Lecture 8: Mental Health

Question 1

Briefly describe evidence that sleep is related to depression

Clinical samples 
Buysse et al (1994)
>—% those with I have — 
Clinical interview in sleep clinic 
SD associated with MD 
Stein et al (2001) 
I and DTS strongly associated with CBC 
In particular D,A and AP

PSG
Borbely et al (1984)
o SWS loss is most sig during the -st ——— but depressed patients appear to have ———— delta EEG power and —- counts throughout the night

Benca et al (1992)
robust = ————— REM sleep latency and abnormalities in REM such as ————- REM density and as a sleep%

Answer 1

Clinical samples

Buysse et al (1994)
- > ½ of patients with insomnia and medical or psychiatric patients - - clinical interview in sleep disorders centres
= sleep disorder associated with mood disorder as per the ICD

Stein et al (2001)
I and DTS strongly correlated with elevated score on the CBC and insomnia was particularly associated with symptoms of depression anxiety and attention problems

Question 2

Briefly describe evidence that sleep is related to anxiety

Answer 2

• About ½ that met diagnostic criteria also met criteria for a mental disorder – mood and anxiety disorders are most common

Stein et al (2001)

I and DTS strongly correlated with CBC and insomnia was particularly associated with symptoms of depression anxiety and attentional problems

Johnson et al., 2006 – TR in ADs insomnia was more likely to occur subsequent to the onset of anxiety 3.5 times more likely

Jansson-Frojmark and Lindblom (2008)
odds of developing insomnia if have anxiety = 4.27

GAD
Positive correlations – Rosa (1983)
	Number of awakenings 
	Latency to N1
	% of N2 
o	PSG 
	Increased sleep latency reduced sleep efficieny 
	Increased amountso f N1 and N2 slep 
	Reduced SWS 
	Increased Hz and duration of awakenings 
	Normal or increased REM sleep latency 
	Decreased REM sleep %

Panic disorder
o Other complaints may include sleep paralysis and hypnagogic hallucinations
o Recurrent sleep paralysis has been reported
o Night terrors
o During NREM sleep the value for total power was sig higher in nocturnal panic patients the PD patients as a group had higher values
o Lower sleep efficiency
o PSG
 Increase sleep
 Reduced sleep efficiency and abrupt awakening with sensation of panic out of N2
 Specific treatment of the sleep disturbance may be needed
• Cervena et al reported that convention therapy of PD in 20 subjects wasn’t sufficient to treat the coexisting insomnia

PTSD
Lee et al (2010)
PTSD assocaited with I (Hz arousal, fragmented sleep) nightmares and increased motor activity
Eye movments in REM are increased - time to REM increased, SWS decreased N1 increased

Question - might have an underlying sleep problem or abnormal emotional regualtion that increases the risk of PTSD
Causal Problem – soliders

Question 3

Briefly describe evidence that sleep is related to depression

General Population

Roth et al 2006
— - — % w I showed MD vs 1% SC in the GP
Those with I -.- > likely to have MD

Yates (2007) Liu (2007)

Mitchell (2008)
BD report I

Taylor et al (2005) 
Deg or dur of I +vly correlate w MajD
50F and 50M
20-90yrs
9.82 risk 

Johnson et al (2006)
> increased rate of D in those with I . vs those with no sleep complaints

Answer 3

35% of the adult popultion report some sleep problems
lack of sleep is associated with an increse in slef-reported symotms of psychopathology - somaitc anxiety, depression, paranoia

simialrly psychiatric issuces accompany many sleep disorders
insomnia is co-morbid and has been associated with several metnal disorders one of which is dpression

Roth et al (2006)
14-20% of people with sig complaints of insomnia and 10% of those showing hyper-insomnia showed evidence of maj depression compared to 1% without sleep complaints
people with insomnia 5.4 times more likely to have a mood disorder

Yates (2007) Liu (2007)
–75% of adults, kids and teens report I or HI CHECK THIS
Mitchell (2008)
–BD report I
Taylor et al (2005)
– Degree and duration Insomnia positively correlated with sever or recurrent maj depression
– small 50 male 50 female in eac 10 year age bracket 20-90yrs
– OR 9.82

