The Neuropsychological and Emotional Profile of Adults with Parasomnia: A Case Series

Although parasomnias are nocturnal phenomena occurring during sleep or during arousals from sleep, there is increasing evidence that they are associated with daytime dysfunction as well. However, systematic studies in this field are scarce. The aim of the current case series was to investigate the sleep–wake, neuropsychological and emotional profiles of patients with parasomnias. Thirty patients with parasomnia (13 NREM, 17 REM) and 30 healthy subjects matched for age, sex and educational status were included. All participants underwent comprehensive neuropsychological, cognitive and behavioral evaluation. We found that parasomnia patients scored higher in all neuropsychological, emotional, sleep–wake and quality of life scales compared to healthy subjects. The presence of a parasomnia was associated with major impact on daytime functioning across several domains with increased levels of fatigue (FSS > 4) in 56%, sleepiness (ESS > 10) in 47%, depressive symptoms (BDI > 20) in 17%, anxiety (PSWQ > 52) in 17%, anger expression out (STAXI A > 16) in 27% and anger expression in (STAXI B > 16) in 23%, as well as a reduced average quality of life score (RAND derived from SF-36). Sleep–wake disturbances were significantly correlated with QoL scores. In the intergroup analysis between REM/NREM, we found that the REM group had worse cognitive performance and lower levels of fatigue/energy compared to NREM patients. These findings suggest that parasomnia is associated with difficulties in several aspects of daytime functioning (cognitive, affective/emotional and physical) and, therefore, parasomnia diagnostic workup should not be limited only to nocturnal phenomena

Psycho-social factors associated with mental resilience in the Corona lockdown.

The SARS-CoV-2 pandemic is not only a threat to physical health but is also having severe impacts on mental health. Although increases in stress-related symptomatology and other adverse psycho-social outcomes, as well as their most important risk factors have been described, hardly anything is known about potential protective factors. Resilience refers to the maintenance of mental health despite adversity. To gain mechanistic insights about the relationship between described psycho-social resilience factors and resilience specifically in the current crisis, we assessed resilience factors, exposure to Corona crisis-specific and general stressors, as well as internalizing symptoms in a cross-sectional online survey conducted in 24 languages during the most intense phase of the lockdown in Europe (22 March to 19 April) in a convenience sample of N = 15,970 adults. Resilience, as an outcome, was conceptualized as good mental health despite stressor exposure and measured as the inverse residual between actual and predicted symptom total score. Preregistered hypotheses (osf.io/r6btn) were tested with multiple regression models and mediation analyses. Results confirmed our primary hypothesis that positive appraisal style (PAS) is positively associated with resilience (p < 0.0001). The resilience factor PAS also partly mediated the positive association between perceived social support and resilience, and its association with resilience was in turn partly mediated by the ability to easily recover from stress (both p < 0.0001). In comparison with other resilience factors, good stress response recovery and positive appraisal specifically of the consequences of the Corona crisis were the strongest factors. Preregistered exploratory subgroup analyses (osf.io/thka9) showed that all tested resilience factors generalize across major socio-demographic categories. This research identifies modifiable protective factors that can be targeted by public mental health efforts in this and in future pandemics

