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STUDY OBJECTIVES: The heritable trait of non-rapid eye movement (NREM) parasomnias is well known, but differences between sporadic and familial phenotypes have not been studied. The aim of our study was to evaluate, in a clinical series of adults with NREM parasomnias, clinical and sleep differences between familial versus sporadic forms, and between childhood versus adolescent versus adult-onset forms. METHODS: We prospectively collected clinical features, family history, questionnaires (Epworth Sleepiness Score and Paris Arousal Disorders Severity Scale (PADSS)), and video-polysomnography measures from patients with NREM parasomnias confirmed by video-polysomnography, admitted over a 12-year period. Familial NREM parasomnia was defined as having at least one relative of the index case with NREM parasomnia. RESULTS: Of the 625 consecutive adults with NREM parasomnias, 50% had a family history of NREM parasomnia (most commonly parents, followed by siblings, then children). Compared to those with sporadic NREM parasomnias, participants with familial NREM parasomnias had an earlier age of onset and greater severity of NREM parasomnias (according to the PADSS). They were more likely to report sleepwalking, sleep terrors, and a combination of parasomniac manifestations (but no more confusional arousals or sleep-related eating disorders), and were less likely to report sexsomnia. In contrast, monthly episode frequency, sleepiness score, sleep structure, and EEG and behavioral markers of NREM parasomnias did not differ between groups. CONCLUSIONS: Familial NREM parasomnias have a typical phenotype with an earlier age of onset and a more severe clinical course. This phenotyping may guide medical care and future genetic studies.
OBJECTIVE: To evaluate the efficacy and safety of Ginkgo biloba extract (GBE) compared with Desmopressin and their combination in children with monosymptomatic nocturnal enuresis (MNE). METHODS: In this double-blind, randomized, placebo-controlled trial, 398 children aged 5-14 years with MNE were assigned to four groups: placebo, GBE (60 mg daily), Desmopressin (0.2 mg daily), or GBE plus Desmopressin for 3 months. Primary outcomes included the number of wet nights per week. Secondary outcomes assessed sleep quality using the Sleep Disturbance Scale for Children (SDSC), arousal by the Disorders of Arousal (DA) score, and quality-of-life using the Pediatric Incontinence Questionnaire (PinQ). RESULTS: After 3 months, the combination group demonstrated the greatest improvement in wet nights (median 0 [IQR 0-2]) compared to GBE (6 [0.5-6.5]) and Desmopressin (2 [0-6]) (p < 0.001). Full response rates (≥90% reduction in wet nights) were highest with combination therapy (88.3%), followed by Desmopressin (46.5%), GBE (24.8%), and placebo (9.5%) (p < 0.001). GBE-containing groups showed significantly increased DA and SDSC scores, indicating enhanced arousal and lighter sleep. Quality-of-life (PinQ) score decreased in all treatment groups denoting improvement, with the best outcomes observed in the combination arm. Adverse effects were mild and comparable across groups, and serum sodium levels remained stable. CONCLUSION: GBE is a safe and effective novel therapy for MNE, improving sleep arousal and symptom control. Its combination with Desmopressin offers superior efficacy, better quality of life, and lower relapse rates than either agent alone.
Physiologic theories of emotion suggest that activation is important in the experience of emotion; patients exhibiting "neglect" as a consequence of right parietotemporal of dysfunction show flattened affect. We studied arousal in patients with lesions of the right hemisphere who also exhibited emotional indifference, in aphasic patients with lesions of the left hemisphere, and in non-brain-damaged controls, by stimulating the forearm ipsilateral to the side of the brain lesion while recording galvanic skin responses (GSRs) from the fingers on the same side. The group exhibiting neglect had lower GSRs than aphasic patients or non-brain-damaged controls. Aphasic patients had higher GSRs than non-brain-damaged controls. These results suggest that neglect is associated with disturbances in bilateral arousal and that this disorder of arousal may be responsible in part for flattened affect. The heightened GSR in aphasic patients may reflect disinhibition, which might be partly responsible for increased emotionality in these patients.
The psychophysiological literature on psychopathy is reviewed in the context of low-arousal theory. Difficulties in the theory are discussed both in general terms and specifically in relation to psychopathy. Contrary to the low-arousal theory, the data indicate that psychopaths exhibit a wider degree of variability in arousal levels and reactivity than normal indiciduals. A more accurate model of the disorder might be one in which psychopaths display a faster rate and a greater magnitude of change in physiological and behavioral activity than normals. It is suggested that psychopathy might be usefully viewed as a biochemical disturbance manifested in abnormal oscillations in neurotransmitter functioning, autonomic activity, and behavior. The literature is reexamined in light of this hypothesis, and a number of avenues for further research are discussed.
