A pilot study examining hemomania behaviors in psychiatry outpatients engaged with nonsuicidal self-injury.

BACKGROUND: This study aims to conduct the first-ever evaluation of our previously proposed behaviors of "hemomania" in individuals engaged with nonsuicidal self-injury (NSSI). METHODS: The study encompassed 130 outpatients engaged with NSSI who applied at the psychiatry outpatient clinic. NSSI behaviors were assessed using the Inventory of Statements About Self-Injury, while psychiatric diagnoses were evaluated using the Structured Clinical Interview for DSM-5 Disorders-Clinician Version. Subsequently, participants completed the Depression Anxiety Stress Scale-21 and Short Form of Barratt Impulsiveness Scale. RESULTS: The prevalence of at least one hemomania behavior including seeing blood, tasting blood, bloodletting, and blood-drinking was observed to be 43.1% in individuals with NSSI. When participants were divided into two groups, individuals with hemomania exhibited: (1) a higher incidence of psychiatric comorbidities, increased suicide attempts, and more severe symptoms of depression, anxiety, stress, and impulsivity, (2) higher comorbidity rates of borderline personality disorder, body-focused repetitive behaviors, and dissociative disorders, and (3) elevated frequencies of certain NSSI behaviors, including cutting, biting, needle-ticking, and carving, compared to those without. CONCLUSION: Hemomania could be considered a specific impulse control disorder, characterized by heightened impulsivity and a persistent urge to obtain one's own blood. However, further studies are needed to validate this hypothesis.

Excessive mind wandering, rumination, and mindfulness mediate the relationship between ADHD symptoms and anxiety and depression in adults with ADHD.

BACKGROUND: Persistent mind-wandering processes are associated with negative emotions; however, mindful states exhibit an anticorrelation with mind-wandering patterns. The aim of this study is to investigate the mediating role of excessive mind wandering (EMW), rumination, and trait mindfulness between attention-deficit hyperactivity disorder (ADHD) symptoms and the severity of anxiety/depression in adults with ADHD. METHODS: Medication-free 159 adults diagnosed with ADHD completed a test battery that included a sociodemographic form as well as the Adult ADHD Severity Rating Scale, Hospital Anxiety Depression Scale, Mind Excessively Wandering Scale, Ruminative Response Scale, and Freiburg Mindfulness Inventory after the diagnostic examination according to the Structured Clinical Interview for DSM-5-Clinician Version (SCID-5). RESULTS: ADHD symptoms exhibited an indirect, but not a direct, association with the severity of anxiety and depression, mediated by increased excessive mind wandering and rumination, as well as decreased trait mindfulness. LIMITATIONS: This study was carried out within a clinical population using a cross-sectional design. While diagnostic assessments were conducted using SCID-5, psychiatric symptoms were evaluated through self-report measures. CONCLUSIONS: Coping with EMW and rumination and promoting mindfulness ability may be promising targets in treating comorbid conditions in adults with ADHD. These findings have highlighted the effects of mentation processes on depression and anxiety, which are common comorbidities with ADHD in adults; however, longitudinal studies are needed.

Delayed Mid-Sleep Time Associated With Weight Gain While Controlling for Eating Behaviors and Attention Deficit Hyperactivity Disorder Symptoms During the COVID-19 Pandemic.

OBJECTIVE: Society's sleep-wake cycle and eating behaviors have altered and are considered the psychological outcomes of the coronavirus disease-2019 (COVID-19) pandemic. Our aim was to examine the relationship between sleep-wake rhythms, eating behaviors (dieting, oral control, and bulimic behaviors), and attention deficit hyperactivity disorder (ADHD) symptoms with weight gain during the COVID-19 pandemic. METHODS: The participants were 578 female university students divided into three groups based on weight change during COVID-19 who lost weight, whose weight did not change (nWC), and who gained weight (WG). The participants' information about weight change in the last year and responses to the Pittsburg Sleep Quality Index, Eating Attitudes Test, Adult ADHD Severity Rating Scale, and Wender Utah Rating Scale were collected via an online survey from January 8, 2021 to January 11, 2021. RESULTS: The sleep-wake phase was more delayed in WGs than in the other two groups. The bulimic behavior score was higher and the oral control behavior score was lower in the WG group than in the nWC group. A hierarchical regression analysis model, in which weight change scores were dependent variables, showed that mid-sleep time in second step (ß=4.71, t=2.18, p=0.03), and oral control (ß=-0.11, t=-3.24, p=0.001)/bulimic behaviors (ß=0.20, t=3.20, p=0.001) in third step were associated with weight change after controlling for both current and childhood ADHD symptoms. CONCLUSION: Chronotherapeutic approaches that regulate sleep-wake rhythm may facilitate weight control of individuals during stressful periods, such as the COVID-19 outbreak.

