Hans-Joachim Haug

Dissociative symptoms in schizophrenic patients with positive and negative symptoms.

Given the close historical relationship between schizophrenia and dissociative disorders, namely multiple personality disorder, we assessed 27 ICD-10 diagnosed schizophrenic inpatients for dissociative symptoms using the German version of the Dissociative Experience Scale and compared them to a nonclinical control group matched for gender and age. Other self-report instruments covering general psychopathology, and an expert rating on the predominance of positive or negative schizophrenic symptoms, were also administered. Schizophrenic patients have significantly more dissociative symptoms than controls. Moreover, patients with a plus type of schizophrenia show significantly higher levels of dissociation than patients mainly exhibiting less productive symptoms. However, dissociative phenomena are only significantly correlated with delusions and hallucinatory behavior, and do not show any correlation with other positive symptoms of schizophrenia. Severe dissociative psychopathology is also associated with impairment in other psychopathological dimensions. The implications of these findings are discussed with regard to the theory of dissociation, the differential diagnosis between schizophrenia and dissociative disorders and a possible contribution of dissociative phenomenology to the clinical heterogeneity of schizophrenia.

Prediction of sleep deprivation outcome by diurnal variation of mood

This study investigates whether response to total sleep deprivation in depressed patients may be predicted by the presence of diurnal variation of mood. Diurnal variation was measured with two different self-rating scales in 140 untreated depressed patients. Sleep deprivation responders manifest a higher percentage of diurnal variation than nonresponders, with a pattern of improved mood in the evening. Patients with marked diurnal variation respond better to sleep deprivation than those with little. The symptom of diurnal variation is a potential marker for a patients likelihood to respond to different therapies.

Sleep deprivation response in seasonal affective disorder during a 40-h constant routine.

BACKGROUND There are no controlled studies investigating the response of patients with seasonal affective disorder (SAD) to a total sleep deprivation (SD). METHODS The clinical response to SD of patients with SAD in winter was investigated under the stringently controlled conditions of a 40-h constant routine protocol. RESULTS 52% of the SAD patients (N=11 women) improved, using a mean of a multiple ratings. This is in the range of response found for non-seasonal major depression. In contrast, controls (N=8 women) showed less improvement of mood (29%). CONCLUSION SAD patients respond to SD as do non-seasonal major depressives. The best discrimination of response was obtained in an observer rating (Clinical Global Impression: global severity improvement), and the morning values of two different self ratings (v. Zerssen depression scale, 100 mm VAS with the criterion of > or =10 mm improvement). LIMITATION A more reliable estimate of the SD response rate in SAD patients would require a larger group. CLINICAL RELEVANCE SAD patients do not differ from other subgroups of major depression in their response to SD, and therefore this is an additional treatment option to light therapy.

Sleep electroencephalogram in seasonal affective disorder and in control women: Effects of midday light treatment and sleep deprivation

The role of sleep regulation in Seasonal Affective Disorder (SAD) was studied in 11 female SAD patients and eight controls in winter before and after light treatment (LT, 6000 lux, 10-14h, 5 days). The sleep electroencephalogram (EEG) was recorded at baseline and after the total sleep deprivation (TSD) of a 40-h constant routine. The well-known effects of TSD on sleep parameters and on EEG power spectra were replicated, indicating normal homeostatic sleep regulation in SAD. Sleep improved after LT in both groups. Since the condition following LT was the second session, these improvements may be an order effect and/or an effect of LT itself. After LT, sleep EEG spectra of SAD patients, but not of controls, showed modifications resembling those of recovery sleep. Since only SAD patients curtailed their sleep while remitting during the LT period, these EEG modifications can be explained by normal sleep regulation alone. We conclude that the robust antidepressant effect of LT in SAD is unlikely to be mediated by changes in sleep, and that sleep regulatory mechanisms are not a crucial factor in the pathogenesis of winter depression.

Long-term follow-up of depression in seasonal affective disorder

Twenty-six patients diagnosed as having seasonal affective disorder (SAD) completed weekly depression self-ratings for at least 2.5 and up to 8.25 years. Seasonal recurrence of depression persisted in nine patients, seven remitted, four were chronically depressed, and six showed a diffuse pattern. The age at SAD onset and duration of SAD history before entry into this prospective study could not be identified as predictors of the subsequent course of the disease. Short-lasting, recurrent periods of depression could be identified in many of the long-term records. They were found primarily in autumn and winter in patients with either a persistent seasonal or a remitted pattern. In the core group of patients with persistent seasonal pattern, the onset and offset of depressive periods (DPs) were more variable than the DSM-III-R 60-day window criterion for seasonal pattern allows.

Accelerated post-glucose glycaemia and altered alliesthesia-test in Seasonal Affective Disorder

BACKGROUND Little is known about the link between mood, food and metabolic function in Seasonal Affective Disorder (SAD). METHODS We investigated this link in a combined glucose tolerance-alliesthesia test in eight SAD patients in winter before and after one week light therapy, and in summer. RESULTS SAD patients exhibited faster post-glucose glycaemic and insulin responses (p <0.05), and increased hedonic ratings of high concentrated sucrose solutions (p <0.035) when depressed in winter than when euthymic (one week after light treatment or in summer). CONCLUSIONS The rapid glycaemic and insulin responses to an oral glucose load may be a result of accelerated gastric emptying. LIMITATIONS The number of studied patients was rather small and no control group was studied in parallel. CLINICAL RELEVANCE the more rapid post-glucose glycaemia may impair glucose homeostasis in depressed SAD patients.

Effect of Light on Unmasked Circadian Rhythms in Winter Depression

Abstract Nine women with winter depression carried out a “constant routine” protocol of 40 hours sustained wakefulness to measure endogenous circadian rhythms (rectal temperature, mood, alertness, performance). Bright light given in the middle of the day reduced depressive symptoms and improved mood, as did the sleep deprivation of the constant routine protocol itself. Mood and alertness showed a bimodal rhythm under unmasked conditions, with both a nocturnal and afternoon trough. Light did not modify the endogenous rhythm of alertness but did improve a simple performance task at all circadian phases both in winter and in summer.