Νευροψυχολογικά και συναισθηματικά χαρακτηριστικά των ασθενών με παραϋπνία

Although parasomnias are nocturnal phenomena that occur during sleep or during arousals from sleep, there is increasing evidence that they are associated with daytime impairment as well. However, studies on this field are scarce. The aim of the current study was to investigate the sleep-wake, neuropsychological and emotional profile of patients with parasomnias. Thirty patients with parasomnia (13 NREM, 17 REM) and 30 healthy subjects matched for age, gender and educational status were included. All participants underwent comprehensive neuropsychological, cognitive and behavioral evaluation. We found that parasomnia patients scored higher in all neuropsychological, emotional, sleep-wake and quality of life scales compared to healthy subjects. The presence of a parasomnia was associated with major impact on daytime functioning across several domains with increased levels of fatigue (FSS>4) in 56%, sleepiness (ESS>10) in 47%, depressive symptoms (BDI>20) in 17%, anxiety (PSWQ>52) in 17%, anger expression out (STAXI A>16) in 27%, anger expression in (STAXI B>16) in 23%, as well as with reduced average score of Quality of Life (assessed by the RAND scale, derived from SF-36). Sleep-wake disturbances were significantly correlated with quality of life scores. These findings suggest that parasomnia is associated with difficulties in several aspects of daytime functioning (cognitive, affective/emotional and physical) and, therefore, parasomnia diagnostic workup should not be limited only to nocturnal phenomena.Αν και οι παραϋπνίες είναι νυχτερινά φαινόμενα που συμβαίνουν κατά τη διάρκεια του ύπνου ή κατά τη διάρκεια της αφύπνισης από τον ύπνο, υπάρχουν αυξανόμενες ενδείξεις ότι σχετίζονται και με ημερήσια συμπτώματα. Ωστόσο, οι συστηματικές μελέτες σε αυτό το πεδίο είναι σπάνιες. Σκοπός της παρούσας μελέτης ήταν η διερεύνηση του ύπνου-εγρήγορσης, του νευροψυχολογικού και συναισθηματικού προφίλ των ασθενών με παραϋπνίες. Στην συγκεκριμένη εργασία συμπεριελήφθησαν 30 ασθενείς με παραϋπνία (13 NREM, 17 REM) και 30 υγιή άτομα αντίστοιχα ως προς την ηλικία, το φύλο και την εκπαιδευτική κατάσταση. Όλοι οι συμμετέχοντες υποβλήθηκαν σε ολοκληρωμένη νευροψυχολογική, και συμπεριφορική αξιολόγηση. Βρέθηκε ότι οι ασθενείς με παραϋπνία σημείωσαν χειρότερη επίδοση σε όλες τις κλίμακες νευροψυχολογίας, συναισθηματικής κατάστασης, ύπνου-εγρήγορσης και ποιότητας ζωής σε σύγκριση με τα υγιή άτομα. Η παρουσία της παραϋπνίας συσχετίστηκε με σημαντικό αντίκτυπο στην ημερήσια λειτουργία σε διάφορους τομείς, συγκεκριμένα με αυξημένα επίπεδα κόπωσης (FSS>4) στο 56%, υπνηλία (ESS>10) στο 47%, καταθλιπτικά συμπτώματα (BDI>20) στο 17%, άγχος (PSWQ>52) στο 17%, εξωτερίκευση της έκφρασης θυμού (STAXI A>16) στο 27%, εσωτερίκευση έκφρασης θυμού (STAXI B>16) στο 23%, καθώς και με μειωμένη μέση βαθμολογία ποιότητας ζωής (κλίμακα RAND, προερχόμενη από το ερωτηματολόγιο SF-36). Οι διαταραχές ύπνου-εγρήγορσης βρέθηκε να συσχετίζονται σημαντικά με τις βαθμολογίες ποιότητας ζωής. Αυτά τα ευρήματα υποδηλώνουν ότι η παραϋπνία σχετίζεται με δυσκολίες σε διάφορες πτυχές της ημερήσιας λειτουργικότητας (νοητική, συναισθηματική και σωματική) και, ως εκ τούτου, η διαγνωστική εξέταση της παραϋπνίας δεν πρέπει να περιορίζεται μόνο στην διερεύνηση των νυχτερινών συμπτωμάτων και εκδηλώσεων

