Pekka Tani

Insomnia is a frequent finding in adults with Asperger syndrome

BackgroundAsperger syndrome (AS) is a neurodevelopmental disorder belonging to autism spectrum disorders with prevalence rate of 0,35% in school-age children. It has been most extensively studied in childhood while there is scarcity of reports concerning adulthood of AS subjects despite the lifelong nature of this syndrome. In children with Asperger syndrome the initiation and continuity of sleep is disturbed because of the neuropsychiatric deficits inherent of AS. It is probable that sleep difficulties are present in adulthood as well. Our hypothesis was that adults with AS suffer from difficulty in initiating and maintaining sleep and nonrestorative sleep (insomnia).Methods20 AS without medication were compared with 10 healthy controls devoid of neuropsychiatric anamnesis. Clinical examination, blood test battery and head MRI excluded confounding somatic illnesses. Structured psychiatric interview for axis-I and axis-II disorders were given to both groups as well as Beck Depression Inventory and Wechsler adult intelligence scale, revised version.Sleep quality was assessed with sleep questionnaire, sleep diary during 6 consecutive days and description of possible sleep problems by the participants own words was requested.Resultscompared with controls and with normative values of good sleep, AS adults had frequent insomnia. In sleep questionnaire 90% (18/20), in sleep diary 75% (15/20) and in free description 85% (17/20) displayed insomnia. There was a substantial psychiatric comorbidity with only 4 AS subject devoid of other axis-I or axis-II disorders besides AS. Also these persons displayed insomnia. It can be noted that the distribution of psychiatric diagnoses in AS subjects was virtually similar to that found among patient with chronic insomnia.Conclusionsthe neuropsychiatric deficits inherent of AS predispose both to insomnia and to anxiety and mood disorders. Therefore a careful assessment of sleep quality should be an integral part of the treatment plan in these individuals. Conversely, when assessing adults with chronic insomnia the possibility of autism spectrum disorders as one of the potential causes of this condition should be kept in mind.

Human impulsive aggression: a sleep research perspective.

Impulsive aggression is commonly associated with personality disorders, in particular antisocial and borderline personality disorders as well as with conduct disorder and intermittent explosive disorder. The relationship between impulsive aggression and testosterone is well established in many studies. One of the aims of this study was to characterize the relationship between earlier-mentioned different categorical psychiatric diagnosis describing human impulsive aggression and sleep using polysomnography and spectral power analysis. Another aim was to study the relationship between serum testosterone and sleep in persons with severe aggressive behaviour. Subjects for the study were 16 males charged with highly violent offences and ordered for a pretrial forensic psychiatric examination. The antisocials with borderline personality disorder comorbidity had significantly more awakenings and lower sleep efficiency compared with the subjects with only antisocial personality disorder. The subjects with severe conduct disorder in childhood anamnesis had higher amount of S4 sleep and higher relative theta and delta power in this sleep stage compared with males with only mild or moderate conduct disorder. The same kind of sleep architecture was associated with intermittent explosive disorder. In subgroups with higher serum testosterone levels also the amount of S4 sleep and the relative theta and delta power in this sleep stage were increased. The study gives further support to the growing evidence of brain dysfunction predisposing to severe aggressive behaviour and strengthens the view that there are different subpopulations of individuals with antisocial personality varying in impulsiveness. The differences in impulsiveness are reflected in sleep architecture as well.

Inverse correlation between severity of psychopathic traits and serum cortisol levels in young adult violent male offenders

