Camila Morelatto de Souza

Midpoint of sleep on school days is associated with depression among adolescents

Depression is a serious and prevalent disease among adolescents. Identifying possible factors involved with its genesis and presentation is an important task for researchers and clinical practitioners. The individual’s chronotype and social jetlag have been associated with depression in different populations. However, information on this is lacking among adolescents. The objective of this cross-sectional study was to examine the relationship between chronotype (midpoint of sleep) and social jetlag with the presence of depression symptoms in young students. We assessed 351 students aged 12–21 years old. They answered a questionnaire on demographic characteristics, the Munich Chronotype Questionnaire (MCTQ) and the Beck Depression Inventory (BDI). Demographic characteristics (age, sex and classes’ schedule) and circadian rhythmic variables for school and free days (sunlight exposure, sleep duration, midpoint of sleep and social jetlag) were taken as factors and the presence of at least mild depression symptoms as outcome. In univariate analysis, girls (χ2 = 5.01, p ≤ 0.05) and evening students (χ2 = 6.63, p ≤ 0.05) were more frequently present among the depressed. Also, the depression group was significantly delayed for both midpoints of sleep during school (t = 2.84, p ≤ 0.01) and free days (t = 2.20, p ≤ 0.05). The two groups did not differ in relation to their social jetlag hours (t = −0.68, p = 0.501) neither subjects with two or more hours of social jetlag were more frequent among the depressed (χ2 = 1.00, p = 0.317). In multivariate analysis, the model that best explained our outcome (R2 = 0.058, F = 2.318, p ≤ 0.05) included sex (β = −0.12, p ≤ 0.05) and the midpoint of sleep on school days (β = −0.21, p ≤ 0.001) as significant predictor variables. A sleep phase delay (later midpoints of sleep for school and free days) was associated with higher levels of depression. However, we were not able to detect similar relationship with the social jetlag hours. This could be attributed to the fact that our sample showed a smaller amount of social jetlag, possibly because even during free days a social routine, this time parents’ rules, limited the observation from what could be a natural tendency to sleep later and over. Yet, even when considering the group with more social jetlag, we did not find an association. Perhaps, this variable will only manifest its effect if it is maintained for longer periods throughout life. Additionally, when considering all the variables together, the midpoint of sleep on school days was pointed as the predictor of greatest weight for depression, together with the factor sex. Young girls, possibly earlier types, who are required to study in the evening have more chances of presenting depression symptoms. This study explicit some peculiar characteristics of the assessment of chronobiological variables in the young, such as the presence of an imposed social routine also during free days. Therefore, the expression of chronotype under the influence of the weekly social schedule (midpoint of sleep on school days) could be a more useful marker to measure the stress produced from the mismatch between external and inner rhythms rather than social jetlag. This also reinforces the importance of reconsidering the weekly routine imposed on young people.

Association of daytime sleepiness and the morningness/eveningness dimension in young adult subjects in Brazil.

Sleepiness is a major public health problem associated with motor vehicle crashes, occupational accidents, decreased productivity, and interpersonal problems. It can be influenced by many factors, including the individuals circadian rhythm. The objective of this study is to assess the correlation between the morningness/eveningness dimension and daytime sleepiness in medical school students. This is a cross-sectional study; 310 subjects (123 women and 187 men, M age 20.5 ± 1.9 yr.) completed a questionnaire on use of drugs, diagnostic diseases, sleeping habits, the Morningness/Eveningness Questionnaire and the Epworth Sleepiness Scale. The only variable related to daytime sleepiness was the morningness/eveningness dimension (r = –.18, p = .002). Questions with higher coefficients of discrimination between the morning and the evening chronotype were “Lying down to rest in the afternoon when circumstances permit” (.61), “Sitting and reading” (.53), and “As a passenger in a car for an hour without a break” (.53). The implications of the findings are discussed.

Performance of chronotypes on memory tests during the morning and the evening shifts.