Heterogeneity of associations between dissociation and attention deficit symptoms.

Childhood trauma and dissociative experiences are suggested to be predisposing transdiagnostic factors for attention deficit /hyperactivity disorder (ADHD) as well as many psychiatric disorders. Trauma-related symptoms such as motor restlessness, emotional instability, and concentration problems can mimic, trigger, or exacerbate ADHD symptoms. Moreover, given the relationship between ADHD and trauma-induced distress, it has been suggested that dissociative experiences and attention problems may reveal overlapping characteristics. The aim of this study was to investigate the associations between dissociative experiences and attention deficits by carrying out mixture analysis. A thousand and thirty-seven participants volunteered to the online investigation. Participants completed a test battery that included a sociodemographic form as well as the Adult ADHD Severity Rating Scale (ASRS), Wender Utah Rating Scale (WURS), Childhood Trauma Questionnaire (CTQ), Dissociative Experiences Scale (DES), and Somatoform Dissociation Questionnaire (SDQ). Item responses on the DES and attention deficit symptoms as indexed by the ASRS were subjected to latent class analysis. The three-latent-class model outperformed alternative mixture models. Mixture analysis classified the sample into three homogenous subgroups as follows: (1) No/low dissociation or attention problems; (2) Moderate dissociation with attention problems; and (3) High dissociation with attention problems. High dissociators with attention problems were characterized by heightened scores on somatoform dissociation and emotional neglect. No/low dissociation or attention problems latent class reported significantly lower scores on hyperactivity/impulsivity, depression, attention deficit in childhood, and sexual abuse than both moderate and high dissociation latent classes. High dissociators and moderate dissociators significantly differed on conduct problems and physical abuse. We concluded that impulsive hyperactivity, depression, and childhood sexual abuse were common features in heightened dissociation latent classes, as well as attention deficit.

Dissociative Absorption May Contribute to Internet Gaming Disorder Independent of Childhood Trauma and ADHD Symptoms Among Male University Students.

OBJECTIVE: We aimed to investigate the relationship between childhood trauma, dissociative experiences, and internet gaming disorder in male university students with probable attention-deficit hyperactivity disorder determined by both childhood and current attention-deficit hyperactivity disorder symptoms. MATERIALS AND METHODS: Volunteers were 376 university students who completed a test battery that included a sociodemographic form as well as the Adult ADHD Severity Rating Scale, Wender Utah Rating Scale, Childhood Trauma Questionnaire, Dissociative Experiences Scale, Somatoform Dissociation Questionnaire, and Internet Gaming Disorder Scale-Short Form. Volunteers were divided into 2 groups as with and without probable attention-deficit hyperactivity disorder D based on both childhood and current attentiondeficit hyperactivity disorder symptoms. RESULTS: Childhood Trauma Questionnaire (t=-3.94; P < .01), Dissociative Experiences Scale (t=-5.97; P < .01), Somatoform Dissociation Questionnaire (t=-3.80; P < .01), and Internet Gaming Disorder Scale-Short Form (t=-5.21; P < .01) scores were significantly higher in the group with probable attentiondeficit hyperactivity disorder than in those without. Two different hierarchical regression analysis models in which internet gaming disorder scores were dependent variables showed that dissociative experiences in first model (ß=0.15, t=2.28, P = .023) and dissociative absorption in second model (ß=0.22, t=2.76, P = .006) were associated with internet gaming disorder after controlling for childhood trauma and attentiondeficit hyperactivity disorder symptoms. CONCLUSION: Dissociative absorption may contribute to internet gaming disorder independent of childhood trauma and attention-deficit hyperactivity disorder symptoms, however further studies are needed to investigate this claim.

