Systematic evaluation of Axis-I DSM diagnoses in delayed sleep phase disorder and evening-type circadian preference

Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA. Electronic address: .
Sleep Medicine (Impact Factor: 3.15). 08/2012; 13(9):1171-7. DOI: 10.1016/j.sleep.2012.06.024
Source: PubMed


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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    • "These profiles may distinguish between depressive subtypes (typical versus atypical) (Blanco et al., 2012), individuals with unipolar or BD depression (Weinstock et al., 2009) and individuals at risk of BD (Mitchell et al., 2011). Although DSP is nearly always associated with an evening-type circadian preference (with increased activity during the late evening/early morning hours), not all evening types have DSP (Reid et al., 2012). Also, while there are similarities and overlaps between DSP and evening chronotype, one important difference is that DSP is considered a sleep disturbance. "
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    ABSTRACT: Background Theoretical models of Bipolar Disorder (BD) highlight that sleep disturbances may be a marker of underlying circadian dysregulation. However, few studies of sleep in BD have reported on the most prevalent circadian sleep abnormality, namely Delayed Sleep Phase (DSP). Methods A cross-sectional study of 404 adults with BD who met published clinical criteria for insomnia, hypersomnia or DSP, and who had previously participated in a study of sleep in BD using a comprehensive structured interview assessment. Results About 10% of BD cases with a sleep problem met criteria for a DSP profile. The DSP group was younger and had a higher mean Body Mass Index (BMI) than the other groups. Also, DSP cases were significantly more likely to be prescribed mood stabilizers and antidepressant than insomnia cases. An exploratory analysis of selected symptom item ratings indicated that DSP was significantly more likely to be associated with impaired energy and activity levels. Limitations The cross-sectional design precludes examination of longitudinal changes. DSP is identified by sleep profile, not by diagnostic criteria or objective sleep records such as actigraphy. The study uses data from a previous study to identify and examine the DSP group. Conclusions The DSP group identified in this study can be differentiated from hypersomnia and insomnia groups on the basis of clinical and demographic features. The association of DSP with younger age, higher BMI and impaired energy and activity also suggest that this clinical profile may be a good proxy for underlying circadian dysregulation.
    No preview · Article · Nov 2015 · Journal of Affective Disorders
    • "It might also have been interesting to measure fatigue and alertness during the day, or in the morning, as these are common symptoms in DSPD. Psychiatric disorders such as anxiety and depression are more common in persons with DSPD than in normal sleepers (Dagan, Stein, et al., 1998;Reid et al., 2012). In the current study, anxiety and depression were measured using the HADS. "
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    ABSTRACT: Delayed sleep phase disorder (DSPD) is common among young people, but there is still no evidence-based treatment available. In the present study, the feasibility of cognitive behavioral therapy (CBT) was evaluated as an additive treatment to light therapy (LT) in DSPD. A randomized controlled trial with participants aged 16 to 26 years received LT for two weeks followed by either four weeks of CBT or no treatment (NT). LT advanced sleep-wake rhythm in both groups. Comparing LT+CBT with LT+NT, no significant group differences were observed in the primary endpoints. Although anxiety and depression scores were low at pretreatment, they decreased significantly more in LT+CBT compared to LT+NT. The results are discussed and some suggestions are given for further studies.
    No preview · Article · Aug 2015 · Behavioral Sleep Medicine
    • "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: "
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    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.
    No preview · Article · May 2015 · Psychiatry Research
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