Manic pseudodementia.
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Bipolar Disorder↗
Biomedical subjects
C F Reynolds
Publications and source records attributed to C F Reynolds.
Multiple Sleep Latency Test findings in Kleine-Levin syndrome.
Multiple Sleep Latency Test (MSLT) findings in a case of Kleine-Levin syndrome are reported for the first time. MSLT data indicate sleepiness as severe as in narcolepsy or obstructive sleep apnea and the occurrence of four sleep onset rapid eye movement (REM) periods, with a greater REM propensity at 2:00 p.m. and 4:00 p.m. than at 10:00 a.m. and 12:00 noon. The replication of such findings might suggest that Kleine-Levin syndrome could be considered a form of periodic REM sleep disinhibition. Therefore, the traditional hypothesis of diencephalic dysfunction may require modification to include the role of more caudal brain stem structures specifically activated during REM sleep.
Adult↗
Paranoia, homicidal behavior, and seizures associated with phenylpropanolamine.
A 29-year-old woman with no history of paranoia or homicidal behavior developed paranoia, homicidal behavior, and seizures after abusing a preparation containing phenylpropanolamine. The paranoia and seizures were replicated in a controlled inpatient setting following phenylpropanolamine challenge.
Adult↗
EEG sleep evaluation of depression in borderline patients.
In this study the sleep of borderline patients and patients with primary nondelusional depression showed sleep continuity disturbance and greater REM activity and density (particularly during the first REM period) than that of normal control subjects. First-night REM latencies were more variable in the borderline than in the depressed group, but by the second night both groups showed shorter REM latencies than the controls. The similarities in EEG sleep suggest a relationship between borderline disorder and the affective spectrum and cast doubt on the definition of the borderline disorder as a pure character type.
Adolescent↗
Persistent psychophysiologic insomnia: preliminary Research Diagnostic Criteria and EEG sleep data.
Some patients with persistent psychophysiologic insomnia have a history of generalized anxiety, minor depression, or drug misuse. Their sleep resembles sleep of patients with generalized anxiety (except for night 2 improvement in the insomniacs' sleep continuity) but differs from sleep of patients with major depression.
Adult↗
Diagnosis and management of sleep disorders in the elderly.
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Aged↗
REM latency distribution in major depression: clinical characteristics associated with sleep onset REM periods.
In a sample of 92 inpatients with major depression, REM latency showed a unimodal, rather than bimodal, distribution, with peak frequency between 50-59 min (on each of 4 consecutive nights). A total of 20 patients (21.6%) exhibited a sleep onset REM period (SOREMP-10) i.e., REM latency less than or equal to 10 min, during at least 1 of the 4 nights; an additional 11 patients (12%) showed REM latencies of 11-20 min on at least one night. SOREMP-10 positive patients were older both at the time of study (p less than 0.01) and at the age of onset of depressive illness (p less than .01) than the rest of the sample. They also showed greater sleep continuity disturbances, while patients with at least one SOREMP-20, i.e., REM latency less than or equal to 20 min, exhibited higher REM percentage (p less than or equal to 0.05) and a higher first-period density (p less than 0.05) than the remaining patients. No other clinical or polysomnographic correlates of SOREMP positivity were noted with regard to gender, RDC subtypes, severity of illness, or clinical response to tricyclic antidepressants. The unimodal distribution of REM latency, as well as the absence of a relationship between SOREMP positivity and severity of depression or therapeutic outcome, may result from the low representation of psychotic depressives in this sample (n = 6), who might constitute a qualitatively different subgroup.
Adolescent↗
Depressive psychopathology in male sleep apneics.
Depression has been reported to be frequent in sleep apnea syndromes. In a sample of 25 consecutive male sleep apneics, 40% met Research Diagnostic Criteria for an affective disorder or for alcohol abuse. A multiple regression analysis indicated that 61% of the variance in depression ratings could be explained by four variables: age, REM activity, REM latency (square root), and presence or absence of antihypertensive medications (multiple R = 0.78). The use of these variables in a discriminant function analysis correctly predicted the membership of 68% of the sample in either a low or high depression group (kappa = 0.44; p less than .01). These findings are reviewed in relation to other research on age-related sleep changes and vulnerability to depression.
Adult↗
EEG sleep in outpatients with generalized anxiety: a preliminary comparison with depressed outpatients.