Psychometric properties of the Turkish version of the Anxiety and Preoccupation about Sleep Questionnaire in clinical and non-clinical samples.

Objectives: The aim of the study was to investigate the psychometric properties of the Turkish version of Anxiety and preoccupation about sleep questionnaire (APSQ) in clinical and non-clinical samples. Material and Methods: Two samples (141 university students and 42 patients with major depressive disorders) completed Turkish APSQ, the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI) and the sociodemographic data form. Content validity analysis was performed with the Davis technique after the translation process of the original scale. Explanatory factor analysis and principal component analysis were performed to determine the scales construct validity, and internal consistency and temporal stability analyses were conducted to evaluate its reliability. The PSQI and the insomnia severity index (ISI) were used to assess criterion- related validity. In addition, we divided all the participants into two groups as good-sleepers and clinical insomnia according to ISI scores. Predictive validity analyses were also computed via comparing groups. Results: Confirmatory factor analysis showed that the scale model aligns well with the original scales 10 items and two-factor structure. The scales and subdimensions Cronbach's alpha coefficients were excellent (Factor 1; 0.935, factor 2; 0.906, total scale; 0.952). The test-retest correlations were 0.661 and 0.828 for depression group and university student group, respectively. Turkish APSQ scores were found to be significantly higher in both of the clinical groups (depression group vs. university student group, clinic insomnia group vs. good-sleepers group). Conclusion: The Turkish APSQ is adequate reliability and validity for assessing anxiety and preoccupation about sleep in Turkish clinical and non-clinical samples.

Dissociative Experiences Associated With Internet Gaming Disorder After Controlling For Childhood Trauma And ADHD Diagnosis.

The aim of this study was to investigate the relationships among childhood trauma, dissociative experiences, and internet gaming disorder (IGD) in young adults diagnosed with attention deficit hyperactivity disorder (ADHD) and age- and gender-matched controls. Forty participants diagnosed with ADHD at a university hospital psychiatric outpatient clinic and 40 healthy controls completed a test battery that included a sociodemographic form as well as the Adult ADHD Severity Rating Scale (ASRS), Childhood Trauma Questionnaire (CTQ), Dissociative Experiences Scale (DES), Somatoform Dissociation Questionnaire (SDQ), and Internet Gaming Disorder Scale - Short Form (IGDS9-SF). The CTQ (t = -4.61, p < .01), DES (t = -4.71, p < .01), SDQ (t = -2.40, p < .01), and IGDS9-SF (t = -4.89, p < .01) scores were significantly higher in the ADHD group than in the control group. A hierarchical regression analysis that explained 50% of unique variance in internet gaming disorder (IGD) indicated that being male (ß = 0.41, t = 4.61, p < .001) and having an ADHD diagnosis (ß = 0.48, t = 5.49, p < .001) are robust predictors. Additionally, the DES score, which indicates the severity of psychoform dissociation (ß = 0.34, t = 2.43, p = .017), was found to be significantly associated with IGD after controlling for ADHD diagnosis and childhood trauma. While excessive gaming may increase dissociative symptoms, the mental state of dissociative experiences may be a predisposing factor for IGD; however, further studies are needed to investigate these claims.

The use of buprenorphine + naloxone sublingual tablet in the treatment of neonatal opioid withdrawal syndrome: Two case reports.

