Amy L. Fasiczka

Napping and 24‐Hour Sleep/Wake Patterns in Healthy Elderly and Young Adults

To examine differences between healthy elderly and young adults in daytime napping, nocturnal sleep, and 24‐hour sleep/wake patterns. A second objective was to determine whether elderly subjects with more and less frequent naps differed in their clinical features or nocturnal sleep.

Optimal and normal affect balance in psychotherapy of major depression: Evaluation of the balanced states of mind model

The reformulated balanced states of mind (BSOM) model (Schwartz, 1997) pro- posed new cognitive-affective set-point ratios based on a mathematical model of con- sciousness (Lefebvre, 1990) to differentiate among pathological, normal and optimal bal- ances. Using data derived from the Affects Balance Scale (Derogatis, 1975), the reformulated set-points were empirically evaluated by tracking changes in affect balance SOM (ratio of positive to total affect) in 66 depressed male outpatients undergoing cognitive- behavior therapy (n = 45) or pharmacotherapy (n = 21). Confidence interval estimations indicated that across treatments both remitted (SOM = .35) and unremitted (SOM = .35) patients had pathological pretreatment affect balances near the predicted set-point (.38). At post-treatment, affect balance for remitted patients (SOM = .74) progressed to a normal dialogue near the predicted set-point (.72), whereas unremitted patients maintained a nega- tive balance (SOM = .41). Using Hamilton and Global Assessment Scale ratings, remitted patients were classified into average and optimal responders. At post-treatment, average responders achieved an affect balance (SOM = .70) near the normal dialogue set-point (.72), whereas optimal responders progressed to an affect balance (SOM = .81) at the optimal dialogue set-point (.81), supporting the theoretical distinction between normal and optimal balance. A mathematically generated measure that distinguishes normality and optimality permits increased quantitative precision in comparative psychotherapy outcome research.

Electroencephalographic sleep profiles in single-episode and recurrent unipolar forms of major depression: II. comparison during remission

BACKGROUND Previous studies indicate that recurrent forms of depression are associated with greater biological disturbances as compared to single-episode cases. This study examines whether the observed differences in the sleep patterns during recurrent and single-episode depression persist into remission following nonpharmacologic treatment. METHODS Two groups of patients (27 single episode [SE] and 53 recurrent unipolar [RU]) with major depression underwent sleep studies before and after nonpharmacologic treatment. Groups were equated for age, severity, and proportion of men and women. Groups were compared using multivariate analyses of covariance and/or analyses of covariance to examine six sets of sleep measures. RESULTS The differences observed between the SE and RU groups during the index episode persisted into early remission. The findings of greater disturbances of sleep continuity, rapid eye movement sleep and diminished slow wave sleep in the RU group supports the hypothesis that recurrent depression is associated with a more severe neurophysiological substrate than clinically comparable SE cases. CONCLUSIONS Although these observations are consistent with an illness progression model, the possibility that recurrent affective illness is associated with a more virulent, stable phenotype cannot be ruled out. Resolution of this issue requires longitudinal and family studies.

Affect Intensity and Phasic REM Sleep in Depressed Men before and after Treatment with Cognitive-Behavioral Therapy.

This article explored the relationship between daytime affect and REM sleep in 45 depressed men before and after treatment with cognitive-behavioral therapy and in a control group of 43 healthy subjects. The intensity of daytime affect (as measured by the sum of positive and negative affects) in depressed men correlated significantly and positively with phasic REM sleep measures at both pre- and posttreatment. This relationship was not found in healthy control subjects. In depressed men, both affect intensity and phasic REM sleep measures decreased over the course of treatment. The results suggest a relationship between phasic REM sleep and intensity of affect reported by depressed men. On the basis of this preliminary observation, it was hypothesized that abnormalities in phasic REM sleep in depressed patients are related, in part, to fundamental alterations in the intensity of their affective experience.

Traumatic Grief, Depression and Caregiving in Elderly Spouses of the Terminally Ill

This study examined the effects of changes in role function, caregiving tasks, caregiver burden and gratification on symptoms of depression and traumatic grief. Data were derived from rater-administered and self-report questionnaires completed by seventy aged spouses of the terminally ill. The results of multiple regression analyses indicated that the level of caregiver burden was significantly associated with the respondents level of depression and traumatic grief. Results also indicated that changes in role function, specifically in change in restriction of sports and recreational activities, were associated with the caregivers level of depression, but not with the caregivers level of traumatic grief. The number of IADL tasks performed for the critically ill spouse was negatively associated with the caregivers level of depression (i.e., the fewer IADLs performed for the spouse, the greater severity of depressive symptoms). The number of ADL tasks performed for the spouse or caregiver gratification was not significantly associated with the caregivers level of either depression or traumatic grief.

Effects of sertraline on sleep architecture in patients with depression.