Memory consists of several phases or processes that can be influenced by many factors, including the individuals circadian rhythm and the time of day at which tests are performed. The present objective was to evaluate the performance on memory tests of different chronotypes during the morning and the evening shifts. Subjects (21 men and 26 women, between the ages of 20 and 35 yr.) were evaluated for memory and metamemory differences in the morning and in the afternoon, using a battery of neuropsychological tests composed of the Word List with Emotional Content, Visual Memory, Scale–Semantic Memory, Digit Span, Word-Pairs Associated, Verbal Fluency Test, and Metamemory questionnaire. In the evening shift, there was a statistical difference among chronotypes on the Word List with Neutral Content and on the Verbal Fluency Test. In the morning, there were no statistically significant differences; however, the morning-type subjects had higher scores on the metamemory tests (p < .01), while the evening-type subjects had higher scores in the afternoon (p < .01). In spite of their perception, on Word-Pairs Associated and Word List with Emotional Content, the subjects, independently of their chronotype, showed better performance by the evening than by the morning shift. These results highlight the importance of controlling the shift of day and chronotype in studies with the objective of exploration of human performance.

The midpoint of sleep on working days: A measure for chronodisruption and its association to individuals’ well-being

There is consistent evidence suggesting a relationship between individuals’ sleep–wake rhythms and well-being. The indiscriminate demands from daily working routines, which do not respect this individual physiological rhythm, might be mediating this phenomenon. The aim of the present study was to evaluate the relationship between the characteristics of sleep routines during working days and psychological well-being. This was a cross-sectional study on 825 individuals from rural communities from southern Brazil. The study protocol included a questionnaire on demographic characteristics, working routines, health complaints, and habits; the Munich Chronotype Questionnaire for sleep–wake rhythm and; the WHO-Five well-being index. Since sex has been shown to affect sleep circadian rhythm and well-being, analysis was performed on men and women separately. In the proposed hierarchical regression models, different factors contributed to well-being according to sex. Among men, sleep–wake and work-related variables did not predict well-being scores. Among women, later midpoints of sleep on working days (B = −1.243, SE B = 0.315, β = −0.220), working more days per week (B = −1.507, SE B = 0.494, β = 0.150), having longer working journeys (B = −0.293, SE B = 0.105, β = −0.166), earlier working journey midpoints (B = 0.465, SE B = 0.222, β = 0.115), and being exposed to less sunlight (B = 0.140, SE B = 0.064, β = 0.103) predicted worse well-being. For the subgroup of women with days free from work, we have found a correlation between later midpoints of sleep during the week with worse well-being (Pearson’s r = −0.159, p = 0.045) while the same relationship was not significantly observed with the midpoint of sleep on non-working days (Pearson’s r = −0.153, p = 0.054). Considering WHO-Five as categorical, based on proposed clinical cut-offs, among women working 7-d/week, those with worst well-being (WHO-Five < 13) had the latest midpoint of sleep (F = 4.514, p = 0.012). Thus, the midpoint of sleep on working days represents the interaction between individuals’ sleep–wake behavior and working routines. It plays an important role as a stress factor and may be a useful alternative variable related to chronodisruption.

Relato do uso de clozapina em 56 pacientes atendidos pelo Programa de Atenção à Esquizofrenia Refratária da Secretaria da Saúde e do Meio Ambiente do Estado do Rio Grande do Sul

