- [Show abstract] [Hide abstract] ABSTRACT: Disruptions in activity are core features of mood states in bipolar disorder (BD). In this study, we sought to identify activity patterns that discriminate between mood states in BD. Locomotor activity was collected by using actigraphy for 6 weeks in participants with interepisode BD Type I (n = 37) or participants with no lifetime mood disorders (n = 39). The 24-hr activity pattern of each participant-day was characterized and within-person differences in activity patterns were examined across mood states. Results showed that among participants with BD, depressive days are distinguished from other mood states by an overall lower activity level and a pattern of later activity onset, a midday elevation of activity, and low evening activity. No distinct within-person activity patterns were found for hypomanic/manic days. Given that activity can be monitored noninvasively for extended time periods, activity pattern identification may be leveraged to detect mood states in BD, thereby providing more immediate delivery of care.
- [Show abstract] [Hide abstract] ABSTRACT: Polysomnography (PSG) is the gold standard for the assessment of sleep, and provides valuable information for researchers and clinicians alike. However, the extensive apparatus required for monitoring with PSG can be difficult to tolerate, particularly in children. Clinical populations, such as those with anxiety or tactile sensitivity, may have even greater difficulty tolerating the PSG equipment. A protocol using ambulatory PSG and systematic desensitization is described that was developed to study sleep in individuals with autism spectrum disorders (ASD) or developmental delay (DD), as well as typically developing controls (TD). Using this procedure, PSG was successfully attained in 144 subjects (89.4%). Individuals with ASD were equally able to obtain successful PSG; however, they did take significantly longer to desensitize to the equipment than DD or TD subjects. Age, sex, IQ, and tactile sensitivity did not predict the duration of time required for successful desensitization. Clinicians and researchers might consider use of a similar protocol to facilitate future sleep investigations.
- [Show abstract] [Hide abstract] ABSTRACT: Theory and research indicate that activity is fundamental to mood episodes in bipolar disorder (BD), yet researchers have not tested whether energy is more closely tethered to mood in BD compared to those without BD. Eighty-seven participants (13 with self-reported BD) completed 4396 energy and mood ratings through a mood-monitoring application. Mixed modeling analyses indicated that low energy, but not high energy, was related to mood within the BD group. Low energy could provide a strong and easily recognized indicator of negative mood states in persons with BD. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
- [Show abstract] [Hide abstract] ABSTRACT: Though poorly defined, hypersomnia is associated with negative health outcomes and new-onset and recurrence of psychiatric illness. Lack of definition impedes generalizability across studies. The present research clarifies hypersomnia diagnoses in bipolar disorder by exploring possible subgroups and their relationship to prospective sleep data and relapse into mood episodes. Method. A community sample of 159 adults (aged 18–70 years) with bipolar spectrum diagnoses, euthymic at study entry, was included. Self-report inventories and clinician-administered interviews determined features of hypersomnia. Participants completed sleep diaries and wore wrist actigraphs at home to obtain prospective sleep data. Approximately 7 months later, psychiatric status was reassessed. Factor analysis and latent profile analysis explored empirical groupings within hypersomnia diagnoses. Results. Factor analyses confirmed two separate subtypes of hypersomnia (‘long sleep’ and ‘excessive sleepiness’) that were uncorrelated. Latent profile analyses suggested a four-class solution, with ‘long sleep’ and ‘excessive sleepiness’ again representing two separate classes. Prospective sleep data suggested that the sleep of ‘long sleepers’ is characterized by a long time in bed, not long sleep duration. Longitudinal assessment suggested that ‘excessive sleepiness’ at baseline predicted mania/hypomania relapse. Conclusions. This study is the largest of hypersomnia to include objective sleep measurement, and refines our understanding of classification, characterization and associated morbidity. Hypersomnia appears to be comprised of two separate subgroups: long sleep and excessive sleepiness. Long sleep is characterized primarily by long bedrest duration. Excessive sleepiness is not associated with longer sleep or bedrest, but predicts relapse to mania/hypomania. Understanding these entities has important research and treatment implications.
- [Show abstract] [Hide abstract] ABSTRACT: Background and Objectives Dysregulated affect is a hallmark feature of acute episodes of bipolar disorder (BD) and persists during inter-episode periods. Its contribution to course of illness is not yet known. The present report examines the prospective influence of inter-episode affect dysregulation on symptoms and functional impairment in BD. Methods Twenty-seven participants diagnosed with inter-episode bipolar I disorder completed daily measures of negative and positive affect for 49 days (±8 days) while they remained inter-episode. One month following this daily assessment period, symptom severity interviews and a measure of functional impairment were administered by telephone. Results More intense negative affect and positive affect during the inter-episode period were associated with higher depressive, but not manic, symptoms at the one-month follow-up assessment. More intense and unstable negative affect, and more unstable positive affect, during the inter-episode period were associated with greater impairment in home and work functioning at the follow-up assessment. All associations remained significant after controlling for concurrent symptom levels. Limitations The findings need to be confirmed in larger samples with longer follow-up periods. A more comprehensive assessment of functional impairment is also warranted. Conclusions The findings suggest that a persistent affective dysregulation between episodes of BD may be an important predictor of depression and functional impairment. Monitoring daily affect during inter-episode periods could allow for a more timely application of interventions that aim to prevent or reduce depressive symptoms and improve functioning for individuals with BD.
