders (ASDs), and obsessive-compulsive disorder (OCD)) or adulthood (e.g., alcohol and drug abuse, major depressive disorder (MDD), bipolar disorder (BD), schizophrenia, eating disorders and sleep disorders). Furthermore, we discuss the changes in microglial functions in the context of cognitive aging, and review their implication in neurodegenerative diseases of the aged adult (e.g., Alzheimer's and Parkinson's). Taking into account the recent identification of microglia-specific markers, and the availability of compounds that target these cells selectively , we consider the prospect of disease intervention via the microglial route.
Sleep in Children With Psychiatric Disorders.
Ramtekkar Ujjwal,Ivanenko Anna
Seminars in pediatric neurology
Sleep disturbances are common in pediatric psychiatric disorders and constitute key elements in diagnostic symptomatology of various primary psychiatric disorders including bipolar disorder, depression, and anxiety disorder. Although sleep is not included in key defining criteria of some impairing illnesses such as obsessive-compulsive disorder and schizophrenia, these disorders present with a very high prevalence of sleep disturbances. The interaction between sleep and psychopathology is very complex with significant interrelationship in development, severity, and prognosis of psychiatric disorders and comorbid sleep disturbances. The research ranging from small intervention case series to large epidemiologic studies have demonstrated the role of specific sleep complaints in specific psychiatric diagnoses. However, the research using objective instruments such as polysomnography and actigraphy remains limited in youth with psychiatric disorders. The intervention studies using pharmaceutical treatment specifically focusing on sleep disturbances in psychiatric disorders are also sparse in the pediatric literature. Early identification of sleep disturbances and behavioral management using cognitive behavior therapy-based tools appear to be the most effective approach for treatment. The use of psychotropic medications such as selective serotonin reuptake inhibitors for the treatment of primary psychiatric disorder often alleviate the psychological barriers for sleep but may lead to emergence of other sleep issues such as restless leg syndrome. The safety and efficacy data of hypnotics for primary sleep disorders are limited in pediatrics and should be avoided or used with extreme caution in children with comorbid sleep and psychiatric problems.
Sleep in Children and Adolescents with Obsessive-Compulsive Disorder.
Reynolds Katharine C,Gradisar Michael,Alfano Candice A
Sleep medicine clinics
Sleep problems are not a core feature of obsessive-compulsive disorder (OCD), but emerging empirical data indicate some form of sleep disruption to be highly common. Available research in both adult and child patients is limited in several important ways, including the use of subjective reports (particularly in children), high rates of comorbid depression, and concurrent use of psychotropic medication. The presence of sleep disruption in OCD patients may compound severity and impairment of the disorder. More research is needed to fully understand the nature and consequences of sleep-wake disruption in children with OCD.
Sleep, arousal, and circadian rhythms in adults with obsessive-compulsive disorder: a meta-analysis.
Nota Jacob A,Sharkey Katherine M,Coles Meredith E
Neuroscience and biobehavioral reviews
Findings of this meta-analysis show that obsessive-compulsive disorder (OCD) is related to disruptions in both the duration and timing of sleep. PsycINFO and Google Scholar database searches identified 12 relevant studies that compared measures of sleep in individuals with OCD to those of either a healthy control group or published norms. Sleep measures included sleep onset latency, sleep duration, awakening after sleep onset, percentage of rapid eye movement (REM) sleep, percentage of slow wave sleep, and prevalence of delayed sleep phase disorder (DSPD). Individual effect sizes were pooled using a random effects model. Sleep duration was found to be shorter, and the prevalence of DSPD higher, in individuals with OCD compared to controls. Further, excluding samples with comorbid depression did not meaningfully reduce the magnitude of these effects (although the results were no longer statistically significant) and medication use by participants is unlikely to have systematically altered sleep timing. Overall, available data suggest that sleep disruption is associated with OCD but further research on both sleep duration and sleep timing in individuals with OCD is needed.
A Neurocognitive Comparison of Pediatric Obsessive-Compulsive Disorder and Trichotillomania (Hair Pulling Disorder).
