Christophe Huynh

Is it possible to study sleep-wake patterns in adolescent borderline personality disorder? An actigraphic feasibility study.

Borderline Personality Disorder (BPD) is characterized by severe instability in mood, impulse control, relationships and sleep patterns, alongside with mild cognitive disturbances in some patients. Although research on adolescent BPD has developed over the last decade, little is known about circadian sleep-wake patterns in this population. Low compliance and cooperation frequently reported in these patients impede data collection. Therefore, research had to introduce non-invasive objective measurements such as actigraphy while minimizing attrition and resurgence of suicidal ideation. This article examined the feasibility of an actigraphic study with BPD adolescents. Eighteen BPD adolescents (13-17 years old) were recruited from a specialized outpatient mood disorders clinic and asked to wear an actigraph for nine days including two weekends. Twelve (66.7%) of the 18 BPD patients who consented kept the actigraph for an average of 11.00 days (SD: 2.04), thus completing the required 9-day period. The reasons surrounding difficulties during the experiment, such as aversive emotions during interviews, dermal irritation, fragile alliance with the research assistant, are described. The factors that contributed the most to our satisfactory compliance rate included stabilized mood before inclusion, close ties between the research and the clinical teams, rapid access to an emergency psychiatric assessment if needed.

Prolonged hallucinations and dissociative self mutilation following use of Salvia divinorum in a bipolar adolescent girl

The case of a bipolar 17-year-old girl who developed prolonged vivid hallucinations and a dissociative state involving self-destructive behaviour following the use of Salvia divinorum is presented. The herb has mostly short-term (10–15 min) hallucinogenic properties. Salvatorin A, the main active compound, is a highly selective agonist of the kappa-opioid receptor. The plant is available at tobacco or other specialized stores in many countries such as France, UK, Canada, and USA, where it is legal. The clinical case reported in this article suggests that the recreational use of Salvia divinorum may result in serious psychiatric consequences in vulnerable individuals.

Familial and Clinical Correlates in Depressed Adolescents with Borderline Personality Disorder Traits

Introduction Chart review is a low-cost, but highly informative, method to describe symptoms, treatment, and risk factors associated with borderline personality disorder (BPD) and to adapt screening and intervention to clinical reality. Previous chart review studies report more aggressiveness/anger and psychotic features in youths with BPD. They show that adverse family environment and parental psychopathology constitute important factors for BPD pathology. Objectives To examine clinical characteristics of depressed BPD adolescents (12–17 years old) outpatients according to gender and to explore variables which are associated with BPD traits. Methods A retrospective chart review using the child and adolescent version of the retrospective diagnostic instrument for borderlines was conducted on 30 depressed adolescents with BPD traits and 28 depressed patients without BPD traits. Participants who reached the retrospective diagnostic instrument for borderlines threshold for BPD were included in the BPD traits group. Comparison analyses were performed using Pearson’s Chi-square test. Associated factors were determined using regression analyses. Results BPD traits participants were characterized by higher family problems (parental psychopathology, parent disagreement/argument, and parent–child relational problem), more aggressive symptoms, and higher rates of family intervention and hospitalization. A number of familial factors (parental history of delinquency, substance use, personality disorders, having siblings, or parental disagreement/argument in boys) were associated with BPD traits. Attention seeking and problematic functioning (does not adapt well to group activities) were also associated with BPD traits. Discussion Our study stresses the need to assess BPD traits in adolescent psychiatric evaluation, especially in the presence of aggressive behaviors, family problems and attention seeking. Our results also highlight the importance of exploring family characteristics intervention in adolescents with BPD traits.