The aim of the present study was to fi nd out if there is an association between the severity of psychopathic traits and S cortisol levels in young adult violent male offenders. We recruited 20 healthy, detoxifi ed, medication-free adolescent and young adult (age range 16–22 years, mean 18.9, SD 1.77) male offenders with a history of violent acts. They were charged with either murder, manslaughter, attempted murder, attempted manslaughter or assault, and were recruited from a pre-trial forensic psychiatric examination lasting approximately 2 months. None of the participants had an acute mood disorder, psychosis or organic brain syndrome. All of the participants fulfi lled criteria for antisocial personality disorder. Psychopathy was assessed using the 20-item Hare Psychopathy Checklist-Revised (PCL-R), a semi-structured interview, which includes also a review of fi le information. Each item is rated on a 3-point scale, with a total score of the scale ranging from 0 to 40. The PCL-R reportedly consists of two factors; factor 1 taps affective-interpersonal features and factor 2 socially deviant lifestyle and behaviors [1] . The PCL-R rating was based on the consensus of a team of a forensic psychiatrist, a social worker and a clinically experienced psychologist. The internal consistency of the PCL-R was checked by calculating Cronbach’s coeffi Psychopathy is a clinical construct traditionally defi ned by a constellation of interpersonal and affective characteristics that are associated with a socially deviant lifestyle [1] . Criminal psychopaths typically begin their antisocial and criminal activities at a relatively early age, and continue throughout much of their lives [2] . The neurobiological correlates of criminal psychopathy are relatively unknown. Psychopathy has been associated with low level of both autonomic and cortical arousal [3] . Psychopaths are reported to be under-reactive to stressful, exciting or frightening stimuli and insensitive to several types of fear and punishment contingencies [4] . The limbic system, the neural basis for emotions and social interactions [5] , infl uences functions of both the hypothalamus and the pituitary gland [6] . Many kinds of psychological stress have been shown to affect the level of pituitary-adrenal activity [7] . The HPA axis meets the demands of stress primarily through the synthesis and/or release of corticotropin-releasing hormone, adrenocorticotropic hormone and cortisol [7] . These HPA axis hormones may refl ect alterations of the limbic system functioning in individuals with criminal psychopathy. More specifi cally, the degree of psychopathic tendencies might be refl ected in serum (S) cortisol levels as a sign of reactivity to stress in forensic population. Published online: January 17, 2006

Sleep in Young Adults with Asperger Syndrome

Asperger syndrome (AS) is a neurodevelopmental disorder belonging to autism spectrum disorders. Both children and adults with AS have subjective impairment in the initiation and continuity of sleep, and studies using objective assessment are sparse. Twenty young AS adults with frequent complaints of low sleep quality were compared to 10 age-, gender- and education-matched controls without sleep complaints using polysomnography and spectral power analysis of slow-wave sleep. AS subjects displayed a similar polysomnographic profile as compared with controls. In spectral power analysis, a statistically nonsignificant trend towards decreased relative delta power and increased theta power in slow-wave sleep was found in the AS group. It seems that nonorganic insomnia, due to anxiety inherent in AS, is responsible for the low sleep quality in these subjects.

Asperger Syndrome, Alexithymia and Perception of Sleep

Two research traditions, the one on Asperger syndrome (AS) and the other on alexithymia, have produced similar findings independently of each other indicating a possible association between these two phenomena. Both conditions are also associated with impaired initiation and continuity of sleep. Twenty AS adults were compared with 10 healthy controls using the Toronto Alexithymia Scale and the Basic Nordic Sleep Questionnaire. AS subjects were significantly more alexithymic and reported lower sleep quality as compared with controls. AS and alexithymia are associated although the mediating factors are unknown. It is possible that alexithymic traits predispose to anxiety, which in turn lowers the sleep quality in AS adults. Alternatively, low sleep quality might be due to AS itself.

Quantitative electroencephalographic measures in homicidal men with antisocial personality disorder

Many symptoms of antisocial personality disorder have been proposed to be related to decreased daytime vigilance. To explore this hypothesis, quantitative analyses were conducted of the electroencephalographic (EEG) activity of drug-free and detoxified homicidal male offenders with antisocial personality disorder as the primary diagnosis. Subjects comprised 16 men recruited from a forensic psychiatric examination in a special ward of a university psychiatric hospital. Fifteen healthy age- and gender-matched controls with no criminal record or history of physical violence consisted of hospital staff and students. An overall reduction of alpha power was observed in the waking EEG of offenders. A bilateral increase in occipital delta and theta power was also found in these individuals. This study provides further support to the growing evidence of brain dysfunction in severe aggressive behavior. Homicidal offenders with antisocial personality disorder seem to have difficulties in maintaining normal daytime arousal. Decreased vigilance, together with social and psychological variables, may explain their aberrant behavior in everyday life. New studies are, however, needed to specify the vigilance problems of this patient group.