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A 28-day double-blind assessment of chlorazepate dipotassium, diazepam and placebo was done on 30 outpatient neurotics with a primary symptom of anxiety. Acute, sub-acute and more chronic effects of the drug were assessed after 3 hours, 14 days and 28 days of drug administration. A battery of psychiatric ratings as well as physiological and psychophysiological assessments were done at each period. The psychometric assessments showed a trend for diazepam to be the most anxiolytic of the three drugs, followed by chlorazepate and then placebo. These measurements did not reach uniform statistically significant differences. Psychological measurements demonstrated the same trends, but some of these reached statistically significant levels. These parameters also indicate a slightly different mode of action of the two drugs at equimolecular doses. Diazepam would depress baseline and stimulation arousal, whereas chlorazepate would decrease baseline CNS arousal, but facilitate CNS response upon stimulation.
Somatosensory, visual and auditory evoked potentials (EP) were recorded in different psychatric populations before as well as during psychotropic drug treatment. Drug-free schizophrenic patients showed shorter latencies, smaller amplitudes and an increased intraindividual variability in their EP than controls. Psychotic children but also children of schizophrenic mothers (so-called high-risk children) exhibited similar differences as compared to controls, suggesting a CNS overarousal as the pathoneurophysiological substrate of schizophrenia. Shorter latencies were also seen in children of psychopathic fathers. Regression and correlation analysis of psychopathological and EP measurements in hyperkinetic children revealed the following findings: the shorter the latencies and the higher the amplitudes, the sicker was the child. During psychopharmacotherapy, significant changes occurred in the EP measurements, which were found to be significantly correlated with clinical improvement or deterioration. Neuroleptics induced a latency increase and an amplitude decrease in schizophrenic patients and psychotic children. Interestingly, amphetamine produced in hyperkinetic children a latency increase too, thus explaining the 'paradoxical' clinical response to amphetamine observed in these children. Differences between therapy-responsive and therapy-resistant patients are described and, finally, some data concerning the role of the pretreatment EP as a predictor of therapeutic outcome are discussed.
Thirty-three patients in long-term individual therapy were referred to one of three weekend groups: two experimental (affect-arousing, gestalt therapy) groups and one control (meditation-Tai Chi) group. The impact of the weekend group experience (WGE) on individual therapy was examined six and 12 weeks later. At six weeks the patients in the experimental groups showed, on some measures, a significantly greater improvement in their individual therapy than did controls. By 12 weeks, there were no demonstrable differences. The WGE was not without risk: even though the group leaders were highly trained, responsible clinicians, two patients suffered considerable psychological damage. The control (meditation-Tai Chi) group offered a relatively innocuous experience; there was no risk, but few members found the specific procedures useful in their lives. Intense affect arousal in the WGE was not related to positive change in subsequent individual therapy. Those expressing the greatest affect in either experimental group were no more likely to have had a measurable positive impact on their subsequent individual therapy than patients expressing little or no measurable affect.
This study shows an association between thyroid gland function level and event-related slow brain potential (ERSP) parameters (peak amplitude and area under the curve), obtained during "classical" and "operant" reaction-time paradigms. A significant positive correlation between ERSP parameters and 24-hr I131 uptake and a negative nonsignificant one between them and ankle jerk reflex were found. Organismic factors related to thyroid function had greater influence upon ERSP amplitude and area than situational ones, for no significant effect of task was evidenced and no interaction between them was found under the conditions employed. Hyper- and hypothyroids showed also a tendency to present longer reaction times than euthyroids. These results are discussed within the framework of the arousal-distraction coupling hypothesis as proposed by Tecce and Cole (1976) and compared to those previously obtained in high-neuroticism anxiety-prone indivuduals. Although these and hyperthyroids do show indications of similar behavioral manifestations (excessive reactive arousal), both groups are considered to differ regarding empirical referennts of anticipatory arousal (ERSP parameters). A major difference seems to be the absence of a "ceiling effect" in hyperthyroids. This hypothetical phenomenon can be expected on the basis of the inverted U-shaped relation between ERSP amplitude and arousal level. A stronger "distraction" effect associated with increased arousal in anxiety neurotics is postulated and tentatively attributed to covert verbalizations of worry and feelings added to increased awareness of autonomic input. The contention is advanced that similar behavioral manifestations could be distinguishable at the physiological level employed and this might add further insights to diagnostic typologies (e.g., "psychosomatic" vs. "psychoneurotic" patients).
Necker cube reversals were studied in a group of 24 arrested men in three experimental sessions; two weeks, one week and immediately before trial. The first session was assumed to represent a moderate laboratory stress due to the novelty of the situation, and the last session a real-life stress associated with anticipation of appearing in court. Both were superimposed on the sustained real-life stress of being in jail. There were no stress-related changes between the three sessions in the rate of apparent change (RAC) of the Necker cube. The intra-individual stability of RAC was extremely high. There were significant positive correlations between RAC in all sessions, and a psychopathy-related inventory scale, the Gough delinquency scale.
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Neurophysiological investigations-including sensory-evoked responses, contingent negative variation (CNV), and nerve conduction velocities-were done in 11 male polygonosomic patients and in comparison with a control group. Some significant data are reported pointing out differences which may be related to a hypovigil type (47, XYY) and a hypervigil type (47, XXY). The importance of the CNV and conduction velocity as an index of a constitutional minimal brain dysfunction is discussed.