INTRODUCTION: Neonatal opioid withdrawal syndrome occurs after exposure during pregnancies of mothers with an opioid use disorder. If non-pharmacological treatment is insufficient, pharmacological options are preferred, but a common treatment guideline has not yet been determined. Sublingual buprenorphine tablet is more prominent in the treatment. Since oral alternatives are not available in many clinics, as in our unit, parenteral morphine is still the drug of the first choice. In this paper, we reported that two babies with neonatal opioid withdrawal syndrome were successfully treated with a buprenorphine/naloxone combination, which was not previously shown in the literature. CASES: We followed two babies whose mothers had an opioid use disorder during their pregnancies. The modified Finnegan scoring scale was used for the assessment of the babies. Both infants developed persistent seizures with resistant withdrawal signs. An effective parenteral route could not be provided due to hemodynamic instability. Thus, IV morphine could not be used. Due to the lack of oral treatment alternatives, first, we tried phenobarbital up to 40 mg/kg orally. Afterward, we used buprenorphine/naloxone combined tablet sublingually, which has not been used in children before. Detailed written consent was obtained from the parents for the emergency use of this drug in advance. Shortly after this treatment, the seizures and withdrawal signs were controlled. There were no adverse effects and babies were discharged fully recovered. CONCLUSION: Sublingual Buprenorphine 2 mg + Naloxone 0.5 mg (4:1) tablet could be used efficiently and without side effects to treat neonatal opioid withdrawal syndrome.

From the urge to see one's own blood to the urge to drink it: Can hemomania be specified as an impulse control disorder? Two case reports.

At least half of self-mutilative individuals report that seeing their own blood is comforting, while a quarter report that they have tasted it. Bloodletting and blood-drinking behaviors have been discussed in case reports of disorders such as borderline personality disorder, bulimia nervosa, dissociative identity disorder, and psychotic disorder. The role of blood-drinking behavior, however, needs to be clarified in the psychiatric literature. This paper is the first to discuss blood-drinking behavior as a possible impulse control disorder that progresses from a desire to see or taste one's own blood. It presents the cases of two patients who report drawing blood from their own arms via syringe and drinking it. The first patient began to suck her own blood by removing scabs at age 8. The second started cutting his arm during his middle school years to reduce tension. Both eventually began to drink their own blood by draining it impulsively. This paper presents two cases with blood-drinking behavior diagnosed as impulse control disorder not otherwise specified according to the Diagnostic and Statistical Manual of Mental Disorders. We propose the term "hemomania" to describe an impulse control disorder characterized by impaired functioning due to at least one of the following urges: seeing one's own blood, self-bloodletting, and tasting/drinking one's own blood. We argue that hemomania progresses from an urge to see one's own blood to the urge to drink it, though randomized controlled studies are needed to support this claim.

Comparison of venlafaxine alone versus venlafaxine plus late partial sleep deprivation therapy combination for major depressive disorder.

Treatment resistance, medication non-adherence, and side effects of pharmacotherapeutics make treatment difficult in major depressive disorder. Sleep deprivation is a fast-acting and tolerable reinforcement treatment method. In this study, we investigated the effects of late partial sleep deprivation (PSD) therapy added to venlafaxine treatment on symptoms of anxiety and depression, sleep quality and treatment process. This study was conducted in a sample of 40 patients who were admitted to our inpatient psychiatric unit with a diagnosis of major depressive disorder. While the venlafaxine (Ven) group received only venlafaxine treatment, the venlafaxine+partial sleep deprivation (Ven+PSD) group underwent late partial sleep deprivation therapy three times in the first week in addition to venlafaxine treatment. The Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), Beck Depression Inventory, Pittsburgh Sleep Quality Index, and Insomnia Severity Index (ISI) were administered to both groups at the baseline and at the end of the 1st, 4th, and 6th weeks and, additionally, Profile of Mood State (POMS) was administered to the Ven+PSD group before and after each PSD. The Ven+PSD group had lower HAM-D and HAM-A scores than the Ven group at the end of the 1st and 6th week. Both anxiety and depression subscale scores on the POMS showed a significant decrease after PSD in the Ven+PSD group. The mean venlafaxine dose (mg/d) was significantly lower in the Ven+PSD group than in the Ven group. Late partial sleep deprivation is a fast-acting and tolerable therapy in major depressive disorder.

Evaluation of the relationship between perceived social support, coping strategies, anxiety, and depression symptoms among hospitalized COVID-19 patients.

