O. Le Bon

The first-night effect may last more than one night

The first-night effect in sleep polysomnographic studies is usually considered to last for one night. However, a few observations have indicated that variables associated to rapid eye movement sleep take longer to stabilize. Notwithstanding, current opinion holds that second nights of recording can be used without restriction for research and clinical purposes. The goal of this study was to describe the dynamics of habituation to polysomnography in optimal conditions. Twenty-six young, carefully screened, healthy subjects were recorded in their home for four consecutive full polysomnographies. Repeated measures ANOVA were applied. Between the two first nights, while there were no differences in sleep duration in non-rapid eye movement sleep, marked modifications in corresponding spectral power were observed. The dynamics of adaptation of rapid eye movement sleep appeared to be a process extending up to the fourth night. Similar dynamics in NREMS and REMS homeostasis have been observed in sleep deprivation studies, and it appears that the same mechanisms may be responsible for the FNE. The longer habituation process of REMS in particular has important implications for sleep research in psychiatry.

5‐HT2a receptor polymorphism gene in bipolar disorder and harm avoidance personality trait

The purpose [corrected] of this study was to investigate the relationship between bipolar disorder and the harm avoidance personality trait (HA), and the genetic contribution of the polymorphic DNA variation T102C in exon 1 of 5-HTR2a (chromosome 13q14-21) in bipolar disorder and HA personality trait. Forty bipolar patients and 89 normal subjects completed the TPQ questionnaire and were genotyped for 5-HT2a. Bipolar patients scored higher than normal subjects on the HA dimension. However, no contribution of the 5-HTR2a polymorphism on the bipolar disorder or on the HA personality trait emerged. Despite the limited sample size, these results exclude a major effect of the 5-HTR2a polymorphism on bipolar disorder and HA personality trait but not a minor effect.

Association between novelty‐seeking and the dopamine D3 receptor gene in bipolar patients: A preliminary report

Recent studies in healthy controls suggest an association between novelty-seeking (NS) and the dopamine D4 receptor (DRD4) gene. In this study, we further investigated the relationship between genes implicated in dopamine as well as serotonin neurotransmission and personality traits in bipolar (BP) disorder. Scores on the Tridimensional Personality Questionnaire were examined in 37 recovered Research Diagnostic Criteria-diagnosed BP patients genotyped for DRD3, DRD4, and serotonin 2A receptor (5HTR2a) polymorphisms. Carriers of DRD3 allele 1 showed significantly lower NS values compared to patients without this allele. Scores on NS and on harm-avoidance were not related to DRD4 or 5HTR2a polymorphisms. These preliminary results suggest a role for D3 receptor in NS expression in BP patients.

Calcium-Acetylhomotaurinate for Maintaining Abstinence in Weaned Alcoholic Patients: A Placebo-Controlled Double-Blind Multicenter Study

Drugs used for attenuating alcohol intake consist of two types: 1. Agents postulated to attenuate drinking by causing aversive consequences if alcohol is consumed after they are ingested, including disulfiram. 2. Agents postulated to attenuate directly the desire to drink, including such drugs as lithium, fenfluramine, zimelidine and bromocriptine.

Critical analysis of the theories advanced to explain short REM sleep latencies and other sleep anomalies in several psychiatric conditions

One of the most consistent and most studied sleep modifications in several psychiatric conditions is the shortening of the rapid eye movement (REM) sleep latency. While its clinical usefulness is still to be proven and its meaning relatively obscure, the appearance of a short REM latency continues to be a daily fact in sleep laboratories. Many theories compete to explain what is observed, the most important being the circadian rhythm hypotheses, the homeostatic model and the reciprocal interaction model. These three are summarised and their pros and cons are exposed in a systematic manner. Points of conflict, possible convergences and limitations are discussed in the light of recent developments on the general theories of sleep regulation.

Alcoholism and emotional reactivity: more heterogeneous film-induced emotional response in newly detoxified alcoholics compared to controls—a preliminary study

Alcoholics are thought to be characterized by irregular emotional responses, having trouble reaching an optimal level of emotional arousal. They therefore may use alcohol to restore emotional homeostasis. This study investigated whether recently detoxified alcoholics show different emotional responses as compared to controls. Film excerpts were used to induce emotions in 14 newly detoxified alcoholics (9 men, 5 women) and matched controls in a standardized laboratory setting. Subjective emotional (questionnaires) and physiological measures were employed. Depression and cognitive deterioration were controlled. Based on subjective ratings, alcoholics displayed greater variability of emotion; they displayed also fewer or no physiological arousal changes. Subjective emotional responses were exceedingly high or low. These differences were not accounted for by depression or cognitive deterioration. We hypothesize that alcohol could be used to restore an optimal level of emotional arousal. This homeostatic function of alcohol is yet to be clearly assessed.

