Frequency of delayed sleep phase syndrome among hospitalized adolescent psychiatric patients.

Previous research seems to indicate that a substantial percentage of patients with delayed sleep phase syndrome (DSPS) also suffer from personality disorders. In the present study, we attempted to ascertain whether, in a population of hospitalized psychiatric patients, we would find a greater frequency of DSPS among patients suffering from personality disorders than among patients suffering from any of the other psychiatric disorders. Sixty-three hospitalized adolescents took part in the study. None of them had any diagnosed medical disorders, and all were being treated with psychiatric drugs. Ten subjects were diagnosed as suffering from DSPS according to a sleep-wake schedule structured interview. As hypothesized, subjects diagnosed as suffering from personality disorders had a significantly higher probability of also suffering from DSPS. Additional findings were that patients with DSPS were more likely to have received an Axis II diagnosis only, and were more likely to be diagnosed as suffering from a distinct group of disorders characterized by affective lability. The latter finding may be due to the sleepiness that accompanies DSPS. The findings of the present study suggest that there may be an interrelationship between DSPS and personality disorders, and may lend some support to the hypothesis that inborn peculiarities in the sleep-wake rhythm lead to the social and functional difficulties characteristic of personality disorders.

Evaluating the role of melatonin in the long-term treatment of delayed sleep phase syndrome (DSPS).

Delayed sleep phase syndrome (DSPS) involves a mismatch between the usual daily schedule required by the individual's environment and his or her circadian sleep-wake pattern. Patients suffering from DSPS are treated with chronotherapy, light therapy, or melatonin administration. While chronotherapy and light therapy are demanding and difficult treatments that usually lead to compliance problems, melatonin administration is a relatively simple and easy treatment option. Previous studies carried out on relatively small samples of DSPS patients have shown that melatonin has a sleep-promoting and entraining action when taken in the evening. The present study, which accompanied routine treatment in our sleep clinic, examined the efficiency of melatonin treatment in a relatively large population of DSPS subjects by means of subjective reports. The 61 subjects, 37 males and 24 females, were diagnosed with DSPS by means of clinical assessment and actigraphy at our sleep clinic. Their mean pretreatment falling asleep and waking times were 03:09 (SD = 86.22 minutes) and 11:31 (SD = 98.58 minutes), respectively. They were treated with a 6-week course of 5 mg of oral melatonin taken daily at 22:00. A survey questionnaire was sent to the home of each subject 12-18 months after the end of the treatment; the survey investigated the efficiency of the melatonin treatment and its possible side effects. Of the patients, 96.7% reported that the melatonin treatment was helpful, with almost no side effects. Of these, 91.5% reported a relapse to their pretreatment sleeping patterns within 1 year of the end of treatment. Only 28.8% reported that the relapse occurred within 1 week. The pretreatment falling asleep and waking times of patients in whom the changes were retained for a relatively long period of time were significantly earlier than those of patients whose relapse was immediate (t = 2.18, p < .05; t = 2.39, p < .05, respectively), with no difference in sleep duration. The implications of these findings, as well as further research possibilities, are discussed.

Sleep quality in children with attention deficit hyperactivity disorder: an actigraphic study.

The aim of the present study was to compare the sleep of 12 children with attention deficit hyperactivity disorder (ADHD) with that of 12 normal controls. The children were examined in their natural environment, using continuous actigraphic monitoring over several consecutive nights, as well as undergoing subjective parental reports. It was hypothesized that children diagnosed with ADHD would suffer from reduced sleep quality than children without ADHD. This hypothesis was supported by the actigraphic measures, but not supported by the subjective parental reports. It was also found that the sleep quality of the two groups differed over the course of the night, which suggests a difference in sleep architecture. Various possible explanations for these findings, their implications regarding the relationship between sleep and ADHD, and the resulting treatment ramifications are discussed, and suggestions for further research are provided.

High prevalence of personality disorders among circadian rhythm sleep disorders (CRSD) patients.

The purpose of this study was to examine systematically our previous clinical impression regarding the prevalence of personality disorders in patients suffering from circadian rhythm sleep disorders (CRSD). We hypothesized that, in a group of patients suffering from CRSD, there would be a higher frequency of personality disorders than in a group of healthy controls. The experimental group consisted of CRSD patients diagnosed according to a clinical interview and actigraphic recordings. The control group consisted of healthy volunteers in whom CRSD had been ruled out by means of a self-administered questionnaire. Both groups were assessed for personality disorders using the MCMI, a diagnostic tool based on Millon's biopsychosocial theory of personality and the PRQ-R, a diagnostic tool based on the DMS-III-R. Both tests provided clear and significant support for the hypothesis that individuals suffering from CRSD are characterized to a greater extent by personality disorders than a control group. No specific characteristic pattern or profile of personality disorders was clearly detected. Correct early diagnosis and treatment of CRSD may improve afflicted individuals' adaptive capabilities and perhaps even prevent the development of a personality disorder. This suggests how important a greater awareness of CRSD on the part of the professional community may be.