ABSTRACT Introduction: Schizophrenia is a chronic severepsychiatric disease causing major psychological, so-cial and working deficiencies. Typical neurolepticsare widely used, but often produce incomplete res-ponses, toxicity and adverse effects on motricity.Clozapine was a significant development. It is effecti-ve in treating 30-61% of the psychotic symptoms withminimal adverse effects. Methods: Clinical experien-ce of 56 patients with refractory schizophrenia undertreatment at the Psychiatry Service of the Hospital deClinicas de Porto Alegre, included in the program tosupply clozapine free of charge, promoted by theDepartment of Health and the Environment of theState of Rio Grande do Sul. Results: The mean scorefor the Brief Psychiatric Rating Scale (BPRS) wasinitially 77.9 (SD=16.1) and, at the end, 41.1(SD=16.2). Two patients left the program and onewas excluded because he developed agranulocyto-sis. There were 4 hospitalizations. Discussion: Despi-te its well-established efficacy and applicability, clo-zapine is not free from adverse effects: posturalhypotension, tachycardia, cloudy vision, dry eyes,hypersalivation, constipation and sedation frequentlyoccur. Hematological alterations occur in 0.05-2.8%.Conclusions: There was a significant and lasting im-provement of the symptoms in the patients enrolled.Diseases with a longer evolution had worse respon-ses, probably related to neurochemical and neuro-physiological damage. The importance of early treat-ment and the need for State intervention, offeringpsychosocial and financial support to optimize thetreatment of this population should be highlighted.

Clozapine use report in 56 patients seen by Clerkship of Health and Environment of the State of Rio Grande do Sul's Program of Attention to the Refractory Schizophrenia

ABSTRACT Introduction: Schizophrenia is a chronic severepsychiatric disease causing major psychological, so-cial and working deficiencies. Typical neurolepticsare widely used, but often produce incomplete res-ponses, toxicity and adverse effects on motricity.Clozapine was a significant development. It is effecti-ve in treating 30-61% of the psychotic symptoms withminimal adverse effects. Methods: Clinical experien-ce of 56 patients with refractory schizophrenia undertreatment at the Psychiatry Service of the Hospital deClinicas de Porto Alegre, included in the program tosupply clozapine free of charge, promoted by theDepartment of Health and the Environment of theState of Rio Grande do Sul. Results: The mean scorefor the Brief Psychiatric Rating Scale (BPRS) wasinitially 77.9 (SD=16.1) and, at the end, 41.1(SD=16.2). Two patients left the program and onewas excluded because he developed agranulocyto-sis. There were 4 hospitalizations. Discussion: Despi-te its well-established efficacy and applicability, clo-zapine is not free from adverse effects: posturalhypotension, tachycardia, cloudy vision, dry eyes,hypersalivation, constipation and sedation frequentlyoccur. Hematological alterations occur in 0.05-2.8%.Conclusions: There was a significant and lasting im-provement of the symptoms in the patients enrolled.Diseases with a longer evolution had worse respon-ses, probably related to neurochemical and neuro-physiological damage. The importance of early treat-ment and the need for State intervention, offeringpsychosocial and financial support to optimize thetreatment of this population should be highlighted.

The Mood Rhythm Instrument: development and preliminary report

Objective: To describe the initial steps in the development and validation of a new self-reported instrument designed to assess daily rhythms of mood symptoms, namely, the Mood Rhythm Instrument. Methods: A multidisciplinary group of experts took part in systematic meetings to plan the construction of the instrument. Clarity of items, their relevance to evaluation of mood states, and the consistency of findings in relation to the available evidence on the biological basis of mood disorders were investigated. The internal consistency of the questionnaire was evaluated through Cronbach’s alpha. Results: All of the items proposed in a first version were well rated in terms of clarity. The items more frequently rated as “rhythmic” were related to the somatic symptoms of mood. Their peaks in 24 hours were more frequent in the morning. The items associated with affective symptoms of mood were rated as less rhythmic, and their peak in 24 hours occurred more frequently in the afternoon and evening. Males and females behaved more similarly with respect to somatic than behavioral-affective items. The second version of the Mood Rhythm Instrument had a Cronbach’s alpha of 0.73. Conclusion: The proposed Mood Rhythm Instrument may be able to detect individual rhythms of cognitive and behavioral measures associated with mood states. Validation in larger samples and against objective measures of rhythms, such as actigraphy, is warranted.