Neuropsychological and emotional characteristics of patients with parasomnia

Αν και οι παραϋπνίες είναι νυχτερινά φαινόμενα που συμβαίνουν κατά τη διάρκεια του ύπνου ή κατά τη διάρκεια της αφύπνισης από τον ύπνο, υπάρχουν αυξανόμενες ενδείξεις ότι σχετίζονται και με ημερήσια συμπτώματα. Ωστόσο, οι συστηματικές μελέτες σε αυτό το πεδίο είναι σπάνιες. Σκοπός της παρούσας μελέτης ήταν η διερεύνηση του ύπνου-εγρήγορσης, του νευροψυχολογικού και συναισθηματικού προφίλ των ασθενών με παραϋπνίες. Στην συγκεκριμένη εργασία συμπεριελήφθησαν 30 ασθενείς με παραϋπνία (13 NREM, 17 REM) και 30 υγιή άτομα αντίστοιχα ως προς την ηλικία, το φύλο και την εκπαιδευτική κατάσταση. Όλοι οι συμμετέχοντες υποβλήθηκαν σε ολοκληρωμένη νευροψυχολογική, και συμπεριφορική αξιολόγηση. Βρέθηκε ότι οι ασθενείς με παραϋπνία σημείωσαν χειρότερη επίδοση σε όλες τις κλίμακες νευροψυχολογίας, συναισθηματικής κατάστασης, ύπνου-εγρήγορσης και ποιότητας ζωής σε σύγκριση με τα υγιή άτομα. Η παρουσία της παραϋπνίας συσχετίστηκε με σημαντικό αντίκτυπο στην ημερήσια λειτουργία σε διάφορους τομείς, συγκεκριμένα με αυξημένα επίπεδα κόπωσης (FSS&gt;4) στο 56%, υπνηλία (ESS&gt;10) στο 47%, καταθλιπτικά συμπτώματα (BDI&gt;20) στο 17%, άγχος (PSWQ&gt;52) στο 17%, εξωτερίκευση της έκφρασης θυμού (STAXI A&gt;16) στο 27%, εσωτερίκευση έκφρασης θυμού (STAXI B&gt;16) στο 23%, καθώς και με μειωμένη μέση βαθμολογία ποιότητας ζωής (κλίμακα RAND, προερχόμενη από το ερωτηματολόγιο SF-36). Οι διαταραχές ύπνου-εγρήγορσης βρέθηκε να συσχετίζονται σημαντικά με τις βαθμολογίες ποιότητας ζωής. Αυτά τα ευρήματα υποδηλώνουν ότι η παραϋπνία σχετίζεται με δυσκολίες σε διάφορες πτυχές της ημερήσιας λειτουργικότητας (νοητική, συναισθηματική και σωματική) και, ως εκ τούτου, η διαγνωστική εξέταση της παραϋπνίας δεν πρέπει να περιορίζεται μόνο στην διερεύνηση των νυχτερινών συμπτωμάτων και εκδηλώσεων.Although parasomnias are nocturnal phenomena that occur during sleep or during arousals from sleep, there is increasing evidence that they are associated with daytime impairment as well. However, studies on this field are scarce. The aim of the current study was to investigate the sleep-wake, neuropsychological and emotional profile of patients with parasomnias. Thirty patients with parasomnia (13 NREM, 17 REM) and 30 healthy subjects matched for age, gender and educational status were included. All participants underwent comprehensive neuropsychological, cognitive and behavioral evaluation. We found that parasomnia patients scored higher in all neuropsychological, emotional, sleep-wake and quality of life scales compared to healthy subjects. The presence of a parasomnia was associated with major impact on daytime functioning across several domains with increased levels of fatigue (FSS&gt;4) in 56%, sleepiness (ESS&gt;10) in 47%, depressive symptoms (BDI&gt;20) in 17%, anxiety (PSWQ&gt;52) in 17%, anger expression out (STAXI A&gt;16) in 27%, anger expression in (STAXI B&gt;16) in 23%, as well as with reduced average score of Quality of Life (assessed by the RAND scale, derived from SF-36). Sleep-wake disturbances were significantly correlated with quality of life scores. These findings suggest that parasomnia is associated with difficulties in several aspects of daytime functioning (cognitive, affective/emotional and physical) and, therefore, parasomnia diagnostic workup should not be limited only to nocturnal phenomena

Update on non-pharmacological interventions in parasomnias.

Parasomnias are abnormal behaviors that occur during the sleep and can be associated, in particular during adulthood, with impaired sleep quality, daytime dysfunction and occasionally with violent and harmful nocturnal behaviors. In these cases, therapies are often considered. Pharmacological treatments are invasive and often have limited efficacy. Therefore, behavioral approaches remain an important treatment option for several types of parasomnias. However, the evidence-based approaches are limited. In the current review, we highlight results from various non-pharmacological techniques on different types of parasomnias and provide a glimpse into the future of non-pharmacological treatments in this field

Apathy in Parkinson's disease with REM sleep behavior disorder.

