Sleep Paralysis and the Structure of Waking-Nightmare Hallucinations

Sleep paralysis (SP) entails a period of paralysis upon waking or falling asleep and is often accompanied by terrifying hallucinations. These hallucinations constitute a waking nightmare (w-nightmare) REM experience and are the original referents of the term nightmare. W-nightmare hallucinations are described by a three-factor structure involving experiences consistent with 1) threatening intruders, 2) physical assaults, and 3) vestibular-motor (V-M) bodily sensations. The present study assesses the reliability of this structure and some of the underlying measurement assumptions using several large samples of w-nightmare experients. Causal modeling further elucidated the potential causal relations among the three types of hallucinations. The first two factors appear to be strongly thematically and sequentially linked by an underlying theme of threat and assault. The third factor is relatively autonomous but appears to be sometimes recruited into the threat and assault themes. A theoretical model is proposed that combines REM mechanisms, a threat activated vigilance system (TAVS), and a bodily-self neuromatrix (BSN), as generators and organizers of w-nightmare hallucinatory experiences. More generally, it is argued that these mechanisms underwrite two fundamental domains of conscious experience: the experience of an agent-inhabited world and that of a spatial-kinetic bodily self.     

Panic Probes and the Identification of Panic: A Historical and Cross-Cultural Perspective

This article reviews the historicaldevelopment of the category of panic disorderin the United States, particularly the shiftingperspectives on both what causes panic and howthe presence of panic should be determined. Thenotion that panic attacks of a panic-disordertype must be ``out of the blue' and``unexpected,' except in the case of triggeringby a particular place (i.e., agoraphobia), iscritiqued. The authors illustrate that ameaningful epidemiological determination ofpanic rates in other cultural groups must bepreceded by a detailed ethnography thatascertains the catastrophic cognitions, coresymptoms, and typical cues of panic attacks inthat particular context.     

Panic Disorder,Somatization, and the New Cross-cultural Psychiatry: The Seven Bodies of a Medical Anthropology of Panic

This article aims to adduce aframework that will allow for thecross-cultural study of panic disorder. Theauthors take sensation as the key unit ofanalysis, aiming to contribute to a medicalanthropology of sensation. The seven analyticperspectives that are suggested in the articleare the following: the full spectrum of panicattack sensations (the sensation body), thebiological generation of panic sensations (thebiological body), sensation as invoking anethnophysiology (the ethnophysiological body),sensation as metaphor (the metaphoric body),sensation as invoking the landscape (thelandscape body), sensation as invokingcatastrophic cognitions (the catastrophiccognitions body), and sensation as invokingmemory (the memory-associational body).     

Comparative Phenomenology of Ataques de Nervios,Panic Attacks,and Panic Disorder

This article examines a clinicalsample of 66 Dominican and Puerto Ricansubjects who reported ataques de nerviosand also psychiatric disorder, and disentanglesthe phenomenological experiences of ataquede nervios, panic attacks, and panic disorder. In-depth cultural interviews assessed thesymptomatic phenomenology of ataqueepisodes from the local perspective as well asin terms of key panic features, such asrecurrence, rapid peaking of symptoms, and lackof provocation. Independent diagnosticassessments of panic attacks and disorder werealso used to establish the phenomenologicaloverlap between ataque and panic. Ourfindings indicate that 36 percent ofataques de nervios fulfill criteria for panicattacks and between 17 percent and 33 percentfor panic disorder, depending on the overlapmethod used. The main features distinguishingataques that fulfill panic criteria fromataques that do not include whether theepisodes were provoked by an upsetting event inthe person's life and the rapidity of crescendoof the actual attack. A key finding is thatataques often share individualphenomenological features with panic episodes,but that these features usually do not ``runtogether' during the ataque experience.This confirms previous findings thatataque is a more inclusive construct thanpanic disorder. The importance of thesefindings for the clinical diagnosis andtreatment of persons with ataques isdiscussed.     

Dizziness and Panic in China: Associated Sensations of Zang Fu Organ Disequilibrium

In China, distress is commonlyexperienced as dizziness that can develop intoacute episodes resembling Western panicattacks. These distressing sensations occur ina unique cultural context with a distinctiveset of associated symptoms, beliefs andpurported etiologies. The experience ofillness is informed by traditional Chinesemedicine (TCM), an indigenous theory thatelaborates a system of organ functioning calledzang fu. Depending on the implicatedzang fu organ disequilibrium, dizzinessand panic present with a specific constellationof associated physical and mental symptoms. This paper presents a clinical survey ofpsychiatric disorders that demonstratesdizziness to be characteristic of Chineseanxiety states, most particularly panic. Threespecific cases of dizziness-focused panicascribed to different states of zang fudisequilibrium are described. In a typicalpattern, initial dizziness and associatedsymptoms intensify until they generalize intopanic attacks. The degree of dizziness andpanic corresponds to the state ofdisequilibrium of the zang fu organsystem as well as instability of the social,interpersonal and environmental context of thepatient. This paper elucidates the dynamicinterpretants of dizziness in the Chinesecontext to contribute to a medical anthropologyof this sensation.     