OBJECTIVE: We aimed to evaluate the relationship between perceived social support, coping strategies, anxiety, and depression symptoms among hospitalized COVID-19 patients by comparing them with a matched control group in terms of age, gender, and education level. METHOD: The patient group (n = 84) and the healthy controls (HCs, n = 92) filled in the questionnaire including the socio-demographic form, Hospital Anxiety Depression Scale, Multidimensional Perceived Social Support Scale, and Brief Coping Orientation to Problems Experienced through the online survey link. RESULTS: The COVID-19 patients had higher perceived social support and coping strategies scores than the HCs. However, anxiety and depression scores did not differ significantly between the two groups. In logistic regression analysis performed in COVID-19 patients, the presence of chest CT finding (OR = 4.31; 95% CI = 1.04-17.95) was a risk factor for anxiety and the use of adaptive coping strategies (OR = 0.86; 95% CI = 0.73-0.99) had a negative association with anxiety. In addition, the use of adaptive coping strategies (OR = 0.89; 95% CI = 0.79-0.98) and high perceived social support (OR = 0.97; 95% CI = 0.93- 0,99) had a negative association with depression symptoms. CONCLUSIONS: Longitudinal studies involving the return to normality phase of the COVID-19 pandemic are needed to investigate the effects of factors such as coping strategies and perceived social support that could increase the psychological adjustment and resilience of individuals on anxiety and depression.

The relationship between childhood maltreatment and problematic eating behaviors in bariatric surgery candidates.

PURPOSE: It is known that childhood maltreatment and problematic eating behaviors are higher in bariatric surgery patients compared to over- and normal-weight persons. The aim of the study is to investigate the relationship between childhood maltreatment and problematic eating behaviors such as restraint, eating concern, weight concern, shape concern, and emotional eating in bariatric surgery patients. MATERIALS AND METHODS: 112 consecutive obese individuals seeking bariatric surgery at a University Hospital were administered asset of scales, including Childhood Trauma Questionnaire (CTQ), Dutch Eating Behavior Questionnaire-Emotional Eating subscale (DEBQ-E), and Eating Disorder Examination-Questionnaire (EDE-Q) and sociodemographic form, cross-sectionally. After descriptive statistics, a regression analysis was conducted to understand the relationships of CTQ scores with EDE-Q total, and subscale scores and DEBQ-E. RESULTS: In the Pearson correlation analysis, a statistically significant positive correlation was found between CTQ total score with EDE-Q total score and all subscales scores. In linear regression analyses, it was found that emotional abuse (ß = 0.39, p = 0.02) and physical abuse (ß = 0.36, p = 0.01) predicted increased DEBQ-E scores. In addition, sexual abuse was found to significantly predict weight concern (ß = 0.26, p = 0.04) and shape concern (ß = 0.31, p = 0.01). CONCLUSION: Our findings showed that the dynamics of problematic eating behaviors may differ depending on the type of childhood trauma. Psychiatric evaluation of bariatric surgery patients is important in understanding the relationship between childhood maltreatment and problematic eating behaviors. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

The mediating effects of self-perception and somatoform dissociation in the relationship between domestic violence and suicidal ideation.

Domestic violence (DV) against women is a multidimensional public health problem that has both psychologically and socially devastating consequences, especially in patriarchal societies. The aim of this study was to investigate the mediating role of self-perception and somatoform dissociation in the relationship between DV and suicidal ideation in women living in Turkey. The sociodemographic data form, Severity of Violence Against Women Scale, Somatoform Dissociation Questionnaire, Social Comparison Scale, and Suicidal Ideation Scale were administered to 102 participants. In addition to descriptive statistics, linear and mediation regression analyses were performed. DV scores were significantly negatively correlated with self-perception and positively correlated with somatoform dissociation scores. While negative self-perception and increased somatoform dissociation were partial mediators in the relationship of threat and sexual violence with suicidal ideation and full mediators in the relationship of physical violence with suicidal ideation. Negative self-perception and increased somatoform dissociation were critical mediators in relation to DV and suicidal ideation in women. Psychotherapeutic approaches focused on self-perception and somatoform symptoms may reduce the risk of suicide in women who have been exposed to DV. Long-term clinical studies are needed to investigate the factors mediating suicidal ideation in women who have been exposed to DV.

Feeding and Eating Disorders in the Context of Circadian Rhythms.

