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Delayed Sleep Phase in Severe Obsessive-Compulsive Disorder: A Systematic Case-Report Survey

  • Suman Mukhopadhyay, Naomi A. Fineberg, Lynne M. Drummond, Joanne Turner, Sarah White, Katharina Wulff and Hamid Ghodse...

Abstract

Introduction:

To study the prevalence of delayed sleep phase (DSP) in a cohort of inpatients with severe obsessive-compulsive disorder (OCD) and to identify clinical and demographic correlates.

Methods:

A systematic retrospective case-report study of consecutive OCD admissions to a specialist inpatient unit from January 1995 to December 2003. Nursing and medical records of sleep, demographic, clinical, and other relevant details were recorded.

Results:

Of 194 eligible consecutive case reports, 187 were located, and nursing and medical reports of sleep were identified in all 187 (100%). Thirty-three patients (17.6%) fulfilled operationally defined criteria for DSP after exclusion of possible confounding factors. All the patients with DSP were unemployed. Phase-shifted patients were significantly younger than non-shifted patients (P=.019) and reported an earlier age of onset of their OCD (P=.005). There was a non-significant trend toward more severe OCD in the phase-shifted group, but they were not more depressed than their non-shifted counterparts.

Conclusion:

A substantial number of patients with severe, enduring OCD also suffer with DSP, which seems to be specifically linked to OCD as opposed to comorbid depression. Clarification of the etiology within DSP and its interaction with core OCD symptoms on clinical function and disability may identify new treatment targets. To this end, further studies of sleep in OCD using actigraphy and biological measures are indicated.

Copyright

Corresponding author

Please direct all correspondence to: Suman Mukhopadhyay, MRCPsych, Pield Heath Road Uxbridge Middlesex UB8 3NN, UK; Tel: 44-18-9527-9970, Fax: 44-18-9545-2108; E-mail: smukho1239@aol.com.