- [Show abstract] [Hide abstract] ABSTRACT: Objectives Bipolar disorder is associated with idiosyncratic precursors of clinically important states such as suicidal ideation. Ecological momentary assessment (EMA) - high frequency data collection in a subject's usual environment - provides the potential for development of temporal, individualized prediction of risk states. The present study tested the ability of EMA data to predict individual symptom change in clinician-rated suicidal ideation. Methods Thirty-five adults diagnosed with inter-episode bipolar disorder completed daily measures of affect in their home environments using diaries administered over an eight-week assessment timeline. Suicidal ideation was assessed monthly at in-person visits using the Inventory of Depressive Symptomatology-Clinician Rated. We used a novel application of functional linear models (FLMs) to generate prospective predictions of suicidal ideation at in-person clinician assessments based on intensively sampled trajectories of daily affect. ResultsEight instances of suicidal ideation scores > 0 were recorded during the study period on six participants. Utilizing trajectories of negative and positive affect, cross-validated predictions attained 88% sensitivity with 95% specificity for elevated suicidal ideation one week prior to in-person clinician assessment. This model strongly outperformed prediction models using cross-sectional data obtained at study visits alone. Conclusions Utilizing EMA data with FLM prediction models substantially increases the accuracy of prediction of study-emergent suicidal ideation. Prediction algorithms employing intensively sampled longitudinal EMA data could sensitively detect the warning signs of suicidal ideation to facilitate improved suicide risk assessment and the timely delivery of preventative interventions.
- [Show abstract] [Hide abstract] ABSTRACT: Objective To evaluate the relative role of psychopathology in the relationship between physical activity and sleep, the present study investigated the day-to-day relationship between physical activity and sleep in individuals without a psychiatric disorder and individuals with bipolar disorder using a longitudinal, naturalistic design. Method Participants in two groups—a healthy group with no psychiatric illness (N=36) and an inter-episode bipolar disorder group (N=32)— were studied over a two-month period. Physical health was assessed by the SF-36. Daily subjective and objective measures of physical activity and sleep were collected. A total of 6,670 physical activity measurements and 6,548 sleep measurements were logged. Results The bipolar disorder group exhibited poorer physical health on the SF-36 and more sleep disturbance relative to the healthy group. No group differences were found in physical activity, nor in models examining the relationship between physical activity and sleep. Hierarchical linear models indicated that for every standard deviation increase in sleep disturbance (i.e., increased total wake time), there was a three percent decrease in subsequent day physical activity, in both the healthy and bipolar groups. Increased physical activity was associated with improved sleep for participants who reported greater average sleep disturbance. Conclusions The results for all participants in the study suggest that reduced physical activity and sleep difficulties may be mutually maintaining processes, particularly for individuals who suffer from poor sleep. Findings also raise the potential importance of targeting physical activity and sleep concurrently in interventions aimed at improving physical and mental health.
- [Show abstract] [Hide abstract] ABSTRACT: In this article, we consider similarities and differences in emotion research on older adults and individuals with bipolar disorder (BD). Recent research and theory within both areas has focused on the importance of positive emotion, but the case of older adults is generally considered a case of "adaptive" positivity whereas BD is usually considered maladaptive positivity. We explore the paradox of the same phenomenon being labeled as adaptive in one group and yet maladaptive in another, with attention to commonalities and distinctions between these two groups. We identify only limited areas of overlap, and suggest a refinement of models of positive emotionality in the two populations.