To develop further perspective on the psychophysiology of generalized anxiety disorder and primary depression, all-night electroencephalographic (EEG) sleep measures in outpatients with diagnoses of generalized anxiety disorder and primary (nondelusional) depression were compared. Both groups had difficulty initiating and maintaining sleep, and diminished amounts of slow-wave sleep. Compared to patients with generalized anxiety disorder, depressives had a shorter rapid eye movement (REM) latency, greater REM sleep percent and eye movement activity, and a different temporal distribution of REM sleep. Anxious patients showed few changes from first to second night, whereas depressives showed increases in several REM sleep indexes. The combination of REM sleep latency and REM percent correctly classified 86.7% of patients. These data may provide a more direct measure of central nervous system arousal and sleep/wake function than previous studies in the psychophysiology of anxiety. They also lend support to the clinical distinction between generalized anxiety disorder and primary depression and to the classification of anxiety states as disorders of initiating and maintaining sleep.
Adult↗
Sleep in narcolepsy and depression. Does it all look alike?
Depression has been reported to be frequent in narcolepsy and has been considered to be variously a reaction to chronic sleepiness or an endogenous expression of the pathophysiology of narcolepsy. Supporting the latter possibility are reports of similarities between the nocturnal rapid eye movement (REM) sleep of narcoleptics and inpatients with endogenous depression. In a comparison of 25 consecutive narcoleptics and 25 age-matched outpatient primary depressives, significant group differences were found in nocturnal EEG sleep measures of sleep continuity, sleep architecture, and REM sleep. Twenty per cent of the narcoleptic sample met Research Diagnostic Criteria (RDC) for a past history of major or chronic intermittent depression, but 60 per cent did not meet RDC criteria for any present or past psychiatric disorder. These findings mandate a cautious reevaluation of the nature of depressive symptoms in narcolepsy and leave open the question of whether there are common neurobiological control mechanisms in narcolepsy and depression.
Adult↗
A critical review of sleep and its disorders from a developmental perspective.
A review of EEG sleep physiology and disorders of sleep is presented from a developmental perspective. After sleep physiology is reviewed in relation to the aging process, with various sleep changes considered as possible signs of normal or pathological aging, sleep disorder characteristics of different parts of the life cycle and/or the ontogenetic aspects of sleep disorders per se are also described. This review highlights the need for four diverse but related areas of research: (1) longitudinal studies to describe the natural history of primary sleep disorders; (2) controlled treatment and outcome studies; (3) additional epidemiologic inquiries using the currently available systematic nosology of sleep-wake disorders; and (4) further neurochemical and chronobiological investigation of basic mechanisms potentially involved in age-related sleep changes.
Adolescent↗
REM latency in depression: is there one best definition?
The concurrent validity of different definitions of REM latency has been tested by comparing the ability of each definition to discriminate between primary depressives (outpatients and inpatients) and normal controls. In outpatients the percentage of cases correctly identified ranged from 62.5% to 70.8%; in inpatients, from 64.6% to 70.8%. REM latency definitions with the least stringent sleep-onset criteria yielded the lowest specificity. In contrast, the range of sensitivities yielded by different definitions was narrower and not clearly affected by sleep-onset criterion or exclusion/inclusion of wakefulness between sleep onset and first REM period. Furthermore, different definitions of REM latency correlated equally well (p less than 0.01) with Hamilton depression ratings. The shorter REM latencies in both outpatients and inpatients were associated with a later time of NREM sleep onset than in controls, rather than with an earlier REM sleep-onset time.
Adult↗
Electroencephalographic sleep, aging, and psychopathology: new data and state of the art.
Dysregulation of sleep-wake function is an important problem in both normal aging and in the two most common neuropsychiatric disorders of old age, depression and primary degenerative dementia. Since considerable overlap of symptoms in depression and dementing disorders (e.g., sleep disturbance, dysphoria, and cognitive impairment) often results in patients with a "mixed" syndrome, the development of specific, objective indicators as diagnostic markers, using electroencephalographic sleep patterns, was undertaken. Patients with dementia showed significantly less sleep continuity disturbance than patients with depression, less rapid eye movement activity, a different temporal distribution of REM density, and a longer REM latency. A discriminant function analysis using three variables (REM latency, REM density, and scaled sleep maintenance) correctly identified eight of nine depressives and six of nine dementing patients (78%) (k = 0.56, p = 0.008). These differences in REM sleep timing and density may be related to several factors: (i) defects in acetylcholine production in dementia; (ii) cholinergic mechanisms of REM sleep; and (iii) increased cholinergic induction of REM sleep in depression. The data suggest the utility of EEG sleep measures in the differential diagnosis of dementia and depression in the elderly.