帕金森病伴快速眼动睡眠期行为障碍

快速眼动(REM)睡眠期行为障碍(RBD)是REM睡眠期出现肌张力缺失并伴有与噩梦相关的复杂运动为特征的发作性疾病,RBD与帕金森病(PD)密切相关,在PD患者中的发生率高。伴RBD的PD患者临床上多表现为强直型,病程更长,运动症状、非运动症状更重,生活能力及生活质量的损害更突出。RBD的病理生理机制可能主要涉及脑桥被盖部、蓝斑/蓝斑下区复合体及其投射通路功能的紊乱。诊断RBD主要依据特征性临床表现及视频多导睡眠图(v-PSG)的监测结果。治疗上除了积极干预PD外,应对患者及其床伴采取保护措施;当患者的异常睡眠行为对其造成严重的困扰并具有危险性时,需给予药物治疗。     

Light Exposure Among Adolescents With Delayed Sleep Phase Disorder: A Prospective Cohort Study

The objective of this study was to compare light exposure and sleep parameters between adolescents with delayed sleep phase disorder (DSPD; n?=?16, 15.3?±?1.8 yrs) and unaffected controls (n?=?22, 13.7?±?2.4 yrs) using a prospective cohort design. Participants wore wrist actigraphs with photosensors for 14 days. Mean hourly lux levels from 20:00 to 05:00?h and 05:00 to 14:00?h were examined, in addition to the 9-h intervals prior to sleep onset and after sleep offset. Sleep parameters were compared separately, and were also included as covariates within models that analyzed associations with specified light intervals. Additional covariates included group and school night status. Adolescent delayed sleep phase subjects received more evening (p?<?.02, 22:00–02:00?h) and less morning (p?<?.05, 08:00–09:00?h and 10:00–12:00?h) light than controls, but had less pre-sleep exposure with adjustments for the time of sleep onset (p?<?.03, 5–7?h prior to onset hour). No differences were identified with respect to the sleep offset interval. Increased total sleep time and later sleep offset times were associated with decreased evening (p?<?.001 and p?=?.02, respectively) and morning (p?=?.01 and p?<?.001, respectively) light exposure, and later sleep onset times were associated with increased evening exposure (p?<?.001). Increased total sleep time also correlated with increased exposure during the 9?h before sleep onset (p?=?.01), and a later sleep onset time corresponded with decreased light exposure during the same interval (p?<?.001). Outcomes persisted regardless of school night status. In conclusion, light exposure interpretation requires adjustments for sleep timing among adolescents with DSPD. Pre- and post-sleep light exposures do not appear to contribute directly to phase delays. Sensitivity to morning light may be reduced among adolescents with DSPD. (Author correspondence: auger.raymond1@mayo.edu)     

Sleep paralysis-associated sensed presence as a possible manifestation of social anxiety.

Sensed presence (PRES), the illusory, often fearful impression of someone being present, is the most frequent type of imagery accompanying isolated sleep paralysis (ISP). Because of numerous similarities between PRES and social anxiety, the authors hypothesized that individuals who reported having had PRES during ISP would have higher levels of social anxiety than would either subjects who reported ISP without PRES or controls with neither experience. Forty-five university students (16 ISP + PRES, 10 ISP, 19 controls) were administered validated questionnaires measuring social anxiety, depression, and specific phobias. A one-way analysis of variance revealed that ISP + PRES subjects had higher social anxiety than ISP subjects ( p = .013). The effect size for this analysis was large (.598). However, an analysis of covariance controlling for depression and specific phobias revealed a smaller intergroup difference (effect size = .464), a finding apparently due to elevated depression scores among ISP + PRES subjects (p     

Weekly and Holiday-Related Patterns of Panic Attacks in Panic Disorder: A Population-Based Study

Background

While chronobiological studies have reported seasonal variation in panic attacks (PA) episodes, information on the timing of PA by week-days may enable better understanding of the triggers of PA episodes and thereby provide pointers for suitable interventional approaches to minimize PA attacks. This study investigated weekly variation in potential PA admissions including associations with holidays using a population-based longitudinal, administrative claims-based dataset in an Asian population.