Acamprosate in the Treatment of Alcohol Dependence: A 6-Month Postdetoxification Study

Alcohol-dependent patients remain at high risk of relapsing during the first 6 months of the postdetoxification period (Hunt et al. 1971). There is fairly general consensus that the major objectives during this period are the maintenance of abstinence from alcohol (Marlatt and Gordon 1985), the patient’s return to a normal life, and preferably his or her establishing stable social and working conditions (Wallace et al. 1988). Many pharmacotherapeutic agents intended to assist the patient through this postdetoxification period are presently under evaluation (Lishow and Goodwin 1987; Litten and Allen 1991; Verbanck et al. 1993). Among them, disulfiram (Fuller et al. 1986), serotonergic agents (Naranjo and Bremner 1992) and naltrexone (Volpicelli et al. 1992; O’Malley et al. 1992) appear to be the most promising. However, the design of the trials performed to test the value of these compounds remained far removed from the “naturalistic” conditions of treatment of most alcoholic patients, and, for this reason, their value in common practice is still unclear.

Links between the number of sleep ultradian cycles and REMS duration: confirmation in rats.

Preferential links were found in previous studies between the number of sleep ultradian cycles (NCy) and the duration of rapid eye movement sleep (REMS), not the duration of non-REMS (NREMS). This was shown in healthy human controls [2], depressive patients [4], as well as in mice [3]. Furthermore, in the human control study, no relationship was found between the NCy and the intensity of sleep (slow wave activity). The present retrospective study performed on rats aimed to check whether these relationships could be generalized in another species. Sixteen male Sprague-Dawley rats, 250—300 g, were implanted with chronic electrodes under intraperitoneal chlornembutal 3 ml/kg anesthesia about 10 days before recordings began [5]. Each rat was housed in a 30 cm × 30 cm × 25 cm cage, placed within an 80 cm × 80 cm × 80 cm sound-isolated cube, under a light-dark schedule with lights on from 08:00 to 20:00 local time. Two cortical, one hippocampal and one muscle derivation were brought through a slip-ring assembly to a polygraph. A REMS cycle was defined as comprising one REMS episode and an adjacent interval without REMS. A smoothing procedure was used to incorporate isolated epochs into the surrounding stages. More details on the methodology can be found in Vivaldi et al.’s original paper (1994) [5]. The average daytime total sleep time was 453.2 min (24.8); mean NREMS was 365.4 min (26.1); mean REMS was 88.2 min (14.2); mean NCy was 79.4 (15.4). As in the previous cited studies, positive correlations were found between the NCy and REMS, not NREMS (Fig. 1). The positive correlation between the NCy and the ratio between REMS and NREMS indicates that the more numerous the ultradian cycles, the more REMS will be found in comparison with NREMS. We now have convergent data in two independent human samples as well as in two rodents species. The likelihood of a mammal invariant relationship is thus high, especially since it is now confirmed in both monophasic (humans) and polyphasic (rodents) sleep organizations. The first of the two main hypotheses about the ultradian cyclicity considers NREMS, and especially its deep sleep component (slow wave activity), to be the main drive for the cycling, REMS being permitted between hypothesized peaks [1]. The second hypothesis considers the opposite, i.e., REMS inhibits and interrupts a noncyclical NREMS several times in the night [5]. If REMS and NREMS compete against each other, the relative pressure for their expression should be translated into both duration of episodes and number of cycles. It seems reasonable to predict both a higher number of cycles and longer duration of episodes in cases of higher pressure for a sleep state and thus a positive link between these two variables. In any case, it seems more consistent for any sleep regulation mechanism to present with a link between the number of cycles and the duration of the concerned sleep state than with the other. The present data thus indirectly support that REMS is the primum movens in the alternation between the two sleep states.

Fluparoxan in male erectile disorder: a case report

During a protocol study for the efficacy of fluparoxan (a noradrenergic α2-antagonist) in depression, a positive effect on male erectile impotence has been observed in one case, with no important secondary effects. This result confirms the involvement of α2-antagonists in the handling of male impotence. The action on the erectile disorder appeared slightly before the antidepressive effect (2-3 weeks) and lasted for 6 weeks after the discontinuation of treatment, suggesting that the effects on impotence were not a mere reflection of the antidepressive action.

PW01-26 - Fatigue, sleepiness, sleep quality and their relationships to affective symptom intensity in sleep-disordered patients

Introduction Impaired sleep quality and dyssomnia disorders in particular have repeatedly been linked to affective symptoms. However reports about systematic assessments in larger study samples are generally lacking. Furthermore the associative relationships of fatigue and sleepiness complaints to sleep quality and affective symptoms are poorly described. Methods During a one-year period we recruited 570 patients (mean age 28(0.26), 287 males) attending the sleep laboratory of a general University Hospital. Psychometrics were performed using the Pittsburgh Sleep Quality Index (PSQI), the Hospital Anxiety and Depression Scale (HAD), the Fatigue Severity Scale (FSS) and the Epworth Sleepiness Scale (ESS). All patients underwent two consecutive nights of full polysomnographic recording (PSG). Results Both fatigue (FSS) and sleepiness (ESS) were related to affective symptoms (HAD, p Conclusions These results confirm the tight relations between sleep quality, daytime fatigue or sleepiness and affective symptoms. Residual fatigue is a common and invalidating complaint in mental disorders as major depression. Achievement of clinical remission can be compromised because of residual treatment resistant symptoms. PSG might be useful in certain conditions to rule out co-morbid sleep disorders and to orientate treatment attitudes.