Johnson et al (2006)
– life time prevalence of SD and psychiatric disorders YAs also found greatly increase rate of maj depression in those with insomnia PR=3.8 vs those with no sleep complaints
Johnson et al., 2006 – TR in adolescents
o Insomnia often precedes the onset of a fist episode of major depression or mania 3.8 times more likely

Question 4

BrIefly describe PSG evidence that sleep is related to depression

Borbely et al (1984)
o SWS loss is most sig during the -st ——— but depressed patients appear to have ———— delta EEG power and —- counts throughout the night

Benca et al (1992)
robust = ————— REM sleep latency and abnormalities in REM such as ————- REM density and as a sleep%

Answer 4

PSG 
Borbely et al (1984) 
o	first NREM period
 depressed patients appear to have reduced delta EEG power
Reduced SWS counts

Benca et al (1992)
robust = decreased
Increased

Question 5

What is the direction of anxiety depression and sleep

Ohayon & Roth (2003)

Answer 5

Benca and Peterson (2008)
o Those with recurrent mood disorders 75% became depressed after or at same time as insomnia began
o Whereas those with anxiety 75% were anxious before or at same time as insomnia began

Question 6

Why is it important to know which came first?

Answer 6

Intervention purposes

Less helpful to interven with sleep if it is the outcome not the cause

Question 7

Which came first

What did Ohayon & Roth (2008) find

what is the problem with there study

Answer 7

75% of people with depression after or same time as onset of insomnia

75% with anxiety before or same time as onset of insomnia

asked phone interview asking psychiatric history

Question 8

Describe sleep changes in GAD

Answer 8

GAD
Positive correlations – Rosa (1983)
	Number of awakenings 
	Latency to N1
	% of N2 

PSG
 Increased sleep latency reduced sleep efficieny
 Increased amountso f N1 and N2 slep
 Reduced SWS
 Increased Hz and duration of awakenings
 Normal or increased REM sleep latency
 Decreased REM sleep %

Question 9

Describe sleep changes in panic disorder

Answer 9

Panic disorder
o Other complaints may include sleep paralysis and hypnagogic hallucinations
o Recurrent sleep paralysis has been reported
o Night terrors
o During NREM sleep the value for total power was sig higher in nocturnal panic patients the PD patients as a group had higher values
o Lower sleep efficiency
o PSG
 Increase sleep
 Reduced sleep efficiency and abrupt awakening with sensation of panic out of N2
 Specific treatment of the sleep disturbance may be needed
• Cervena et al reported that convention therapy of PD in 20 subjects wasn’t sufficient to treat the coexisting insomnia

Question 10

Describe sleep changes in PTSD

Answer 10

Lee et al (2010)
PTSD assocaited with I (Hz arousal, fragmented sleep) nightmares and increased motor activity
Eye movments in REM are increased - time to REM increased, SWS decreased N1 increased

Question - might have an underlying sleep problem or abnormal emotional regualtion that increases the risk of PTSD
Causal Problem – soliders

Question 11

Describe sleep changes in schizophrenia

Krystal et al (2008)
\+ve (4) 
REM 
REM 
efficienct 
latency 

-ve (2)
SWS
REM

Answer 11

Understanding not fully there

sleep alterations related to severity and tpye of symtpoms

Krystal et al (2008) 
\+ve 
short REM latency 
increased REM density 
reduced sleep efficieny 
increased sleep latency 

-ve
SWS deficits
short REM latency

reduced number amplitude and duration of spindels - pwer in spindle frequency band

Thalamocortical dsyfucntion could be underlying schizotypal traits - Lustenerger et al (2015)
Fast spindle density also correlated with glutamate/glutamine in the thalamus

Question 12

Describe sleep changes in substance abuse

ALCOHOL

Lee and Douglass (2010)
1st 1/2 (3) Sleep latency, SWS and REM
2nd 1/2 (3) efficiency and fragmentation
REM rebounds - dreaming/nightmares