Methods

This study used ambulatory care data from the “Longitudinal Health Insurance Database 2000. We identified 993 patients with panic disorder (PD), and they had 4228 emergency room (ER) admissions for potential PA in a 3-year period between 1 January 2009 and 31 December 2011. One-way analysis of variance (ANOVA) was used to examine associations between the potential PA admissions and holidays/weekend days/work-days of the week.

Results

The daily mean number of potential PA admissions was 3.96 (standard deviation 2.05). One-way ANOVA showed significant differences in potential PA admissions by holiday and day of the week (p<0.001). Daily frequencies showed a trough on Wednesday-Thursday, followed by a sharp increase on Saturday and a peak on Sunday. Potential PA admissions were higher than the daily mean for the sample patients by 29.4% and 22.1%, respectively on Sundays and holidays. Furthermore, the weekly variations were similar for females and males, although females always had higher potential PA admissions on both weekdays and holidays than the males.

Conclusions

We found that potential PA admissions among persons with PD varied systematically by day of the week, with a significant peak on weekends and holidays.     

CCK-4-Induced Calcium Mobilization in T Cells Is Enhanced in Panic Disorder

Abstract: We investigated the effects of brain cholecystokinin (CCK) receptors on the intracellular calcium concentration and protein kinase C in human T cells. CCK-4 produced a transient increase in calcium in the absence of extracellular calcium. CCK-B agonists stimulated calcium mobilization in a dose-dependent manner in T cells. CCK-B antagonists suppressed CCK-4-induced calcium mobilization more potently than CCK-A antagonist. The recovery of desensitization of the CCK-4-induced response was delayed by a phosphoserine/phosphothreonine phosphatase inhibitor, calyculin A. The responsiveness to CCK-4 was also reduced by phorbol 12,13-dibutyrate (PDBu), and this effect of PDBu was abolished completely by preincubation with staurosporine. CCK-4-induced calcium mobilization was too small to attribute the desensitization to the protein kinase C transduction pathway. T cells from patients with untreated panic disorder exhibited significantly higher cholecystokinin-4-induced calcium mobilization than those from healthy controls or patients with treated panic disorder. These results suggest that cholecystokinin-B receptor function in T cells of patients with panic disorder is enhanced. Cholecystokinin-4-induced calcium mobilization in T cells may be state dependent and useful as a biological marker of panic disorder.     

注意缺陷多动障碍儿童睡眠障碍与铁缺乏关系的临床研究

目的：探讨注意缺陷多动障碍（ADHD）患儿睡眠障碍与血清铁蛋白水平的关系。方法：符合美国精神疾病诊断与统计手册第4版（DSM-Ⅳ）中ADHD诊断标准的62例6．14岁ADHD患儿,由ADHD患儿的父母填写睡眠障碍量表（SDSC）,检测ADH-D患儿的血清铁蛋白水平。结果：与血清铁蛋白水平高于45／μg／L的ADHD患儿相比较,血清铁蛋白水平低于45／μg／L的ADHD患儿的SDSC“睡眠醒觉转换障碍”项评分和总分明显高于前者（P〈0．05）。2组间其他项评分比较无显著性差异（P〉0．05）。SDSC“睡眠醒觉转换障碍”项评分与血清铁蛋白水平成负相关（P〈0．05）。结论：血清铁蛋白水平低于451μg／LADHD患儿SDSC“睡眠醒觉转换障碍”（睡眠中的异常运动）的危险性显著增加。     

Disturbed Sleep in Shift Workers,Day Workers,and Insomniacs

Very little is known about differences in sleep between day and shift workers in representative samples of the population. This study compared a national representative sample (N=3400) of shift (with night shifts) and day workers regarding the different types of sleep disturbances and also the level of sleep symptoms with that of insomnia patients. The results showed very few differences between shift and day workers; only “too little sleep” and “nodding off at work” were marginally higher among shift workers. The results also showed that the complaints of insomnia patients for most sleep disturbances corresponded to the 2nd–16th percentile of the shift workers' levels of complaints. The results suggest, at least with the present questionnaire methodology, that shift work does not appear to be a major source of sleep disturbances and that their complaint levels bear no resemblance to those seen in insomniac patients.     