Wilton Emily P,Flessner Christopher A,Brennan Elle,Murphy Yolanda,Walther Michael,Garcia Abbe,Conelea Christine,Dickstein Daniel P,Stewart Elyse,Benito Kristen,Freeman Jennifer B
Journal of abnormal child psychology
Obsessive-compulsive disorder (OCD) and trichotillomania (hair pulling disorder, HPD) are both considered obsessive-compulsive and related disorders due to some indications of shared etiological and phenomenological characteristics. However, a lack of direct comparisons between these disorders, especially in pediatric samples, limits our understanding of divergent versus convergent characteristics. This study compared neurocognitive functioning between children diagnosed with OCD and HPD. In total, 21 children diagnosed with HPD, 40 diagnosed with OCD, and 29 healthy controls (HCs), along with their parents, completed self-/parent-report measures and a neurocognitive assessment battery, which included tasks of inhibitory control, sustained attention, planning, working memory, visual memory, and cognitive flexibility. A series of analyses of variance (or covariance) indicated significant differences between groups on tasks examining planning and sustained attention. Specifically, children in both the OCD and HPD groups outperformed HCs on a task of planning. Further, children with OCD underperformed as compared to both the HPD and HC groups on a task of sustained attention. No between group differences were found with respect to tasks of reversal learning, working memory, spatial working memory, visual memory, or inhibitory control. The implications these findings may have for future, transdiagnostic work, as well as limitations and future directions are discussed.
Stein Dan J,Costa Daniel L C,Lochner Christine,Miguel Euripedes C,Reddy Y C Janardhan,Shavitt Roseli G,van den Heuvel Odile A,Simpson H Blair
Nature reviews. Disease primers
Obsessive-compulsive disorder (OCD) is a highly prevalent and chronic condition that is associated with substantial global disability. OCD is the key example of the 'obsessive-compulsive and related disorders', a group of conditions which are now classified together in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the International Classification of Diseases, 11th Revision, and which are often underdiagnosed and undertreated. In addition, OCD is an important example of a neuropsychiatric disorder in which rigorous research on phenomenology, psychobiology, pharmacotherapy and psychotherapy has contributed to better recognition, assessment and outcomes. Although OCD is a relatively homogenous disorder with similar symptom dimensions globally, individualized assessment of symptoms, the degree of insight, and the extent of comorbidity is needed. Several neurobiological mechanisms underlying OCD have been identified, including specific brain circuits that underpin OCD. In addition, laboratory models have demonstrated how cellular and molecular dysfunction underpins repetitive stereotyped behaviours, and the genetic architecture of OCD is increasingly understood. Effective treatments for OCD include serotonin reuptake inhibitors and cognitive-behavioural therapy, and neurosurgery for those with intractable symptoms. Integration of global mental health and translational neuroscience approaches could further advance knowledge on OCD and improve clinical outcomes.
Obsessive-Compulsive Symptoms in Obsessive-Compulsive Disorder and in Generalized Anxiety Disorder: Occurrence and Correlations.
Citkowska-Kisielewska Anna,Rutkowski Krzysztof,Mielimąka Michał,Sobański Jerzy A,Dembińska Edyta
Journal of psychiatric practice
OBJECTIVE:Because of the heterogeneity of obsessive-compulsive disorders (OCDs) and their co-occurrence with anxiety disorders, we investigated the prevalence, severity, and correlations between obsessive and compulsive symptoms reported by patients diagnosed with OCD or generalized anxiety disorder (GAD). METHODS:A retrospective study was conducted in 2 groups of patients: 76 patients diagnosed with OCD [F42 according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10)], and 186 patients diagnosed with GAD (F41.1 according to ICD-10), who had presented for therapy at the day ward. The Symptom Questionnaire "O," based on the Symptom Checklist 90-Revised (SCL-90-R) questionnaire, was used to assess obsessive, compulsive, and anxiety symptoms. The analysis took into account the impact of sex and the presence or absence of cognitive dysfunction (as assessed using the Bender Benton Visual Retention and Bender-Gestalt tests) on the associations being investigated. RESULTS:We observed that obsessive and compulsive symptoms were more prevalent and more strongly expressed in the group with OCD than in the group with GAD. However, almost all patients with GAD (94%) confirmed the presence of some obsessive-compulsive symptoms. The study revealed differences in correlations with obsessions and compulsions between the OCD and GAD groups. In the group with OCD, no significant correlation between the severity of obsessions and compulsions was identified, whereas in the group with GAD, a significant positive correlation was found between the severity of those symptoms. In both the GAD and OCD groups, a greater intensity of obsessive-compulsive symptoms was accompanied by an increase in the severity of anxiety symptoms (with this effect noted to a greater extent with obsessions than compulsions). CONCLUSIONS:The study revealed that patients with GAD often have coexisting obsessive-compulsive symptoms, which may not be identified during routine psychiatric examination. Obsessive-compulsive symptoms observed in patients with GAD may show a different structure than obsessive-compulsive symptoms in patients with OCD. The results of this study suggest that compulsions are more specific for the diagnosis of OCD than obsessions. Compulsions, such as counting related to the need for order and symmetry, may be associated with some cognitive dysfunctions and male sex, a finding that requires further research.