Commentary: Are Children Like Werewolves? Full Moon and Its Association with Sleep and Activity Behaviors in an International Sample of Children

A recent article by Chaput and colleagues (1) provides evidence that if a relationship exists between lunar cycle and sleep duration and physical activity in children, its association is rather weak and less-than-meaningful. Using an international sample of 9- to 11-year olds (n = 5812), monitored by accelerometers, Chaput and his team found no relationship between lunar cycle and physical activity, and a minimal effect between lunar cycle and sleep duration (~5 min/night less sleep under full moon vs. new moon). While this relationship has been studied in the past, this is the first time it has been studied among a diverse pediatric sample of this size. The authors’ findings are important because they provide further evidence against the notion of a so-called lunar effect, a phenomenon that purports increased violence, crime, and birth-rate, occurring in the full moon phase. While this concept may seem far-fetched to some, to many people it is not. In fact, according to a survey of 325 people (2), 140 (43%) thought that “lunar phenomena could alter personal behavior” [(3), p. 149]. Interestingly, this belief was most popular among the health professionals, including social workers, clinical psychologists, and nurses’ aides, surveyed in the sample. A separate survey was consistent with these findings. In an examination of lunar cycle on emergency medicine personnel (n = 50), Danzl (4) found that 80% of the emergency department nurses and 64% of the physicians believed that lunar cycle impacts patients. Among the nurses, 92% found higher stress on lunar shifts and expressed desire for financial compensation. Though these anecdotal findings have been empirically debunked (5–11), the portent of the full moon lingers on. To date, the literature on lunar cycle–sleep relationship has been inconsistent in its findings. Among a sample of adults (n = 205), Della Monica and colleagues (12) found a lunar class × sex interaction, with women with reduced sleep, and men with increased REM sleep, in relation to the full moon phase. A study by Turanyi and colleagues (13) found reduced deep sleep and sleep efficiency, occurring at the full moon phase. In contrast, several studies (14, 15) have shown no sleep effect at all, occurring at the full moon phase. And in one of the few studies using children (n = 795), Sjodin and colleagues (16) found longer sleep length and reduced activity, both occurring at the full moon phase. With respect to these works, the study by Chaput and colleagues (1) is the largest of its kind, in terms of sample size and geographic scope. Another strength of the Chaput and colleagues study (1) is its interpretation of statistical results. Although the association between lunar cycle and sleep duration was statistically significant at p < 0.01, the authors actually point out that such a result, i.e., a 5-min reduction at full moon compared with new moon, is not clinically relevant. They explain correctly that a large sample size tends to increase the likelihood of finding a statistically significant result (17, 18). Their discussion demonstrates an intellectual rigor that needs to be highlighted, because too often it is tempting to interpret a statistically significant result as a meaningful and relevant discovery. Rather, Chaput and his team downplay their findings – findings that could have been interpreted as a robust relationship between lunar cycle and sleep duration. In their closing remarks, Chaput and colleagues (1) stress their need to delve much deeper, in terms of future research. In particular, they mention testing the relationship between the full moon on subgroups of vulnerable children, including “those with mental disorders and physical ailments” [(1), p. 5]. While this is an expected course to take, the authors should remember that sleep problems are associated with many physical ailments, which in turn can be cormorbid with mental disorders (19). What is needed, therefore, is a better understanding of the impact of mental and physical comorbidities on sleep parameters as potential third and confounding variables. We recommend this step prior to the proposed testing of the lunar cycle–sleep relationship among samples of vulnerable children. But regardless of their tack, movement forward with this work has the potential to unearth interesting findings, in particular, if the authors have a sample of the size and the diversity as the one they used in this study. Another aspect of this study worth mentioning again is its geographical diversity in sampling. It is unusual to encounter a study that has such diversity in sampling, not just racially, ethnically, and economically but also geographically. The authors’ finding of no differences across the study sites (i.e., geographically) suggests the findings are consistent, independent of location, for children in this age group (9–11 years) around the world. In conclusion, Chaput and colleagues (1) have moved us one step closer, in our understanding of lunar cycle, sleep, and activity. Other methods of assessment, such as forced desynchrony protocols (20), will allow exploring other questions on the impact of lunar cycle on behavior. These methods may contribute to debunking long-held myths, or possibly confirming lay beliefs.