A circadian rhythm is a 24-hour rhythm controlled by a master clock, the suprachiasmatic nucleus, and driven by synchronizing internal/external zeitgebers. Food intake is one of the most important external cues/zeitgebers. Studies in humans and animals have shown that misalignment of food intake leads to chronodisruption, which is associated with metabolic disruption, obesity, and disordered eating attitudes. The term chronotype, which expresses the circadian typology, has been classified into 3 main types that represent the differences in the reflection of circadian rhythms shown in human studies on daily behaviors. It has been reported that evening-type individuals are more prone to disrupted eating attitudes, such as skipping meals, eating at night, and consuming a calorie-rich diet. In addition, eating disorders up to the diagnostic level is associated with the evening type. The bidirectional relationship between impaired circadian rhythms and disordered eating attitudes has brought chronotherapeutic interventions, which are biological rhythm-oriented treatment approaches, to the agenda. Bright light therapy has been found to reduce bulimic eating behaviors and night eating symptoms. More evidence is needed regarding the effect of chronotherapeutic approaches on metabolic disorders, disordered eating attitudes, and eating disorders associated with obesity.

Do chronotype differences and night eating syndrome affect dental health?

OBJECTIVE: Our aim in this study was to examine the effect of chronotype differences and night eating syndrome on dental health parameters such as the decay-missing-filled teeth (DMFT) index, the severity of the periodontal disease and the number of endodontically treated teeth in patients admitted to the dental clinic. METHODS: The participants, 210 patients, filled out a package of psychological tools, including the Morningness-Eveningness Questionnaire (MEQ), the Night Eating Questionnaire (NEQ) and the Insomnia Severity Index (ISI). Afterwards, the DMFT index scores, the severity of the periodontal disease and the number of endodontically treated teeth of patients were recorded simultaneously with a routine dental examination. RESULTS: Findings show that the ISI and NEQ scores were significantly higher in the evening-type individuals (E-types) than in the morning-type individuals, and there was no significant difference between the chronotypes in terms of the number of endodontically treated teeth and the DMFT scores. In ordinal regression analyses, not brushing teeth (OR 7.94, CI 6.40-9.85), increased number of decayed teeth (OR 1.16, CI 1.13-1.19) and decreased MEQ scores (OR 0.95, CI 0.94-0.95) were statistically significant predictors for periodontal disease. CONCLUSION: Although there was no correlation between chronotype differences and the DMFT index, and the number of endodontically treated teeth, E-types had a higher risk of periodontal disease severity.

The effects of individual circadian rhythm differences on insomnia, impulsivity, and food addiction.

PURPOSE: Individuals can generally be divided into morning, neither and evening types according to behavioral, psychological, and biological variables including appetite levels, usual meal times, sleep times, and melatonin secretion. These factors together identify a person as being part of a certain chronotype, i.e., as feeling more efficient either in the morning (morning type) or later in the day (evening type). Food addiction is defined as addictive behavior toward palatable foods and is thought to be one of the underlying risk factors for obesity. Our aim in this study was to investigate the relationship between circadian rhythm differences and food addiction via insomnia and impulsivity in university students. METHOD: Participants were 1323 university students, filled out a package of psychological tools, including the Morningness-Eveningness Questionnaire, Insomnia Severity Index, Barratt Impulsiveness Scale Short Form, and Yale Food Addiction Scale. Logistic regression analysis was used to investigate direct relation of food addiction with insomnia, impulsivity and obesity, and mediation regression analysis was used to investigate the indirect effect of circadian rhythm differences on food addiction. RESULTS: Our findings indicated that evening types were more prone to insomnia and impulsivity, and also insomnia and impulsivity significantly contributed to the variance of food addiction. Although there was no significant linear relationship between circadian rhythm differences and food addiction, evening-type circadian preferences were indirectly associated with higher food addiction scores mediated by insomnia and impulsivity. CONCLUSION: The most remarkable result of our work was that circadian rhythm differences seem to indirectly effect on food addiction through elevated insomnia and impulsivity. LEVEL OF EVIDENCE: Level V, descriptive cross-sectional survey.