Chronic use?
3-9 days
SL
SE, SWS, REM , TST

WHat may alchol also exacerbate?
4

Answer 12

Lee and Douglass (2010) 
1st 1/2 night :
acute alcohol use 
decreases sleep latency 
marginally increases SWS 
and reduces REM 
2nd 1/2 night: 
sleep efficiency is reduced 
sleep is fragmented 
REM rebounds and is associatedwith intense dreaming and nightmares 

With chronic use 3-9 days , tolerance leads to increased sleep latency
decreased sleep efficiecny SWS REM and TST

Alcohol may also excerbate OSA, PLMD, RLS and parasomnias (sleepwalking, RBD)

Question 13

describe sleep changes in dementia

Answer 13

Rothman and Mattson (2012)
ageing may disrupt sleep through loss of orexinergic and GABAergic neruons in the brainstem and hypothalamus

loss of cellualar maintenance/recovery fucntion of sleep? build up of toxins in the brain

Question 14

Describe sleep changes with substance abuse
OPIATES and MARIJUANA

Opiates
effects (3)
stablization
withdrawal (I with r S__ and R__)

Mari
effects (3; R.. R..D……. and S….. L…….)
stablization
withdrawal (D……. D……)

Answer 14

Lee and Douglass (2010)

acute opiate reduce TST, REM and SWS
chronic use = changes are normalised
upon withdrawal insomnia Hz occurs with reduced SWS and REM

Mari reduces REM, REM density and sleep latency
tolarance builds and withdrawal associated with disturbing dreams

Question 15

substance abuse predictors (sleep?)

Wong et al (2004)

Answer 15

SPs overtidredness and trouble sleeping in early childhood are predicitve of later substance abuse (alcohol, Marijuana and illicit drugs)

kids wil sleep problems at 3-5rs were 2.3 x more likely to dirnk alcohol at 12-14 years

Question 16

which came first depression or insomnia>

Answer 16

Ohayon & Roth (2003)
75% depression came first or at same time as I

Chang et al (1997)
o Insomnia at baseline associated with a long-term (> 30 years) increase relative risk for development of major depression twice as high
• Jansson-Frojmark & Lindblom (2008)
o 1498 ppts
o Baseline nad1 year follow up questionnaires
o Odds of developing insomnia
 A = 4.27
 D =2.28
o Effect of insomnia at baseline
 A = 2.3
 D=3.51
• Cole et al (2003) meta-analysis TR in elderly
o For depression amount community-dwelling elderly 57% of the risk for depression was attributable to insomnia, and insomnia was 2nd only to recent bereavement in predicting depression
• Johnson et al., 2006 – TR in adolescents
o Insomnia often precedes the onset of a fist episode of major depression or mania 3.8 times more likely
o In contrast in anxiety disorders insomnia was more likely to occur subsequent to the onset of anxiety 3.5 times more likely
• Gillespe et al (2012)
o Data from 2 twin cohorts
o Found interaction between age and gender
o In all women
 No direact causal impact of sleep on risk of axiety or depression
o In younger women
 Depression and anxiety predict disrupted sleep
o In older women a bi-direactional interaction
o IN all men
 Unclear relationship
• Ford et al (1989) and Breslau et al (1996)
o Subjects reported sleep disturbances at both baseline and 1-3 year follow up interviews were much more likely to have developed new-onset major depression
• Goyal et al (2007) TR in pregnant women
o Women with more disrupted sleep also had more depression both before and after giving birth
o Presence of initial insomnia seed to be the most relevant screening question for identifying women at risk for postpartum depression
• Frediksen et al (2004) TR in children
o Children who reported decreased amounts of sleep or insomnia were more likely to develop symptoms of depression and reduced self-esteem
• Pelman et al (2006) TR in previous episode of depression or mania
o sleep changes remain a robust predictors of recurrent mood episodes and their persistence is associated with more severe course
Insomnia and fatigue were the most commonly report symptoms preceding a recurrent major depression