Ayca A. Sayin

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.

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 ± 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 biological rhythms and sleep quality on benign paroxysmal positional vertigo and reflux symptom severity

Abstract Recently, there has been increased interest in chronotypes and clinical differences between them. However, there is limited information about the potential influence of the chronotypes on clinical manifestations and symptom intensity of somatic diseases. The aim of this study is to evaluate the impact of biological rhythm differences and sleep quality on benign paroxysmal positional vertigo (BPPV) and larengo pharyngeal reflux (LPR) severity. Forty-four LPR patients, 43 BBPV patients and 42 controls were included in the study. The morningness–eveningness questionnaire was used to determine chronotypes, and the Pittsburgh Sleep Quality Index was used to assess subjective sleep quality. Both patient groups reported a significantly greater tendency to eveningness diurnal preferences compared to healthy controls. As with the circadian preferences, patients with BPPV or LPR characterized by poorer sleep quality and worse insomnia than non-patient individuals. It can be concluded that the circadian rhythm and sleep quality are related to the severity of LPR and BPPV.

Valproate-related hyperammonemic encephalopathy: report of 1 case.

Valproic acid is an anticonvulsant medication that is indicated for the treatment of patients with a wide range of seizures for manic episodes associated with bipolar disorder and for migraine prophylaxis. It is also frequently used for several other psychiatric disorders, including obsessive-compulsive disorder, panic disorder, and schizophrenia. Valproate-related hyperammonemic encephalopathy is an unusual but serious adverse effect of VPA (valproic acid) treatment, which can lead to death. It can be reversed if a precocious diagnosis is made. Valproate-related hyperammonemic encephalopathy is clinically characterized by an acute or subacute decreasing level of consciousness that goes from drowsiness to lethargy and coma, ataxia, and focal neurologic deficit. Hyperammonemic encephalopathy with normal valproic acid levels without hepatic dysfunction is a very rare condition. We report a case of an adult patient with hyperammonemia and confusion that occurred with a therapeutic level of valproate and without hepatic dysfunction or metabolic deficiencies. Bipolar I disorder was diagnosed at the age of 17 years in a 20-year-old woman. After a single manic episode, she was in remission for 3 years under lithium treatment. She was admitted to the hospital because of a mixed episode characterized by 1 week of both mania and depressive symptoms. A few weeks ago, she had discontinued the use of lithium, and symptoms had gradually increased. On mental status examination, she was well oriented, her consciousness was clear, and her memory was intact. The patient was found to be restless with distractibility and mixed affective state with no psychotic features. Her vital signs were stable. Valproic acid doses of 250 mg/d were gradually increased to 1000 mg/d at the end of the fifth day (divided into 2 doses for a day). The complaints of nausea and vomiting begun after the third and fifth days, respectively. Gastrointestinal tract examination was unremarkable. After 9 days of treatment, lethargy, disorientation, confusion, and agitation were determined; shewas nonresponsive to verbal stimuli. Blood ammonia levelwas 237Kmol/L (n = 31 to 123); VPA level was 116 Kg/mL (n = 50 to 100) and aspartate aminotransferase and alanine aminotransferase were in reference ranges at 8 IU/L and 6 IU/L, respectively. Valproic acid treatment was stopped, and fluid therapy was instituted. The patient was assessed by gastroenterology. A total of 3000 mL every 24-hour hydration was started, and a 250-mL saline solution of 15 g L-ornithine L-aspartate was given slowly in 4 hours. After discontinuation of valproic acid treatment and hydration, encephalopathy symptoms disappeared dramatically. After 12 hours, blood ammonia level was 80 Kmol/L, and the patient returned to baseline mental status. In conclusion, valproic acid (sodium valproate, VPA) is the most commonly used antiepileptic drug today in the treatment of epilepsy, and it is also effective in bipolar disorders. Adverse effects associated with VPA include tremor, weight gain, gastrointestinal effects, hepatic toxicity, and hyperammonemia that may be potentially fatal. Hyperammonemia occurs due to inhibition of mitochondrial enzymes (carbamoyl phosphate synthetase I, the enzyme that begins the urea cycle) by VPA. Hyperammonemia elevates the cerebrospinal levels of glutamine via increasing glutamine synthetase activity. Confusion and encephalopathy occur due to astrocyte swelling and cerebral edema caused by elevated glutamine levels. Hyperammonemia and encephalopathy can develop even at therapeutic concentrations without elevated liver function enzymes. Clinicians should be aware that VPA-related hyperammonemia and encephalopathy are still one of the most feared adverse effects of valproate, which may require emergent management.

