Althea M. I. Wagman

Electroencephalographic (eeg) Sleep Recovery Following Prolonged Alcohol Intoxication In Alcoholics

Sleep data from chronic alcoholics have indicated that sleep disturbance represents an important aspect of alcoholic detoxification. Previous studies have been complicated by problems of poor diet, uncertain time for onset of withdrawal, or a limited time schedule for controlled withdrawal. This stu

Reduction of perseverative errors in patients with schizophrenia using monetary feedback.

The influence of monetary feedback on Wisconsin Card Sort Test (WCST) performance of 14 male schizophrenics was investigated. Patients were administered the test under standard instructions and with monetary feedback in counterbalanced order. Monetary reinforcement reduced perseverative errors and increased correct responses (p less than .05). These findings suggest that the WCST perseverative errors of schizophrenics reflect motivational as well as cognitive factors.

Effects of Alcohol Ingestion and Abstinence on Slow Wave Sleep of Alcoholics

Disturbance of sleep is a frequent component of the clinical pathology associated with depression (Hartmann, 1965), schizophrenia (Stern, et. al., 1969) and drug addiction (Watson, et. al., 1972). Reduction in total sleep time, increased awakening, long sleep latency, and REM sleep suppression occur frequently as a function of short-term stresses and are responsive to symptomatic treatment. Slow Wave Sleep (SWS) impairments are more often associated with chronic conditions which respond poorly to situational therapy and may be the result of long-term stress. Short-term as well as long-term sleep disturbances are often associated with alcoholism. Experimental studies which have been concerned with the effect of alcohol on sleep were designed to assess the role of alcohol in producing both kinds of sleep dysfunction in normal subjects and chronic alcoholics.

Sleep polygraphy in schizophrenia: Methodological issues☆

The findings of sleep studies in schizophrenia have remained inconsistent in the literature as exemplified by the recent controversy regarding reduced rapid eye movements (REM) latency in these patients. These inconsistencies can partly be explained by major methodological shortcomings in studies evaluating sleep in schizophrenia. Lack of standardized scoring and diagnostic methods in the earlier studies and more recently, the effect of neuroleptic treatment or its withdrawal, have confounded the sleep results. Data are presented to illustrate the effect of the presence of tardive dyskinesia or active psychotic symptoms that further skew the sleep polygraphic measurements in these patients. Studies in drug-naive patients can circumvent some of these confounds but then these studies are weakened by sampling bias. Available data suggest that previous duration of neuroleptic treatment, duration of neuroleptic withdrawal, presence of tardive dyskinesia, and severity of psychotic symptoms should be considered when interpreting REM sleep measures in schizophrenic patients.

Impaired Wisconsin Card Sort Performance in Schizophrenia May Reflect Motivational Deficits

To the Editor.— During the past several years important reports have appeared in theArchives 1-3 concerning relationships between regional cerebral blood flow and impaired Wisconsin Card Sort (WCS) performance in schizophrenia. One provocative finding has been that impairment on this task is not corrected by instruction. 4 The WCS task requires the respondent to match cards that vary simultaneously in a number of dimensions (color, form, and number of elements) to one of four models. The subject is told whether each placement is correct or incorrect and must discover the correct sorting rule from this feedback. The first rule is to sort by color. When this rule has been learned, the correct dimension is changed, first to form and then to number. The subject is not informed of this change; rather, he or she must discover the new rule. 5 Although many different scores can be derived from the

Do Sleep Patterns Relate to the Desire for Alcohol

A measure of disposition to drink in alcoholics was developed using a progressive ratio schedule for reduction of delay in receiving a drink of two ounces of 95 proof ethanol. This measure showed increased disposition to drink during early abstinence compared to lab abstinence (more than seven days) during experimental intoxication compared to lab abstinence and shortly after a low dose drink during late abstinence. A multiple regression analysis of this measure for four subjects after alcohol withdrawal, showed significant effects for days abstinent and EEG sleep variables, particularly stage REM%. Low REM% was associated with high values for the disposition to drink. REM sleep deprivation, however, failed to significantly alter the measure of disposition to drink. Results are interpreted as supporting the hypotheses that sleep disturbances relate indirectly to the disposition to drink.