Age Factors↗
Application of the multiple sleep latency test in disorders of excessive sleepiness.
Multiple sleep latency tests were performed in 42 drug-free outpatients with excessive sleepiness: 12 narcoleptics, 9 sleep apneics, 7 primary depressives, and 14 patients with miscellaneous disorders. Among-group comparisons were made by one-way ANOVA for each nap (time-of-day effect) and using four-nap means of EEG sleep variables. Four-nap means were significantly different among groups for percent awake, percent time spent asleep, stage 1 latency, and REM latency. Of 22 significant pairwise comparisons (P less than 0.05, LSD test), 77.3% occurred at 12.00 and 14.00. Depressives showed lower sleep percentage (more arousal) and fell asleep later than narcoleptics or apneics. Patients with miscellaneous disorders occupied a middle position. Sleep percentage was gradually reduced during the day in depressives but remained high or rose further in apneics, narcoleptics, and miscellaneous patients. Naps were SOREMP-positive (sleep onset REM) 60.4% of the time in narcoleptics, 25.0% in apneics, 3.5% in depressives, and 5.4% in miscellaneous patients. SOREMP distribution across naps (10.00, 12.00, 14.00 and 16.00) was 19%, 31%, 19% and 31%, respectively. REM latency was significantly shorter in narcolepsy than in apnea. In summary, results show a continuum of excessive daytime sleepiness (EDS), demonstrating MSLT application in the differential diagnosis of EDS and significant diurnal variation in sleep measures.
Circadian Rhythm↗
Electroencephalographic sleep findings in depressed outpatients.
We compared the electroencephalographic (EEG) sleep characteristics of 20 outpatients with those of 20 age-matched inpatients with major primary depressive disorders. Both groups showed similar patterns of sleep disturbance: reduced rapid eye movement (REM) sleep latencies, sleep efficiencies, and slow wave sleep. While the inpatients had greater REM activity in the first REM period than did the outpatients, both groups showed evidence of greater REM sleep time and REM activity during the first half of the night than do normals. The outpatients demonstrated a level of adaptation in that more REM sleep time and activity were present on night 2 than on night 1.
Adult↗
EEG sleep, depression, and aging.
To date little attention has been paid to the possible age-dependent relationships of EEG sleep measures in depression or to the implications of such relationships for diagnostic sensitivity and specificity. In a study of 108 patients with major depressive disorders (67 inpatients, 41 outpatients), age was shown to be a very powerful determinant of electroencephalographic (EEG) sleep patterns. Thus, among other sleep variables, sleep efficiency, delta sleep percent, and REM latency all showed significant linear declines with increasing age. Similar trends were seen in both inpatients and outpatients. Some variables were without age trends (age-stable), including sleep latency, REM sleep percent, and REM activity. These findings confirm those of an earlier report from our laboratory [45] and suggest that age-corrected sleep variables can be developed for clinical diagnostic application. Thus, using normative data from Gillin et al. [19] for comparison, a sensitivity level of 65% for age-corrected REM latency was demonstrated, together with a specificity of 95% and a diagnostic confidence of 92%. Data from a pilot study comparing EEG sleep measures in depression and dementia are also presented; these data suggest the potential utility of EEG sleep measures in the differential diagnosis of these two disorders, especially in patients with mixed symptoms. Additional areas for further research are reviewed with enumeration of specific testable hypotheses.
Adult↗
Prevalence of sleep apnea and nocturnal myoclonus in major affective disorders: clinical and polysomnographic findings.
We performed screening polysomnography on 86 inpatients with affective disorders and found that 13 (15.1 per cent) had sleep apnea and one had nocturnal myoclonus. The apnea tended to be extremely mild, with an average of 27.8 episodes per patient and with a mean duration of 15.0 seconds. No clinically significant cardiac arrhythmia accompanied the apnea. The apnea was predominantly obstructive or mixed, not central. Only four patients (4.7 per cent) had apnea indices greater than five, and even here the total apnea was considered mild. Much of the apnea (68.3 per cent) occurred during rapid eye movement sleep. While there was no association of apnea with gender or with type of sleep-wake complaint, a significant relationship with age emerged. On the basis of these data, we suggest that routine polysomnographic screening for sleep apnea and nocturnal myoclonus in affective disorders is not indicated. On occasion, however, both an affective disorder and a sleep-apnea syndrome co-exist in the same patient. In such cases, the sleep-wake complaint is usually very prominent and/or long-standing in relation to other psychopathology and requires appropriate polysomnographic evaluation.
Adult↗