Hisashige Nan'no

The nature of sleep attack and other symptoms of narcolepsy

Abstract The electroencephalogram, electro-oculogram and electromyogram of the mental muscle were simultaneously recorded in eighteen narcoleptics and thirty controls under each of the following three conditions in the daytime, on different days: (I) lying on a bed: bed(1); (II) sitting on a stool, then, on a chair, and finally, lying on a bed: stool(2), chair(2) and bed(2); (III) sitting on a chair: chair(3). Recording in each posture was performed for about 50 min and 152 recordings, 81 in the narcoleptics and 71 in the controls, were obtained. Under every condition, the narcoleptics fell asleep with a shorter latency and spent in sleep a larger percentage of recording time than the controls, and sleep of the narcoleptics was deeper than that of the controls. Sleep of the narcoleptics was deeper and more stable under bed(1) and bed(2) than under chair(2) and chair(3), and the latter than under stool(2) condition. Similar relations were found in the controls. The REM stage of sleep occurred in variable number of narcoleptics with sleep attack and other main symptoms under different conditions. It occurred in fifteen of eighteen narcoleptics under bed(1), in eleven of eighteen narcoleptics under both chair(2) and bed(2), in five of nine narcoleptics under chair(3) and in only two of eighteen narcoleptics under stool(2) condition. Latency of the REM stage was 29 min and 34.5 min respectively under stool(2). Under the other conditions this stage occurred at the onset of, or soon after the onset of sleep in most cases. These and other findings would suggest that, during sleep under unstable and uncomfortable conditions, narcoleptics are completely or incompletely deprived of the REM stage, and that, during sleep in the following period under stable and comfortable conditions, they tend to show a compensatory increase in its amount. Cataplexy of brief duration occurred in one narcoleptic under chair(2). Sleep paralysis, hallucinations and/or dreams were experienced by twelve narcoleptics; under stool(2) by one, under chair(2) by four and under bed(2) by seven. All of the twelve patients showed the REM stage under these conditions. In conclusion, a marked tendency to fall asleep in narcoleptics brings about sleep attack, and another tendency to fall in the REM stage at the sleep onset brings about cataplexy, sleep paralysis and hypnagogic hallucinations.

Sleep satiation in narcoleptic patients

UNLABELLED Polygraphic sleep recording was performed in 20 narcoleptics with one or more of the auxiliary symptoms, 4 narcoleptics with only sleep attacks and 10 normals during one night and into the following day. Total sleep time in the narcoleptics did not differ significantly from that in the normals. Sleep of the narcoleptics with auxiliary symptoms was unstable with frequent awakening. The temporal organization of the REM--NREM sleep cycle was irregular in the narcoleptics with auxiliary symptoms, compared with those in the other two groups. Percentage of Stage 1 was significantly larger in the narcoleptics with auxiliary symptoms than in the other two groups and percentage of Stage 2 was smaller. Percentage of Stage 4 was smaller in the narcoleptics with auxiliary symptoms than in those with only sleep attacks. Percentages of Stages 3 and REM did not differentiate the three groups. Spindle density during Stage 2 did not differentiate the three groups. Sleep onset Stage REM was frequently observed exclusively in the narcoleptics with auxiliary symptoms. Excluding the instances showing sleep onset Stage REM, mean latency of initial episodes of REM sleep in the three groups was shorter after daytime sleep onset than after nighttime sleep onset. In the narcoleptics with auxiliary symptoms, no significant correlation was found between the percentage of Stage REM and clinical findings. CONCLUSIONS the sleep attacks in narcoleptics are due to an ill-timed, strong tendency to fall asleep (including both REM and NREM sleep), and it is therefore suggested that they are manifestations of their disturbed circadian rhythm of sleep--wakefulness cycle.

Event-related potentials in panic disorder and generalized anxiety disorder

Abstract  To evaluate the neurophysiological differences between panic disorder (PD) and generalized anxiety disorder (GAD), 52 patients with PD and 34 with GAD were investigated using event‐related potentials (ERP). The ERP were recorded using a tone discrimination task, and peak latencies for N1, P2, N2, and P3 at a Pz electrode site were measured. In addition to analyzing the peak latencies of the ERP, the interpeak latencies (IPL; N1–P2, P2–N2, and N2–P3) were also analyzed. The same analysis was performed in 28 age‐matched healthy volunteers (controls). When compared to those of the GAD and control groups, the mean latencies of P2, N2, and P3 were shorter in the PD patients. With regard to the IPL in the PD patients, the N1–P2 IPL was shorter than that in the other groups, and no individual with PD had a longer N1–P2 IPL than 1 SD above the mean of the controls. These findings suggest that certain attention‐related processes in the cerebrum that affect ERP data are accelerated in PD patients. These findings demonstrate that it may be useful to neurophysiologically distinguish PD from GAD by measuring ERP peak latencies and IPL.