References

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1.Karno, M, Golding, JM, Sorenson, SB, Burnam, MA. The epidemiology of obsessive-compulsive disorder in five US communities. Arch Gen Psychiatry. 1988;45:10941099.
2.Schruers, K, Koning, K, Luermans, J, Haack, MJ, Griez, E. Obsessive—compulsive disorder: a critical review of therapeutic perspectives. Acta Psychiatr Scand. 2005;111:261271.
3.Arriaga, F. Lara, E, Matos-Pires, F, Cavaglia, F, Bastos, L. Diagnostic relevance of sleep complaints in anxiety and mood disorders. Eur Psychiatry. 1995;10:386390.
4.Hohagen, F, Lis, S, Krieger, S. et al.Sleep EEG of patients with obsessive-compulsive disorder. Eur Arch Psychiatry Clin Neurosci. 1994;243:273278.
5.Uhde, TH. Anxiety disorders. In: Kryger, MH, Roth, T, Dement, WC, eds. Principles and Practice of Sleep Medicine. 3rd ed. Philadelphia, Penn: Saunders: 2000:11311133.
6.Bobdey, M, Fineberg, N, Gale, T, Patel, A, Davies, HA. Reported sleep patterns in obsessive-compulsive disorder. Int J Psychiatry Clin Pract. 2001;6:1521.
7.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.
8.Coleman, RM, Roffwarg, HP, Kennedy, SJ, et al.Sleep-wake disorders based on a polysomnographic diagnosis. JAMA. 1982;247:9971003.
9.Zammit, GK. Delayed sleep phase syndrome and related conditions. In: Pressman, MR, Orr, WC, eds. Understanding Sleep: The Evaluation and Treatment of Sleep Disorders. Washington, DC: American Psychology Association; 1997:229248.
10.Weitzman, ED, Czeisler, CA, Coleman, RM, et al.Delayed sleep phase syndrome. Arch Gen Psychiatry. 1981;38:737746.
11.Weitzman, MM, Bland, RC, Canino, GJ, et al.The cross-national epidemiology of obsessive-compulsive disorder. J Clin Psychiatry. 1994:55(suppl 3):510.
12.Thorpy, MJ, Korman, E, Spielman, AJ, Greenwald, S. Delayed sleep phase syndrome in adolescents. J Adolesc Health Care. 1988;9:2227.
13.Drummond, LM, Pillay, A, Rani, RS, Kolb, PJ. Specialized inpatient treatment for severe, chronic resistant obsessive-compulsive disorder. Psychiatric Bulletin. 2007;31:4952.
14.Regestein, QR, Monk, TH. Delayed sleep phase syndrome: a review of its clinical aspects. Am J Psychiatry. 1995;152:602608.
15.Marks, IM. Behavioural Psychotherapy. Bristol, UK: Wright; 1986.
16.Beck, AT, Ward, CH, Mendelson, M, Mock, J, Erbaugh, J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:5363.
17.Schrader, H, Bovim, G, Sand, T. The prevalence of delayed and advanced sleep phase syndrome. J Sleep Res. 1993;2:5155.
18.Roenneberg, T, Kuenhnle, T, Pramstaller, PP, et al.A marker for the end of adolescence. Curr Biol. 2004;14:R1038R1039.
19.Wirz-Justice, A, Cajochen, C, Nussbaum, P. A schizophrenic patient with an arrhythmic circadian rest-activity cycle. Psychiatry Res. 1997;73:8390.
20.Hermesh, H, Lemberg, H, Abadi, J, Dagan, Y. Circadian rhythm sleep disorders as a possible side effect of fluvoxamine. CNS Spectr. 2001;6:511513.
21.Monteleone, P, Catapano, F, Del Buono, G, Maj, M. Circadian rhythms of melatonin, Cortisol and prolactin in patients with obsessive compulsive disorder. Acta Psychiatr Scand. 1994;89:411415.
22.Monteleone, P, Catapano, F, Tortorella, A, Maj, M. Plasma melatonin and Cortisol circadian pattern in patients with obsessive compulsive disorder before and after fluoxetine treatment. Psychoneuroendocrinology. 1995;20:763770.
23.Dagan, Y. Circadian rhythm sleep disorders. Insomnia. 2004;3:1117.
24.Shirayama, M, Shirayama, Y, Iida, H, et al.The psychological aspects of patients with delayed sleep phase syndrome (DSPS). Sleep Med. 2003;4:427433.
25.Hayakawa, T, Uchiyama, M, Kamei, Y, et al.Clinical analyses of sighted patients with non-24-hour sleep—wake syndrome: a study of 57 consecutively diagnosed cases. Sleep. 2005;28:945952.
26.Wulff, K, Joyce, EM, Middleton, B, Jandijk, D, Foster, RG. The suitability of actigraphy, diary data, and urinary melatonin profiles for quantitative assessment of sleep disturbances in schizophrenia: a case report. Chronobiol Int. 2006;23:485495.
27.Tagaya, H, Matsuno, Y, Atsumi, Y. A schizophrenic with non-24-hour sleep-wake syndrome. Jpn J Psychiatry Neurol. 1993;47:441442.
28.Kokkoris, CP, Weitzman, ED, Pollak, CP, Spielman, AJ, Czeisler, CA, Bradlow, H. Long-term ambulatory temperature monitoring in a subject with a hypernychthermal sleep-wake cycle disturbance. Sleep. 1978;1:177190.
29.McArthur, AJ, Lewy, AJ, Sack, RL. Non-24-hour sleep-wake syndrome in a sighted man: circadian rhythm studies and efficacy of melatonin treatment. Sleep. 1996;19:544553.
30.Morinobu, S, Yamashita, H, Yamawaki, S, Tanaka, K, Ohkawa, M. Obsessive compulsive disorder with non-24-hour sleep-wake syndrome. J Clin Psychiatry. 2002;63:838840.
31.Goodman, WK, Price, LH, Rasmussen, SA, et al.The Yale-Brown Obsessive-Compulsive Scale: development, use and reliability. Arch Gen Psychiatry. 1989;46:10061011.

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