Previous studies indicate that selective serotonin reuptake inhibitors (SSRIs), including fluoxetine, fluvoxamine, citalopram and paroxetine, suppress rapid eye movement sleep, and increased nocturnal arousals. There has been no published report of the impact of sertraline on the sleep of depressed patients. This study examines such effects. Forty-seven patients with major depressive disorder, randomized to double-blind treatment with sertraline or placebo, completed sleep studies before and after 12 weeks of pharmacotherapy. Groups were compared using multivariate analyses of covariance and/or analyses of covariance to examine 4 empirically defined sets of sleep measures. Compared to the placebo-treated group, patients who received sertraline experienced an increase in delta wave sleep in the first sleep cycle and prolonged rapid eye movement (REM) sleep latency. Although, sertraline therapy decreased the average number of REM periods (from 3.86 to 2.40), the activity of both REM period 1 and REM period 2 was significantly increased. Aside from an increase in sleep latency, sertraline therapy was not associated with a worsening of measures of sleep continuity. There was also no significant difference between the groups on a measure of subjective sleepiness. These findings are both similar and different from those observed in previous studies of other SSRIs. The increase in delta sleep ratio and consolidation of REM sleep may have some other clinical implications. However, the generalizability of these findings is limited because of a number of reasons. Further studies are needed to examine the effects of SSRIs in acute treatment of depressed patients with severe insomnia, and the relationship of acute changes and relapse prevention of recurrent depression.

Clinical Features and Functioning of Patients with Minor Depression

Background: The two essential features of minor depression are that it has fewer symptoms than major depression and that it is less chronic than dysthymia. This study describes the clinical features and functioning of outpatients with minor depression. Methods: Subjects with minor depression (with and without a prior history of major depression) were recruited through clinical referrals and community advertising. Assessments included the Structured Clinical Interview for DSM-IV (SCID), the 17-item Hamilton Rating Scale for Depression (HAM-D), the Inventory of Depressive Symptomatology-Self Report (IDS-SR) and Clinician Rated (IDS-C) scales, the Global Assessment of Functioning (GAF) scale, the Medical Outcomes Study 36-item Short-Form scale (MOS), and the Clinical Global Impressions Severity Scale (CGI). Data from previously published studies of major depression, minor depression, and normal controls were compared to our data set. Results: Minor depression is characterized primarily by mood and cognitive symptoms rather than vegetative symptoms; the functional impairment associated with minor depression is as severe as for major depression in several areas; minor depression occurs either independently of major depression or as a stage of illness during the long-term course of major depression, and minor depression patients with and without a history of major depression have similar levels of depressive severity and functional impairment. Conclusions: These findings support the notion that minor depression is an important clinical entity that fits within the larger spectrum of depressive disorders.

Effects of bupropion SR on anterior paralimbic function during waking and REM sleep in depression: preliminary findings using [18F]-FDG PET

This study sought to clarify the effects of bupropion SR on anterior paralimbic function in depressed patients by studying changes in the activation of these structures from waking to REM sleep both before and after treatment. Twelve depressed patients underwent concurrent EEG sleep studies and [18F]fluoro-2-deoxy-D-glucose ([18F]-FDG) positron emission tomography (PET) scans during waking and during their second REM period of sleep before and after treatment with bupropion SR. Nine subjects completed pre- and post-treatment waking PET studies. Five subjects completed pre- and post-treatment waking and REM sleep PET studies. Bupropion SR treatment did not suppress electrophysiologic measures of REM sleep, nor did it alter an indirect measure of global metabolism during either waking or REM sleep. Bupropion SR treatment reversed the previously observed deficit in anterior cingulate, medial prefrontal cortex and right anterior insula activation from waking to REM sleep. In secondary analyses, this effect was related to a reduction in waking relative metabolism in these structures following treatment in the absence of a significant effect on REM sleep relative metabolism. The implications of these findings for the relative importance of anterior paralimbic function in REM sleep in depression and for the differential effects of anti-depressant treatment on brain function during waking vs. REM sleep are discussed.

Gender Differences in Complicated Grief among the Elderly

The resolution of grief has been frequently posited to progress through stages. Seventy-one widows and twenty-six widowers bereaved from five months to thirty-seven years were studied to determine if their resolution of grief-related symptoms could be mapped onto a stage theory of grief and to examine if men and women follow the same temporal course. An analysis of variance was used to test for differences in complicated grief symptoms over time and between widows and widowers. Widowers bereaved three years or longer were found to have increased bitterness. By contrast, widows who were bereaved three years and beyond were found to have lower levels of complicated grief. These preliminary findings suggest that grief may not resolve in stages and that symptoms of complicated grief may not decline significantly over time. Rather symptoms of complicated grief appear to remain stable at least for the first three years of bereavement for both men and women but, thereafter, among widowers tend to increase and among widows to decrease.

The balance of positive and negative affects in major depression: A further test of the states of mind model

The States of Mind (SOM) model provided a framework for assessing the balance between self-reported positive and negative affects in a sample of 39 outpatients with major depression and 43 healthy control subjects. The SOM model proposes that healthy functioning is characterized by an optimal balance of positive (P) and negative (N) cognitions or affects (P/(P + N) approximately 0.63), and that psychopathology is marked by deviations from the optimal balance. Research thus far has focused on the functional significance of cognitive rather than affective balance. Within this framework, we hypothesized that patients in untreated episodes of major depression would balance their positive and negative affects at the same level where depressed patients in other studies have balanced their positive and negative cognitions--namely, at P/(P + N) approximately 0.37. Points and confidence interval (CI) estimation procedures yielded results (mean = 0.35, 95% CI = 0.30 - 0.40) consistent with this hypothesis in a sample of 39 depressed male outpatients. Correlational analysis indicated that affect balance is inversely related to symptom severity as measured by self-report (Beck) and clinician-rating (Hamilton) scales.