F. Gordon Foster

Interval between onset of sleep and rapid-eye-movement sleep as an indicator of depression.

Abstract An analysis of electroencephalographic Summary sleep patterns in thirty-five consecutive patients admitted for the treatment of depression revealed that a single sleep characteristic—the interval between onset of sleep and the start of rapid-eye-movement (R.E.M.) sleep—is an objective indicator of depressive disease and correlates inversely with its severity. The mean R.E.M. latency for the entire group was 35 minutes; however, in patients with severe depression the R.E.M. latency averaged 18 minutes.

Waking and All-Night Sleep EEG's in Anorexia Nervosa

Despite an abundance of literature on EEG findings in other psychiatric syndromes and renewed interest in the biological aspects of eating disorders, there is a surprising scarcity of published information about the EEG in anorexia nervosa. In fact, several major reviews of the EEG in psychiatric populations fail to mention this disorder entirely.(1-3) A small number of reports describe the EEGs of individual cases of the illness, but diagnostic criteria have often been poorly-defined, and the majority of these patients appear to have been suffering from concurrent neurologic illnesses.(4-8) The only systematic study of the EEG in anorexia nervosa was performed by Crisp et al.,(9) in a series of 32 patients. Of these, 59% had abnormal EEG background activity, 31% had unstable responses to hyperventilation, and 12.5% displayed epileptiform paroxysmal dysrhythmias. While a few patients presented evidence of a primary CNS etiology for these abnormalities, the majority were attributed by the investigators to reversible secondary manifestations of self-starvation: electrolyte imbalance, metabolic alkalosis, and relative hypoglycemia. All-night EEG sleep profiles have become increasingly important tools for the assessment and classification of psychiatric disorders. (10) In an earl ier controlled study of EEG sleep in a small number of patients from our laboratory, a significant reduction of both tonic and phasic components of REM sleep was found in primary anorexia nervosa.(11, 12) This type of abnormality has most frequently been observed in neurological disorders(13) and in symptomatic psychiatric syndromes accompanying primary medical illnesses.(14, 15) Unlike the clinical EEG findings of Crisp et al.,(9) this EEG sleep profile persisted even after patients had regained weight during therapy.(11) Moreover, a pedigree study revealed concordance of this sleep marker in three siblings, each of whom was in a different stage of an eating disorder or its remission.(12) The present study was designed to reexamine the clinical EEG findings of Crisp, et al.,(9) using standardized research diagnostic criteria. In addition, we compared waking EEG abnormalities to all-night EEG sleep profiles in this series of anorectics, as an extension of previous work by Foster et al. (11,12,14)

Small group dynamics and survival on chronic hemodialysis.

Two groups of patients undergoing hemodialysis for chronic renal failure were prospectively studied for twenty-four months. Group A patients (n=12) were dialyzed on Mondays and Thursdays; Group B patients (n=9) on Tuesdays and Fridays. Although patients were supposedly assigned to dialysis groups on a random basis, over a twenty-four month period Group A had significantly more deaths (7 patients) than did Group B (none). This phenomenon is interpreted in the framework of an ongoing intergroup interaction among patients and between patients and staff, as conceptualized in the Tavistock Model propounded by Bion. It is hypothesized that in the dialysis unit, unconscious splitting by the staff led to a bias in patient-group assignment, such that those patients with more severe personality disruption, and “bad” in that sense, were assigned to Group A. Since patients in Groups A and B did not differ significantly in biological or demographic parameters at time of entry into the study, it is suggested that the increasing density of psychopathology in Group A was related to poorer care, more physical morbidity and a decreasing survival rate. Although no intermediary psychobiological mechanisms were defined, these findings suggest a significant interaction between the social, psychological and biological factors determining survival on chronic renal hemodialysis, beginning with the treatment decision and continuing throughout the course of treatment. These phenomena should be studied further and may have important implications for planning patient care and patient-staff interactions.

Activity Sensors for Use in Psychiatric Evaluation

The need for objective methods of patient evaluation has long been recognized in clinical psychiatry. While the relationship between mood states and motor activity has been observed for many years, this relationship was never accurately defined due to the imprecise nature of the available observational techniques. This report describes two activity sensors and their related systems which objectively measure motor activity levels and patterns without affecting the patients movements.

The movement-activated recording monitor: A third-generation motor-activity monitoring system

The movement-activated recording monitor (MARM) is a small noninvasive device that continuously detects, accumulates, and stores the amount of motor activity produced during sequential time intervals of designed duration. If motor activity totals are recorded every 15 min, the MARM is capable of calculating and storing 96 data points/day for 5.33 days. The MARM employs large-scale-integrated complementary-metal-oxide integrated circuits. To date, application has been primarily limited to psychiatric investigations, but the MARM is readily applicable for other time-motion studies of human or animal subjects.

Rapid eye movement analyzer

Abstract While there have been several efforts to develop rapid eye movement (REM) detection systems, a REM analyzer designed in our laboratory provides REM integrals for cumulative periods in addition to the detection of REM. Detector criteria and circuit operation are fairly straightforward. The on-line REM analyzer includes measurements of the REM integral of individual REMs and the summated integral for a series of REMs, as well as the REM interval. It is expected that use of this analyzer will assist the investigator in delineating the roles of the phasic and tonic components during REM sleep.

Anorexia nervosa: telemetric assessment of family interaction and hospital events.

Abstract We have completed an extensive longitudinal investigation of a patient with anorexia nervosa, in which psychomotor activity measures were obtained continuously. In our attempt to point out the overall value of objective measurements of activity, we have investigated family impact data in this case. This report illustrates the first application of a telemetric mobility system for the assessment of family interaction and hospital ward events. Furthermore, it proposes a method for quantifying one aspect of the biologic impact of day-time psycho-social occurences.

A computer-compatible multichannel event counting and digital recording system

An inexpensive multichannel event counting digital recording system has been designed for compatibility with automated data analysis equipment. For as many as 16 channels, events are simultaneously summed over preselected repetitive time intervals and recorded. Each data entry is marked with the time of day and a code identifying each channel’s data. The data is formated to be computer compatible and is logged on inexpensive readily available digital magnetic tape cassettes.