注意缺陷多动障碍儿童睡眠障碍与铁缺乏关系 的临床研究

目的:探讨注意缺陷多动障碍(ADHD)患儿睡眠障碍与血清铁蛋白水平的关系。方法:符合美国精神疾病诊断与统计手册第4版(DSM-Ⅳ)中ADHD诊断标准的62例6-14岁ADHD患儿,由ADHD患儿的父母填写睡眠障碍量表(SDSC),检测ADHD患儿的血清铁蛋白水平。结果:与血清铁蛋白水平高于45μg/L的ADHD患儿相比较,血清铁蛋白水平低于45μg/L的ADHD患儿的SDSC"睡眠醒觉转换障碍"项评分和总分明显高于前者(P<0.05)。2组间其他项评分比较无显著性差异(P>0.05)。SDSC"睡眠醒觉转换障碍"项评分与血清铁蛋白水平成负相关(P<0.05)。结论:血清铁蛋白水平低于45μg/LADHD患儿SDSC"睡眠醒觉转换障碍"(睡眠中的异常运动)的危险性显著增加。     

Delayed Sleep Timing and Symptoms in Adults With Attention-Deficit/Hyperactivity Disorder: A Controlled Actigraphy Study

Patients with attention-deficit/hyperactivity disorder (ADHD) often exhibit disrupted sleep and circadian rhythms. Determination of whether sleep disturbance and/or circadian disruption are differentially associated with symptom severity is necessary to guide development of future treatment strategies. Therefore, we measured sleep and ADHD symptoms in participants aged 19–65 who met the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) criteria for ADHD and insomnia without psychiatric comorbidities by monitoring actigraphy and daily sleep logs for 2 wks, as well as the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), the ADHD Rating Scale (ADHD-RS), and a clinic-designed sleep behavior questionnaire. Principal components analysis identified correlated circadian- and sleep-related variables in all participants with ADHD who completed the study (n?=?24). The identified components were entered into a backwards stepwise linear regression analysis, which indicated that delayed sleep timing and increased sleepiness (ESS) (but not sleep duration or sleep efficiency) significantly predicted greater severity of both hyperactive-impulsive and inattentive ADHD symptoms (p <?.05 for partial regression coefficients). In addition, combined subtypes had the most impaired age-adjusted sleep quality (PSQI scores; p?<?.05 compared with healthy controls; n?=?13), and 91.7% of them reported going to bed late due to being “not tired/too keyed up to sleep” compared with 57.2% and 50% of inattentive and symptom-controlled participants, respectively (p?<?.05). In conclusion, the results of this study suggest that ADHD symptom severity correlates with delayed sleep timing and daytime sleepiness, suggesting that treatment interventions aimed at advancing circadian phase may improve daytime sleepiness. In addition, ADHD adults with combined hyperactive-impulsive and inattentive symptoms have decreased sleep quality as well as the delayed sleep timing of predominately inattentive subtypes. (Author correspondence: rfargason@uab.edu)     

阻塞性睡眠呼吸暂停综合征临床监测分析

目的:探讨阻塞性睡眠呼吸暂停综合征患者的临床特征及评价疗效。方法:回顾分析70例阻塞性睡眠呼吸暂停综合征患者PSG监测数据。结果:随着呼吸紊乱指数的增加,年龄、体重指数、最长呼吸暂停时间、最低SaO_2%、平均SaO_2%下降等指标在轻度与中、重度SAS之间差异显著;70例患者中伴有高血压52.9%、糖尿病5.7%、冠心病21.4%。结论:OSAS是一种具有潜在危险的疾痛,对OSAS早期诊断治疗是预防发生严重并发症的关键。     

Sleep in amphibians and reptiles: a review and a preliminary analysis of evolutionary patterns

Despite the ubiquitous nature of sleep, its functions remain a mystery. In an attempt to address this, many researchers have studied behavioural and electrophysiological phenomena associated with sleep in a diversity of animals. The great majority of vertebrates and invertebrates display a phase of immobility that could be considered as a sort of sleep. Terrestrial mammals and birds, both homeotherms, show two sleep states with distinct behavioural and electrophysiological features. However, whether these features have evolved independently in each clade or were inherited from a common ancestor remains unknown. Unfortunately, amphibians and reptiles, key taxa in understanding the evolution of sleep given their position at the base of the tetrapod and amniote tree, respectively, remain poorly studied in the context of sleep. This review presents an overview of what is known about sleep in amphibians and reptiles and uses the existing data to provide a preliminary analysis of the evolution of behavioural and electrophysiological features of sleep in amphibians and reptiles. We also discuss the problems associated with analysing existing data, as well as the difficulty in inferring homologies of sleep stages based on limited data in the context of an essentially mammalian‐centric definition of sleep. Finally, we highlight the importance of developing comparative approaches to sleep research that may benefit from the great diversity of species with different ecologies and morphologies in order to understand the evolution and functions of sleep.     

A Role for Astroglial Calcium in Mammalian Sleep and Sleep Regulation

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