The brains of high functioning autistic individuals do not synchronize with those of others

Multifaceted and idiosyncratic aberrancies in social cognition characterize autism spectrum disorders (ASDs). To advance understanding of underlying neural mechanisms, we measured brain hemodynamic activity with functional magnetic resonance imaging (fMRI) in individuals with ASD and matched-pair neurotypical (NT) controls while they were viewing a feature film portraying social interactions. Pearsons correlation coefficient was used as a measure of voxelwise similarity of brain activity (InterSubject Correlations—ISCs). Individuals with ASD showed lower ISC than NT controls in brain regions implicated in processing social information including the insula, posterior and anterior cingulate cortex, caudate nucleus, precuneus, lateral occipital cortex, and supramarginal gyrus. Curiously, also within NT group, autism-quotient scores predicted ISC in overlapping areas, including, e.g., supramarginal gyrus and precuneus. In ASD participants, functional connectivity was decreased between the frontal pole and the superior frontal gyrus, angular gyrus, superior parietal lobule, precentral gyrus, precuneus, and anterior/posterior cingulate gyrus. Taken together these results suggest that ISC and functional connectivity measure distinct features of atypical brain function in high-functioning autistic individuals during free viewing of acted social interactions. Our ISC results suggest that the minds of ASD individuals do not ‘tick together’ with others while perceiving identical dynamic social interactions.

Reorganization of functionally connected brain subnetworks in high-functioning autism

Previous functional connectivity studies have found both hypo‐ and hyper‐connectivity in brains of individuals having autism spectrum disorder (ASD). Here we studied abnormalities in functional brain subnetworks in high‐functioning individuals with ASD during free viewing of a movie containing social cues and interactions. Twenty‐six subjects (13 with ASD) watched a 68‐min movie during functional magnetic resonance imaging. For each subject, we computed Pearsons correlation between haemodynamic time‐courses of each pair of 6‐mm isotropic voxels. From the whole‐brain functional networks, we derived individual and group‐level subnetworks using graph theory. Scaled inclusivity was then calculated between all subject pairs to estimate intersubject similarity of connectivity structure of each subnetwork. Additional 54 individuals (27 with ASD) from the ABIDE resting‐state database were included to test the reproducibility of the results. Between‐group differences were observed in the composition of default‐mode and ventro‐temporal‐limbic (VTL) subnetworks. The VTL subnetwork included amygdala, striatum, thalamus, parahippocampal, fusiform, and inferior temporal gyri. Further, VTL subnetwork similarity between subject pairs correlated significantly with similarity of symptom gravity measured with autism quotient. This correlation was observed also within the controls, and in the reproducibility dataset with ADI‐R and ADOS scores. Our results highlight how the reorganization of functional subnetworks in individuals with ASD clarifies the mixture of hypo‐ and hyper‐connectivity findings. Importantly, only the functional organization of the VTL subnetwork emerges as a marker of inter‐individual similarities that co‐vary with behavioral measures across all participants. These findings suggest a pivotal role of ventro‐temporal and limbic systems in autism. Hum Brain Mapp 37:1066–1079, 2016.

Adult Dyslexia and Attention Deficit Disorder in Finland—Project DyAdd: WAIS-III Cognitive Profiles

The project Adult Dyslexia and Attention Deficit Disorder in Finland (Project DyAdd) compares adults (n = 119, 18—55 years) with dyslexia, attention-deficit/hyperactivity disorder (ADHD), dyslexia together with ADHD (comorbid), and healthy controls with neuropsychological, psychophysical, and biological methods. The focus of this article is on the Wechsler Adult Intelligence Scale—Third Edition (WAIS-III). The clinical groups performed well compared to the norms, and they did not differ from each other. However, compared to the controls, all of them were slightly poorer in their Full IQ, and of the factors, processing speed was relatively difficult for all of them. In addition to the group comparisons, a cluster analysis based on subtest scores was conducted over the clinical groups. It did not suggest a solution that would differentiate between the clinical groups. Instead, four clusters emerged: above average, average, poor perceptual organization, and poor working memory. Thus, differentiating between these clinical groups with the WAIS-III was not possible. However, all of them shared a relative difficulty in processing speed, and group-independent clusters with perceptual or memory difficulties emerged.

Clinical neurological abnormalities in young adults with Asperger syndrome

Abstract  Children with Asperger syndrome (AS), a neurodevelopmental disorder falling in the autism spectrum disorders, have an increased rate of neurological abnormalities, especially in motor coordination. While AS is a lifelong condition, little is known about the persistence of neurological abnormalities in adulthood. Twenty young adults with AS were compared with 10 healthy controls using a structured clinical neurological rating scale. The score for neurological abnormalities was higher in the AS group. In addition, a subscore for neurological soft signs indicating defective functioning of the central nervous system with a non‐localizing value was significantly higher in the AS subjects. This preliminary study indicates that neurological abnormalities, soft signs in particular, represent a non‐specific vulnerability factor for AS. Consistent with other features of AS, neurological abnormalities seem to persist into adulthood.