Alterations in sleep polygraphy after neuroleptic withdrawal: A putative supersensitive dopaminergic mechanism

Although a number of studies have reported sleep disturbances following neuroleptic withdrawal, a full description of such changes in sleep architecture is not available. Polysomnographic, plasma prolactin, and clinical measurements were carried out in a small number of patients on chronic neuroleptic treatment and after drug withdrawal. Preliminary findings show that in these chronically treated schizophrenic patients with and without tardive dyskinesia (TD), abrupt neuroleptic withdrawal induces reductions in total sleep, rapid eye movement (REM) sleep, and plasma prolactin. Furthermore, an increase in delta sleep was observed only in patients without TD. The REM suppression occurred significantly earlier in TD patients compared to the non-TD schizophrenic patients. These changes were transient, and both sleep measures and plasma prolactin stabilized during the 2-4 weeks after withdrawal to levels somewhere between the values observed during chronic treatment and withdrawal (week 1) periods. As the withdrawal-induced exaggerated changes mimicked the dopamine agonist effect on these sleep and hormonal measures, one can hypothesize that the observed changes are due to unmasking of supersensitive dopamine receptors following drug cessation. Normalization of these receptors and/or adaptational changes in other nondopaminergic system(s) can hypothetically explain the eventual stabilization of these measures during the following weeks.

Residual effects of ethanol and chlordiazepoxide treatments for alcohol withdrawal

Eighteen male alcoholics were randomly assigned to one of two alcohol detoxification treatments. One group received a low dose ethanol treatment while the other group received a chlordiazepoxide treatment. This study compares recovery of sleep EEG and clinical symptomatology following these two detoxification treatments. Sleep EEG and clinical measures were obtained for the final medication day and during a 6-day postmedication “recovery” period. The chlordiazepoxide treatment produced suppression of rapid eye movement (REM) sleep lasting for about 4 days and virtually eliminated δ sleep (stages III and IV) during the recovery period. The low dose ethanol treatment regimen produced less disruption of REM and δ sleep during the recovery period. These findings suggest that under some circumstances an ethanol treatment regimen may prove more beneficial to the healthy alcoholic patient than current regimens which employ other psychoactive medication. In particular, the long lasting suppression of δ sleep during the recovery period in subjects treated with chlordiazepoxide suggests a vulnerability of the slow wave sleep mechanisms during early alcohol abstinence and raises the possibility that this regimen prolongs functional tolerance to alcohol effects. Continued clinical evaluation of low dose ethanol detoxification treatment is suggested.

The embedded set procedure. Comment on Galbraith, MacCrimmon, and Steffy.

The reaction-time crossover phenomenon discovered by Rodnick and Shakow has come to be studied mainly with the embedded isotemporal sets procedure and indexed by the difference in reaction time to regular and irregular trials at a 7-second preparatory interval (PI). A 1983 report in this journal by Galbraith et al. (J New Ment Dis 171:670-675) demonstrated that the magnitude of crossover at this PI was influenced by the duration of the preparatory interval immediately prior (PPI) to the first trial of the 7-second isotemporal blocks. Secondary analyses reported here extend the examination of PPI influences and indicate: a) that the crossover phenomenon as assessed in the embedded sets procedure is due mainly to the very slow reaction time to the first trial of the 1-second isotemporal blocks; and b) that crossover in this paradigm is partially due to uncontrolled PPI influences across the 1-, 3-, and 7-second embedded blocks. These are further reasons for returning to the original Rodnick-Shakow method as Galbraith et al. recommended.

Multivariate Approach to Alcoholic Cognitive Function

There is no doubt that ingestion of moderate to large amounts of alcohol disrupts a broad spectrum of behavior systems. Although very few studies have addressed the question of residual dysfunction following the termination of alcohol consumption, the evidence is becoming stronger that chronic alcohol consumption induces characteristic changes in brain morphology for at least a proportion of patients. Therefore, behavior systems which are dependent upon the integrity of these altered neural systems would be characteristically disrupted.