Sleep quality in children and adolescents with obsessive-compulsive disorders.
Miniksar Dilşad Yıldız,Özdemir Mikail
Nordic journal of psychiatry
BACKGROUND:Although the effect of obsessive-compulsive disorder (OCD) on sleep is not well-known, recent studies suggest an association between OCD and sleep quality. AIMS:We aimed to assess sleep quality in children and adolescents with OCD and to seek its association with OCD symptoms and OCD severity. METHODS:All of the subjects were assessed using DSM 5 and affective disorders and schizophrenia for school-age children - present and lifetime version, which is based on DSM-IV. The Yale-Brown obsessive-compulsive scale and children's Yale-Brown obsessive-compulsive scale were applied to the subjects with OCD. Pittsburgh sleep quality index (PSQI) was used to assess sleep quality, and the Wechsler intelligence scale for children-revised (WISC-R) was used to measure their intelligence levels. RESULTS:PSQI total score was significantly higher in patients with OCD ( < 0.001), suggesting that patients with OCD have a significantly worse sleep quality. The presence of somatic disorders was also associated with worse sleep quality ( = 0.040). Sleep quality was not significantly associated with OCD severity ( = 0.152). Among patients with extreme OCD, the 'sleep duration' component of the PSQI was higher than those with moderate or severe OCD ( = 0.019). The patients with 'contamination/cleaning' symptom group had a lower total PSQI score compared with 'symmetry/hoarding' symptom group ( = 0.014). CONCLUSIONS:The findings of the present study indicate that the sleep quality of children and adolescents with OCD is influenced, and there may be an association between sleep quality and OCD symptoms and severity in these patients.
Sleep in obsessive-compulsive and related disorders: a selective review and synthesis.
Cox Rebecca C,Parmar Angelee M,Olatunji Bunmi O
Current opinion in psychology
Despite growing interest in the link between sleep disturbance and psychopathology, much remains unknown regarding obsessive-compulsive and related disorders (OCRDs). The present review integrates contemporary research on the relations between sleep and OCRDs, including hoarding disorder, trichotillomania, and excoriation disorder in order to inform future programmatic research. Findings indicate a robust link between sleep disturbance and OCD; however, the impact of sleep on OCD treatment outcome is unclear. Extant work on sleep disturbance in hoarding disorder indicates a relationship independent of comorbidities. In contrast, observed links between trichotillomania, excoriation disorder, and sleep may be due to mood and anxiety symptoms. These findings suggest that sleep disturbance may indicate a more similar pathophysiology between OCD and hoarding relative to trichotillomania and excoriation disorder. However, given limited research in this area, these findings should be interpreted with caution. Additional research is needed to characterize sleep in etiology, maintenance, and treatment of OCRDs.
Polysomnographic and psychometric correlates of napping in primary insomnia patients.
