Systematic evaluation of Axis-I DSM diagnoses in delayed sleep phase disorder and evening-type circadian preference
ABSTRACT Alterations in circadian rhythms can have profound effects on mental health. High co-morbidity for psychiatric disorders has been observed in patients with circadian rhythm disorders, such as delayed sleep phase disorder (DSPD), and in those with an evening-type circadian preference. The aim of this study was to systematically determine the prevalence and type of Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM IV) Axis-I disorders in those with DSPD compared to evening-type controls.
Forty-eight DSPD and 25 evening-type participants took part in this study. Sleep and wake parameters were assessed with actigraphy, diary and questionnaires (Pittsburgh Sleep Quality Index (PSQI) and Functional Outcomes of Sleep Questionnaire (FOSQ). Evening-type preference was defined by the Horne-Ostberg questionnaire. DSPD was determined by an interview according to International Classification of Sleep Disorders criteria. Current and past diagnoses of psychiatric disorders were assessed with a Structured Clinical Interview for DSM-IV disorders.
DSPD was associated with a later wake time, longer sleep time, higher PSQI score and lower Horne-Ostberg and FOSQ scores compared to evening-types. There were no significant differences in the prevalence or type of Axis-I disorders between those with DSPD or evening-type preference. Over 70% of participants met criteria for at least one past Axis-I disorder. Approximately 40% of both the DSPD and evening-types met criteria for a past diagnosis of mood, anxiety (most frequently phobia) or substance-use disorders. Evening types were more likely to have a past diagnosis of more than one Axis-I disorder.
These results highlight the important link between circadian rhythms and mental disorders. Specifically, an evening circadian chronotype regardless of DSPD status is associated with a risk for anxiety, depressive or substance-use disorders.
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- "A longitudinal study also found that MT was the most persistent chronotype with ageing and that a majority of ET change for another type with ageing (Broms et al., 2014). Furthermore, there is evidence for the association between circadian rhythmicity and psychiatric disorders , particularly with mood disorders (Chelminski et al., 1999; Kasof, 2001; Giglio et al., 2010; Reid et al., 2012) supporting the hypothesis that chronotype could be a risk factor linked to Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/psychres "
ABSTRACT: Studies have shown that Evening-Type (ET) subjects used more stimulating and sedative substances, and presented more psychiatric disorders than Morning-Type (MT) subject. However, there is a lack of data on the chronotype of patients with addiction. The aim of our study was to describe chronotype and associated factors in a sample of outpatients beginning treatment for addiction. Subjects were assessed with the Morningness-Eveningness questionnaire of Hörne & Ostberg, the Addiction Severity Index and the Mini International Neuropsychiatric Interview. In the 333 subjects with an addiction, 20% were MT and 32% were ET. When comparing ET to MT, multivariate analysis showed that ET was significantly associated with poly-problematic addiction, non-substance addictions, cannabis addiction, and mood disorders, but not with severity of addiction. MT was associated with antisocial personality disorder. Results suggested that chronotype was associated with specific addiction pattern and psychiatric disorders. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.Psychiatry Research 05/2015; 229(3). DOI:10.1016/j.psychres.2015.05.026 · 2.47 Impact Factor
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- "There is convincing evidence that a low MEQ score is associated with a broad spectrum of psychological and psychiatric problems. These include associations with adult ADHD (Voinescu et al., 2012), bipolar disorder (Hakkarainen et al., 2003), substance-use disorders (Reid et al., 2012), and suicidal thoughts/attempts (Selvi et al., 2011). Several (Chelminski et al., 1999; Gaspar-Barba et al., 2009; Meliska et al., 2011; Merikanto et al., 2013), but not all (Konttinen et al., 2014) studies have reported negative associations between Morningness and nonseasonal depression. "
ABSTRACT: Several studies documented that lower scores on the Morningness-Eveningness Questionnaire (MEQ) are associated with a higher global seasonality of mood (GSS). As for the Modern Man artificial lighting predominantly extends evening activity and exposure to light, and as evening bright light phase is known to delay circadian rhythms, this chronic exposure could potentially lead to both lower Morningness as well as higher GSS. The aim of the study was to investigate if the MEQ-GSS relationship holds in the Old Order Amish of Lancaster County, PA, a population that does not use network electrical light. 489 Old Order Amish adults (47.6% women), with average (SD) age of 49.7 (14.2) years, completed both the Seasonal Pattern Assessment Questionnaire (SPAQ) for the assessment of GSS, and MEQ. Associations between GSS scores and MEQ scores were analyzed using linear models, accounting for age, gender and relatedness by including the relationship matrix in the model as a random effect. GSS was inversely associated with MEQ scores (p=0.006, adjusted). include a potential recall bias associated with self-report questionnaires and no actual light exposure measurements. We confirmed the previously reported inverse association between MEQ scores and lower seasonality of mood, for the first time in a population that does not use home network electrical lighting. This result suggests that the association is not a byproduct of exposure to network electric light, and calls for additional research to investigate mechanisms by which Morningness is negatively associated with seasonality. Published by Elsevier B.V.Journal of Affective Disorders 11/2014; 174C:209-214. DOI:10.1016/j.jad.2014.11.039 · 3.38 Impact Factor
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- "Recent research indicates that people with DSPS more often develop anxiety, depression, and substance use. Interestingly, this was also true for persons with an evening-type circadian preference (34). "
ABSTRACT: The sleepy teenager puts the doctor in a, often tricky, situation where it must be decided if we deal with normal physiology or if we should suspect pathological conditions. What medical investigations are proper to consider? What differential diagnoses should be considered in the first place? And what tools do we actually have? The symptoms and problems that usually are presented at the clinical visit can be both of medical and psychosocial character - and actually they are often a mixture of both. Subsequently, the challenge to investigate the sleepy teenager often includes the examination of a complex behavioral pattern. It is important to train and develop diagnostic skills and to realize that the physiological or pathological conditions that can cause the symptoms may have different explanations. Research in sleep disorders has shown different pathological mechanisms congruent with the variations in the clinical picture. There are probably also different patterns of involved neuronal circuits although common pathways may exist. The whole picture remains to be drawn in this interesting and challenging area.Frontiers in Neurology 08/2014; 5:140. DOI:10.3389/fneur.2014.00140