Spanish translation of the mood rhythm instrument: a novel approach to mood evaluation

Introduction: The Mood Rhythm Instrument (MRI) is a questionnaire developed to assess the circadian rhythm of mood-related behaviors. The aim of this study was to translate this instrument from Brazilian Portuguese into Spanish. Methods: The translation process consisted of forward translation, adjustment, back translation, back translation review and harmonization. Results: Comparing the initial Spanish translation and the final Spanish version, there were no semantic differences and the items were not changed. Conclusions: The Spanish version of the MRI is ready to be tested in a Spanish population. In the future, assessing and comparing mood-related behaviors in transcultural studies will be possible. Keywords: Circadian rhythms; daily rhythms; mood; psychometric; chronobiology.

Work routines moderate the association between eveningness and poor psychological well-being

Well-being is a useful screening method for the detection of mood disorders. Evidence associating psychological well-being with sleep-wake patterns exists, as well as associations with sleep-wake patterns, work-related parameters, and perceived self-efficacy. Despite the growing research regarding the relationship between these factors and mental health, there are few studies that analyze them together. OBJECTIVE: To investigate if the association between sleep-wake patterns and psychological well-being is mediated or moderated by perceived self-efficacy, work flexibility and work routines. MATERIAL AND METHODS: This cohort study was performed in southern Brazil. A sample of 987 individuals was analyzed (66.9% women; mean age = 43.9 years). Work routines parameters and work schedule flexibility were evaluated, most participants were farmers (46%) and most worked 7 days a week (69.1%). Munich Chronotype Questionnaire (MCTQ) was administered for evaluation of sleep-wake patterns, General Self-Efficacy Scale (GSE) for assessment the participants’ beliefs about how they coped with daily hassles, and World Health Organization Five-item Well-being Index (WHO-5) for evaluation of psychological well-being levels. Moderation and mediation models were tested. RESULTS: The moderation model showed influences of work end time on the relationship between sleep onset time and psychological well-being (R2 = 0.147; F = 24.16; p<0.001). The final regression model showed an association of psychological well-being with sex (Beta = -0.086; p = 0.004), sleep onset time (Beta = -0.086; p = 0.006), and self-efficacy (Beta = 0.316; p<0.001); the work end time showed association in the interaction with sleep onset time (Beta = -0.075; p = 0.016). CONCLUSION: The findings support the direct association of psychological well-being with sleep-wake patterns and self-efficacy, and show an interaction between work routines and sleep-wake patterns. Our results draw attention to the importance of the interplay between individual and social rhythms in relation to psychological well-being.

Impact of the time in an animal model of mood disorder

UNLABELLED The objective of the study is to evaluate whether intervening and testing in different rest-activity periods of the day would produce different measurements in animal behavior studies. METHODOLOGY Thirty-five, 60-day-old male Wistar rats were submitted to an inescapable foot shock (IFS) stress model and behavioral tests (Light-Dark Box test). The animals received intervention and were tested in both light and dark phases, resulting in the following groups: control L (tested in the light), control D (tested in the dark), LL (IFS and tested in the light), LD (IFS in the light and tested in the dark), DL (IFS in the dark and tested in the light), and DD (IFS and tested in the dark). RESULTS The Light-Dark Box test showed that control L was not significantly different from other groups in any of the parameters. However, when comparing control D with the intervention groups, we observed a difference in the mean length of time spent in the light compartment (t=2.56; p=0.045). A significant difference in the number of crossings into the light compartment was only observed between the control D and the LL and LD groups (t=-2.608; p=0.028; t=-2.571; p=0.030, respectively). The latency time for the control D group was significantly lower than that of the DD group (t=-2.556; p=0.043). CONCLUSIONS These results show that behavior testing during the animals period of highest activity (dark period) revealed differences caused by the intervention, whereas no differences were apparent when the control group was observed during the day.