Mazza Marianna,Lapenta Leonardo,Losurdo Anna,Marano Giuseppe,Testani Elisa,Janiri Luigi,Mazza Salvatore,Della Marca Giacomo
Nordic journal of psychiatry
This study aims to evaluate napping in patients with insomnia compared with two control groups and to investigate the relationships between psychometric measures and napping habitude. Sixty-eight adult patients with chronic primary insomnia were enrolled; 27 men and 41 women, mean age 53.6 ± 13. All patients underwent 24 h ambulatory polysomnography (A-PSG). Prevalence of napping behavior in Insomnia Patients (I-group) was compared with Obstructive Sleep Apnea Syndrome (OSAS) patients (OSAS-group) and epilepsy patients (Ep-group). Patients were evaluated with Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and Berlin Questionnaire. Psychometric evaluation included Self-Administered Anxiety Scale (SAS #54), Beck Depression Inventory (BDI), Maudsley's Obsessive Compulsive Inventory (MOCI), Snaith-Hamilton Pleasure Scale (SHAPS), and Eating Attitude Test (EAT-26). No significant differences resulted in prevalence and duration of naps in the three groups. In the comparison between nappers (N+, subject with at least one nap in A-PSG) and non-nappers (N-, subject with no naps in A-PSG) we observed significant differences in PSQI scores (N+ = 14.1 ± 2.7; N- =11.9 ± 3.3; Whitney U-test = 341.0; = 0.004) and in EAT score (N+ = 9.8 ± 9.7; N- = 4.4 ± 5.6; Whitney U-test = 313.5, = 0.0.14); no significant differences were measured in other psychometric parameters and in sleep macrostructural indexes. Our data are in accordance with previous findings outlining that N + insomniacs have higher PSQI scores than N-. Our results do not confirm the suggested association between napping and depressive or obsessive-compulsive symptoms. Conversely, we found a statistically significant difference ( = 0.0014) in EAT scores in N + and N-. Hyperarousal and REM sleep instability in insomniac patients may create an unbalance of the neuroendocrine hypothalamic regulation leading to an appetite alteration.
Sleep disturbances in obsessive-compulsive disorder: Association with non-response to repetitive transcranial magnetic stimulation (rTMS).
Donse Lana,Sack Alexander T,Fitzgerald Paul B,Arns Martijn
Journal of anxiety disorders
Background Repetitive transcranial magnetic stimulation (rTMS) is a promising augmentation strategy for treatment-refractory OCD. However, a substantial group still fails to respond. Sleep disorders, e.g. circadian rhythm sleep disorders (CRSD), are highly prevalent in OCD and might mediate treatment response. The aims of the current study were to compare sleep disturbances between OCD patients and healthy subjects as well as between rTMS responders and non-responders, and most importantly to determine sleep-related predictors of rTMS non-response. Methods 22 OCD patients received at least 10 sessions rTMS combined with psychotherapy. Sleep disturbances were measured using questionnaires and actigraphy. Sleep in patients was compared to healthy subjects. Treatment response was defined as >35% reduction on YBOCS. Treatment response prediction models were based on measures of CRSD and insomnia. Results Sleep disturbances were more prevalent in OCD patients than healthy subjects. The OCD group consisted of 12 responders and 10 non-responders. The CRSD model could accurately predict non-response with 83% sensitivity and 63% specificity, whereas the insomnia model could not. Conclusions CRSD is more prevalent in OCD patients than healthy subjects, specifically in rTMS non-responders. Therefore, CRSD may serve as a biomarker for different subtypes of OCD corresponding with response to specific treatment approaches.
Sleep duration and timing in obsessive-compulsive disorder (OCD): evidence for circadian phase delay.
Coles M E,Schubert J,Stewart E,Sharkey K M,Deak M
OBJECTIVES:To investigate potential delays in endogenous melatonin in individuals with obsessive-compulsive disorder (OCD). METHODS:First, data are presented for 15 individuals with OCD and matched healthy controls. Next, nine additional participants with OCD who did not have matched controls were added, resulting in a sample of 24 individuals with OCD. All participants were assessed for sleep and circadian rhythm disturbance. Dim light melatonin onset (DLMO) was derived from salivary melatonin and was used in conjunction with sleep diaries, interview measures, and questionnaires. A subset of the OCD group (n = 16) also used actigraphy. RESULTS:In sum, 42% percent (10/24) of the patients with OCD met the criteria for delayed sleep-wake phase disorder (DSWPD) in comparison to 0% in the control sample. DLMO was significantly later in individuals with OCD compared to controls. DLMO and bedtime were not significantly associated with the severity of obsessive-compulsive symptoms or negative affect. CONCLUSIONS:Replication of the findings presented herein, particularly the DLMO results, is warranted. Further, there are now three studies showing that nearly ½ of individuals with OCD meet criteria for a DSWPD. Future studies can explore the mechanisms underlying these connections and the implications of this comorbidity. These findings may increase our understanding of OCD and inform future interventions.