- [Show abstract] [Hide abstract] ABSTRACT: Many studies have provided strong evidence of a fundamental and complex role for sleep disturbances in adult posttraumatic stress disorder (PTSD). Investigations of adult PTSD using subjective and objective measures document sleep architecture abnormalities and high prevalence of sleep disordered breathing, periodic limb movement disorder, nightmares, and insomnia. PTSD treatment methods do appear to significantly improve sleep disturbance, and also studies suggest that treatments for sleep disorders often result in improvements in PTSD symptoms. Further, the most recent evidence suggests sleep abnormalities may precede the development of PTSD. Given the importance of sleep disorders to the onset, course, and treatment of adult PTSD, examination of sleep disturbances far earlier in the life course is imperative. Here we review the literature on what we know about sleep disturbances and disorders in pediatric PTSD. Our review indicates that the extant, empirical data examining sleep disturbance and disorders in pediatric PTSD is limited. Yet, this literature suggests there are significantly higher reports of sleep disturbances and nightmares in children and adolescents exposed to trauma and/or diagnosed with PTSD than in non-trauma-exposed samples. Sleep questionnaires are predominantly employed to assess sleep disorders in pediatric PTSD, with few studies utilizing objective measures. Given the important, complex relationship being uncovered between adult PTSD and sleep, this review calls for further research of sleep in children with PTSD using more specific subjective measures and also objective measures, such as polysomnography and eventually treatment trial studies. Kovachy B; O'Hara R; Hawkins N; Gershon A; Primeau MM; Madej J; Carrion V. Sleep disturbance in pediatric PTSD: current findings and future directions. J Clin Sleep Med 2013;9(5):501-510.
- [Show abstract] [Hide abstract] ABSTRACT: Early adversity is a strong and enduring predictor of psychiatric disorders including mood disorders, anxiety disorders, substance abuse or dependence, and posttraumatic stress disorder. However, the mechanisms of this effect are not well understood. The purpose of this review is to summarize and integrate the current research knowledge pertaining to the long-term effects of early adversity on psychiatric disorders, particularly in late life. We explore definitional considerations including key dimensions of the experience such as type, severity, and timing of adversity relative to development. We then review the potential biological and environmental mediators and moderators of the relationships between early adversity and psychiatric disorders. We conclude with clinical implications, methodological challenges and suggestions for future research.
- [Show abstract] [Hide abstract] ABSTRACT: Background: Exposure to life stress is known to adversely impact the course of bipolar disorder. Few studies have disentangled the effects of multiple types of stressors on the longitudinal course of bipolar I disorder. This study examines whether severity of chronic stressors and exposure to trauma are prospectively associated with course of illness among bipolar patients. Method: One hundred and thirty-one participants diagnosed with bipolar I disorder were recruited through treatment centers, support groups and community advertisements. Severity of chronic stressors and exposure to trauma were assessed at study entry with in-person interviews using the Bedford College Life Event and Difficulty Schedule (LEDS). Course of illness was assessed by monthly interviews conducted over the course of 24 months (over 3000 assessments). Results: Trauma exposure was related to more severe interpersonal chronic stressors. Multiple regression models provided evidence that severity of overall chronic stressors predicted depressive but not manic symptoms, accounting for 7.5% of explained variance. Conclusions: Overall chronic stressors seem to be an important determinant of depressive symptoms within bipolar disorder, highlighting the importance of studying multiple forms of life stress.
- [Show abstract] [Hide abstract] ABSTRACT: This study focused on social support and social strain and their cross-sectional associations with instabilities in sleep and social rhythms in inter-episode bipolar disorder (BD). Thirty-five adults diagnosed with inter-episode BD type I and 38 healthy controls completed measures of perceived social support and social strain. Group differences in support and strain were examined. Within the BD group, instabilities in sleep and social rhythms were assessed with 28 days of daily diary and actigraphy. Correlation and regression analyses were used to examine cross-sectional and prospective associations between social support, social strain, instabilities in sleep and social rhythms, and mood symptoms. The BD group reported lower social support and higher social strain than the control group. Additionally, social strain was positively correlated with manic and depressive symptoms in the BD group. Furthermore, there was a cross-sectional association between social support and more stable sleep on actigraphy in the BD group, although social support did not predict future sleep instability. These results indicate that inter-episode BD is associated with deficient social support and elevated social strain compared to controls, and that this may be due to persistent inter-episode mood symptoms. Social strain may be particularly important given its association with manic and depressive symptoms. The results also raise the possibility that sleep instability is related to poor social support in BD.