The relationship between night eating symptoms and disordered eating attitudes via insomnia and chronotype differences.

Humans' sleep timing and the psychological construct "diurnal preference" determines their "chronotype" (i.e., morning or evening type). Diurnal preferences can affect sleep-awake rhythms and eating behaviors. Our aim in this study was to examine the relationship between night eating symptoms and disordered eating attitudes by evaluating insomnia and chronotype differences in university students. The participants, 383 university students, filled out a package of psychological tools, including the Morningness-Eveningness Questionnaire, the Insomnia Severity Index, the Night Eating Questionnaire, and the Eating Attitude Test. One way analysis of variance was used to investigate the relationship of chronotypes with scale scores, and mediation regression analysis was used to investigate the indirect effects of night eating symptoms on disordered eating attitudes. Insomnia and night eating scores of the participants varied statistically according to chronotypes, and both insomnia and night eating scores were associated with the evening type. Findings show that night eating symptoms have a direct effect on the chronotype differences and insomnia and an indirect effect on disordered eating attitudes, by increasing insomnia scores. In conclusion, night eating syndrome may represent the misalignment of food intake and may shift the circadian rhythm to delayed sleep phase, acting as a peripheral oscillator in human.

Heterogeneity of sleep quality in relation to circadian preferences and depressive symptomatology among major depressive patients.

BACKGROUND: The current study aimed at investigating the latent dimensional structure of sleep quality as indexed by the seven components of the Pittsburgh Sleep Quality Index (PSQI), as well as latent covariance structure between sleep quality, circadian preferences and depressive symptoms. METHODS: Two hundred twenty-five patients with major depressive disorder (MDD), with an average age of 29.92 ±â€¯10.49 years (aged between 17 and 63), participated in the study. The PSQI, Morningness-Eveningness Questionnaire (MEQ) and Beck Depression Inventory (BDI) were administered to participants. Four sets of latent class analyses were subsequently run to obtain optimal number of latent classes best fit to the data. RESULTS: Mixture models revealed that sleep quality is multifaceted in MDD. The data best fit to four-latent-class model: Poor Habitual Sleep Quality (PHSQ), Poor Subjective Sleep Quality (PSSQ), Intermediate Sleep Quality (ISQ), and Good Sleep Quality (GSQ). MDD patients classified into GSQ latent class (23.6%) reported the lowest depressive symptoms and were more prone to morningness diurnal preferences compared to other three homogenous sub-groups. Finally, the significant association between eveningness diurnal preferences and depressive symptomatology was significantly mediated by poor sleep quality. LIMITATION: The cross-sectional nature of the study and the lack of an objective measurement of sleep such as polysomnography recordings was the most striking limitation of the study. CONCLUSIONS: We concluded sleep quality in relation to circadian preferences and depressive symptoms has a heterogeneous nature in MDD.

The effects of individual biological rhythm differences on sleep quality, daytime sleepiness, and dissociative experiences.

Individuals who differ markedly by sleep chronotype, i.e., morning-type or evening-type also differ on a number of psychological, behavioral, and biological variables. Among several other psychological functions, dissociation may also lead to disruption and alteration of consciousness, which may facilitate dream-like experiences. Our study was aimed at an inquiry into the effects of individual biological rhythm differences on sleep quality and daytime sleepiness in conjunction with dissociative experiences. Participants were 372 undergraduate college students, completed a package of psychological instruments, including the Morningness-Eveningness Questionnaire, Dissociative Experiences Scale, Insomnia Severity Index, and Epworth Sleepiness Scale. Using logistic regression models, direct relations of pathological dissociation with sleepiness, sleep quality and circadian preferences were investigated. Poor sleep quality and sleepiness significantly contributed to the variance of dissociative symptomatology. Although there was no substantial linear association between circadian preferences and pathological dissociation, having evening-type preferences of sleep was indirectly associated with higher dissociation mediated by poor sleep quality. Poor sleep quality and daytime sleepiness seems to be significant antecedents of pathological dissociation. Sleep chronotype preferences underlie this relational pattern that chronobiological characteristics seem to influence indirectly on dissociative tendency via sleep quality.