Interpeak latency of auditory event-related potentials (P300) in senile depression and dementia of the Alzheimer type

Abstract Most studies on event‐related potentials (ERP) in psychiatric illness or dementia have focused on the single‐peak latency of ERP components. In the present study, not only peak latencies of ERP components (N1, P2, N2, and P3) but also interpeak latencies (IPL; N1–P2, P2–N2, and N2–P3) were analyzed using the auditory oddball task. Thirty‐five senile depressed patients and 34 patients with dementia of the Alzheimer type (DAT) were compared to 39 age‐matched healthy volunteers. The mean latencies of P2 and P3 were shorter in patients with senile depression than in controls. In DAT patients, the N2 and P3 latencies were longer. When the IPL was assessed, however, only the mean IPL of N1–P2 was shorter in patients with senile depression, while the P2–N2 IPL were longer in those with DAT. The IPL results suggest that in senile depression the early cognitive process is hastened and in DAT the middle process is disturbed. Based on these results, we conclude that IPL of the auditory ERP might be used to reveal the disturbed steps within the cognitive process.

A neurophysiological study of sleep paralysis in narcoleptic patients.

Abstract Behavioral response by pressing a switch placed in the hand and EEG arousal response to external stimuli (calling the subject by name 3–5 times at short intervals) were studied in the REM period in nocturnal sleep. Subjects consisted of eight normal controls and eight narcoleptics with sleept paralysis and other narcoleptic symptoms in addition to sleep attacks. All the vocal stimuli, with a few exceptions, were perceived by the subjects. Narcoleptics and controls, when stimulated in the REM period occurring more than 1 h after the sleep onset (the non sleep-onset REM period), responded to most of the stimuli by pressing the switch. In the REM period occurring at the sleep onset (the sleep-onset REM period), in which narcoleptics experienced sleep paralysis, they frequently failed to show a behavioral response (statistically significant). EEG arousal response was more marked in the controls than in the narcoleptics. In the narcoleptics it was more prominent in the non sleep-onset REM period than in the sleep-onset REM period. Based on these findings it is suggested that a dissociation between perception or consciousness level and somatic motor function occurring in narcoleptics in the sleep-onset REM period produces sleep paralysis. Possible neurophysiological mechanisms related to the occurrence of this dissociation in the sleep-onset REM period and of this sleep state in narcoleptics are discussed.

ORIGINAL ARTICLE: Inter‐peak Latency of Auditory Event‐related Potentials (P300) in Cases of Aged Schizophrenia and Alzheimer‐type Dementia

Background: Both patients with schizophrenia and those with dementia show cognitive difficulties, and in many cases of schizophrenia the cognitive disturbance is progressive, as it is in dementia. Event‐related potentials have revealed cognitive impairments in patients with schizophrenia and dementia, but most studies of event‐related potentials in cases of psychiatric illness or dementia have focused on the single peak latency of the event‐related potential components. In the present study, we investigated the cognitive function in elderly patients with schizophrenia and Alzheimer‐type dementia (AID) using auditory event‐related potentials (P300).

Studies on the occupational maladjustment syndrome. Part 3 In reference to the therapeutic system of O.M.A.S. and industrial doctor's roles.

職場不適応症の対応として,私たちが考案した治療的対応システム(後述)の効果や産業医の役割を知るために,直接関与した96名の職場不適応症者を対象に調査を行った.対象は,最近19年間に精神科外来診療を行っている大阪府立公衆衛生研究所精神衛生部外来(以下,当所診療所)を受診した54名と,私たちが精神衛生面の産業医をしている,社員数15,000名を擁する,ある企業の職場内診療所を過去14年間に受診した42名である.タイプ別内訳は,中核群が34名と最も多く,ついで脱落群26名,その他群15名,一過性反応群は13名で,専門職不適応群は8名に認められた.治療的対応システムの内容を中心にして,代表的な2症例を呈示した.1. 私たちは,職場不適応症の治療的対応システムを考案した.その内容は, I.診療と諸検査, II.本人や家族へのカウンセリング, III.復職へのリハビリテーション, IV.職場関係者への治療的助言からなっている.2. 治療的対応システムにより, 96名中81名の職場不適応症者は,就業するようになった.3. 96名のうち,職場関係者への治療的助言が必要であった者は59名で,そのうち助言が受容された者(受容群)は, 49名であった.拒否された10名(拒否群)は,いずれも当所診療所受診者であった.受容群のほうが,拒否群よりも職場によく適応していた.治療的助言として,治療的配置転換が27名と最も多く,ついで職務の軽減,指導が18名で,治療的仮出勤が13名であった.4. 上記の治療的対応システムを活用するためには,精神衛生面を担当する産業医の役割が大であると考えた.

Auditory Event‐Related Potentials (P300) and Regional Cerebral Blood Flow in Elderly Depressed Patients

Background:In order to evaluate the degree of impairment of cerebral function and the organic factors involved in elderly depressed patients, auditory event‐related potentials (ERP; P300) and N‐isopropyl‐p [123I] iodoamphetamine (123I‐IMP) single photon emission computed tomography (SPECT) were examined.