- [Show abstract] [Hide abstract] ABSTRACT: Disturbances in sleep and affect are prominent features of bipolar disorder, even during interepisode periods. Few longitudinal studies have prospectively examined the relationship between naturally occurring sleep and affect, and no studies to date have done so during interepisode periods of bipolar disorder and using the entire set of "gold standard" sleep parameters. Participants diagnosed with bipolar I disorder who were interepisode (n = 32) and healthy controls (n = 36) completed diagnostic and symptom severity interviews, and a daily sleep and affect diary, as well as an actigraphy sleep assessment, for eight weeks (M = 54 days, ± 8 days). Mutual information analysis was used to assess the degree of statistical dependence, or coupling, between time series data of sleep and affect. As measured by actigraphy, longer sleep onset latency was coupled with higher negative affect more strongly in the bipolar group than in the control group. As measured by sleep diary, longer wakefulness after sleep onset and lower sleep efficiency were coupled with higher negative affect significantly more strongly in the bipolar group than in the control group. By contrast, there were no significant differences between groups in the degree of coupling between any measures of sleep and positive affect. Findings support the coupling of sleep disturbance and negative affect during interepisode bipolar disorder. Ongoing monitoring of sleep-affect coupling may provide an important target for intervention in bipolar disorder. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
Article: Sleep and Psychopathology[Show abstract] [Hide abstract] ABSTRACT: Subjective and objective disturbances in sleep have been observed in a wide range of psychopathology. In this chapter, we review evidence implicating insomnia, hypersomnia, and circadian rhythm disturbances as having key roles in mood disorders, anxiety disorders, schizophrenia, and resilience against psychopathology. Furthermore, we describe theories suggesting that sleep is a key mechanism linking stress and psychopathology. We next turn our attention to individual differences in sleep and circadian rhythms, focusing on personality and temperament. We also review data on chronotypes and their neurobiological underpinnings in mood disorders and schizophrenia. The chapter concludes with a brief overview of important clinical implications stemming from these empirical findings.
- [Show abstract] [Hide abstract] ABSTRACT: This study used a comprehensive, interview-based measure of life stress to assess the role of different types of stress in predicting first onset of psychiatric disorders among daughters of depressed (n = 22) mothers and healthy (n = 22) mothers. Several types of stress were assessed: Chronic interpersonal stress, chronic non-interpersonal stress, episodic dependent (i.e., self-generated) interpersonal stress, episodic dependent non-interpersonal stress, episodic independent interpersonal stress, and episodic independent non-interpersonal stress. Daughters (ages 9-14) were recruited to have no clinically significant symptoms upon entry (T1). By a 30-month follow-up assessment (T2), 45% of the daughters of depressed mothers, but none of the daughters of healthy mothers, had developed a psychiatric disorder. Overall, daughters of depressed mothers were exposed to more severe chronic interpersonal and non-interpersonal stress than were daughters of healthy mothers. Further, daughters of depressed mothers who developed a psychiatric disorder by T2 were exposed to more severe chronic non-interpersonal stress and episodic dependent stress than were daughters of depressed mothers who remained healthy. We discuss the implications of these findings in the context of a stress-generation model for the intergenerational transmission of psychiatric risk among children of depressed mothers.
- [Show abstract] [Hide abstract] ABSTRACT: The aim of this article is to highlight the importance of the sleep-wake cycle in children, adolescents, and adults with bipolar disorder. After reviewing the evidence that has accrued to date on the nature and severity of the sleep disturbance experienced, we document the importance of sleep for quality of life, risk for relapse, affective functioning, cognitive functioning, health (sleep disturbance is implicated in obesity, poor diet, and inadequate exercise), impulsivity, and risk taking. We argue that sleep may be critically important in the complex multifactorial cause of interepisode dysfunction, adverse health outcomes, and relapse. An agenda for future research is presented that includes improving the quality of sleep measures and controlling for the impact of bipolar medications.
Chapter: Anxiety and Sleep[Show abstract] [Hide abstract] ABSTRACT: Insomnia, nightmares, or nocturnal panic attacks are prominent features of sleep disturbance that spans across many anxiery disorders. In a meta-analysis of 177 studies, Benca and colleagues (1992) reported that individuals with an anxiery disorder take longer ro get to sleep at the beginning of the night, experience more awakenings during rhe night, obtain less sleep overall, and exhibit poorer sleep efficienry, relative to nonpatients. More recently, a review of dre literature by Papadimitriou and Linkowski 2005) suggesrs rhat the major findings reported bv Benca et al. have held over the ensuing decade. \,foreover, Papadimitriou and Linkowski (2005) tbund an especially strong association beween sleep disturbance and several anxiety disorders, including panic disorder, generalized anxiery disorder (GAD), obsessive-compulsive disorder, and posttraumatic stress disorder (PTSD). Afthough-ort of the evidence to date is based on samples of aduhs in their rriddle years, there is also evidence ofan association)erween sleep disturbance and anxiety disorders in ;hildren and adolescence (Forbes et al., 2006), as well as among older adults (Spira, Friedman, Flint, & Sheikh,2005). The first aim of this chapter is to highlight the potential importance of sleep problems in individuals with anxiery disorders. W'e argue that disturbed sleep not only impairs the qualiry of a patientt life but may also contribute to rhe maintenance of the anxiety disorder. Our second aim is to review the evidence base for rrearing parienrs who sufFer from comorbid sleep disturbance and anxiery disorder. As will become evident throughout the chapter, there is a dearth of evidence that specifically delineates the relationship berween sleep disturbance and anxiery disorder and thus several ofour proposals are based on evidence from healthy nonpatients or patienrs with other clinical disorders. 'We raise this caveat at
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