Heterogenity of Sleep Quality in Relations Between Cirdadian Preferences and Depressive Symptomatology Among Major Depression Patients

Objective The effect of poor sleep quality on depressive symptoms has been consistently found. The aim of our study was to assess the heterogenity of sleep quality in relations between circadian preferences and depressive symptomatology among major depression patients. Method The sample was consisted of 225 patients with first diagnosis major depression. Mean age of the sample was 29.92 (SD±10.49). The patients completed a package of psychological instruments including the Morningness–Eveningness Questionnaire, Pittsburgh Sleep Quality Index, and Beck Depression Inventory. The latent structure of sleep quality among first diagnose major depressive patients was examined by applying latent class analysis (LCA) to the seven components of the PSQI, using Mplus 4.01. We also examined the latent structure of sleep quality in conjunction with the MEQ and BDI scores. Results We found that evening-type depressive patients were more prone to report greater scores of subjective sleep quality, sleep latency, sleep duration, use of sleep medication and daytime dysfunction sub-scales of the PSQI. Direct effect of evening-type chronobiological preference was significantly linked to greater depression scores. Indirect effects of chronobiological characteristics through components of the PSQI were only significant for use of sleep medication and daytime dysfunction sub-scales of the PSQI (p Discussion These findings suggest that sleep quality in general operates and influences on depression in concert with chronobiological characteristics; however, the construct of sleep quality appear like to be heterogeneous in nature and is influential on severity of depression symptoms through distinct mechanisms among depressive patients.

The Effects of Individual Biological Rhythm Differences On Sleep Quality, Daytime Sleepiness and Correlations with Dissociative Experiences

Objective Individuals who differ markedly by chronotype, i.e., morning-type or evening-type, differ on a number of psychological, behavioral, and biological variables. Disruption in the usually integrated functions of consciousness, memory, identity and perception is definitional to dissociation, particularly pathological forms of dissociation. Dissociative experiences possess dream-like properties, which might be fueled by a labile sleep-wake cycle. Our study aimed to investigate the effects of individual biological rhythm differences on sleep quality and daytime sleepiness in conjunction with dissociative experiences. Method Participants were 372 undergraduates, ranged between 18 and 26 years of age, 61.6 % were females. The volunteers completed a package of psychological instruments including the Morningness–Eveningness Questionnaire, Dissociative Experiences Scale, Insomnia Severity Index, and Epworth Sleepiness Scale. Results We performed mediation regression analysis of relations between dissociative symptomatology and chronobiological features mediated by insomnia and sleepiness. We run a multiple mediator model utilizing from the SPSS script in which we bootstrapped 5000 times. We found direct effect of the MEQ scores on the DES scores was not substantial. Direct effect of the MEQ on the ESS was not significant; whilst the direct association between the ESS and the DES was significant (β=0.79; p Discussion We found significant associations of pathological dissociation in terms of DES-taxon with insomnia and sleepiness.

2764 – Valproic acid induced hyperammonemic encephalopathy: report of one case

Introduction Valproate (VPA) is widely used for acute and maintenance therapy of bipolar disease and it is the most prescribed drug for epilepsy treatment worldwide. VPA-induced hyperammonemia is a serious and unusual advers effect of VPA treatment. Objectives We aimed to describe the 20 year-old-woman bipolar case of VPA induced hyperammonemic encephalopaty with therapeutic VPA levels and normal liver functions. Methods The case will be discussed. Results The patient complained of confusion, disorientation, somnolance, agitation and slurred speech at the end of the first week of VPA treatment. VPA blood level was 116.5 μg/mL (N:50-125) and ammonia level was 237 μmol/L (N:10-50). Other laboratory tests including serum transaminases (both ALT and AST) and coagulation profile (PT, PTT and INR) were normal. After discontinuation of VPA treatment and hydration, these symptoms have disappeared dramatically. After 24 hours, blood ammonia level was 80 μmol/L and patient returned the baseline mental status. Conclusions Hyperammonemia occurs due to inhibition of mitochondrial enzymes in the urea cycle by valproic acid. Hyperammonemia and encephalopathy can develop even at therapeutic concentrations without elevated liver function enzymes. Clinicians should be aware that VPA- induced hyperammonemia and encephalopathy is still one of the most feared side effects of VPA which may require emergent management.