OBJECTIVES Rapid eye movement (REM) sleep behavior disorder (RBD) in patients with Parkinson's disease (PD) is associated with increased risk of non-motor symptoms. However, the association between RBD and apathy in PD remains unclear. AIMS To compare the prevalence and severity of apathy symptoms in PD patients with RBD (PD-RBD+) and without (PD-RBD-). In addition, we explored the association between apathy, depressive symptoms and RBD, taking into consideration the concomitant influence of demographic, disease- and therapy-associated variables. METHODS Sixty-four PD patients were evaluated with systematic motor (unified Parkinson's disease rating scale, UPDRS-III) and non-motor assessments. The diagnosis of RBD was based on the international consensus criteria using video-polysomnography. Apathy, sleepiness, depressive symptoms and cognitive performance were assessed using the Starkstein apathy (SAS, cut-off = 14), the Epworth sleepiness (ESS), the Hamilton depression (HAM-D, cut-off = 9) scales and the mini-mental state examination (MMSE), respectively. RESULTS Among 64 patients, 26 (40%) had RBD. In the PD-RBD+ group, apathy symptoms were more frequent (52% vs 42%) and more severe (14.3 ± 5.8 vs 11.2 ± 4.9, p < 0.05), especially in the females (17.3 ± 6.0 vs 11.4 ± 5.8 in males, p < 0.05) compared to the PD-RBD- group. A high percentage of patients, especially in the PD-RBD+ group (53%), had isolated apathy without increased depressive symptoms. Increased depressive symptoms were also more frequent (50% vs 20%) and more severe in the PD-RBD+ group. The two groups were comparable in respect to demographic and clinical characteristics. CONCLUSIONS In PD, RBD is associated with isolated apathy and increased severity of depressive symptoms, independent of medication, motor and other non-motor symptoms. Potential mechanisms underlying this association are discussed

Effects of bilateral stimulation of the subthalamic nucleus in Parkinson's disease with and without REM sleep behaviour disorder.

BACKGROUND Although rapid eye movement sleep behaviour disorder (RBD) in Parkinson's disease (PD) is associated with increased non-motor symptoms, its impact on the deep brain stimulation (DBS) outcome remains unclear. This is the first study to compare the post-DBS outcome between PD patients with RBD (PD-RBD+) and without (PD-RBD-). METHODS We analysed data from PD patients who were treated with bilateral DBS in the nucleus subthalamicus. Assessments included night-polysomnography (only pre-DBS), and motor and non-motor assessments pre-DBS and post-DBS. RESULTS Among 50 PD patients (29 males, mean age 62.5 years, 11.8 mean PD years), 24 (48%) had RBD. Pre-DBS, the two groups were equal in respect to sociodemographic features, disease duration and PD medications. A multivariate analysis showed that the clinical profile linked to motor, non-motor and quality of life features differed significantly between PD patients with and without RBD. The most discriminative elements were Unified Parkinson's Disease Rating Scale (UPDRS)-III, apathy and depression scores. Post-DBS, UPDRS-III, Epworth sleepiness scale and PD questionnaire improved significantly in both groups. UPDRS-II scores significantly improved in the PD-RBD+ group (-45%) but remained unchanged in the PD-RBD- group (-14%). The depression score improved significantly in the PD-RBD+ (-34%) and remained unchanged in the PD-RBD- group. The apathy score remained unchanged in the PD-RBD+ group but increased significantly in the PD-RBD- group (+33%). CONCLUSION While pre-DBS, PD patients with and without RBD showed different clinical profiles, post-DBS, the clinical profiles were comparable between the two groups. In respect to depressive symptoms, apathy and activities of daily living, PD-RBD+ patients show favourable post-DBS outcome. These findings highlight the importance of RBD assessment prior to DBS surgery

Psycho-social factors associated with mental resilience in the Corona lockdown.

The SARS-CoV-2 pandemic is not only a threat to physical health but is also having severe impacts on mental health. Although increases in stress-related symptomatology and other adverse psycho-social outcomes, as well as their most important risk factors have been described, hardly anything is known about potential protective factors. Resilience refers to the maintenance of mental health despite adversity. To gain mechanistic insights about the relationship between described psycho-social resilience factors and resilience specifically in the current crisis, we assessed resilience factors, exposure to Corona crisis-specific and general stressors, as well as internalizing symptoms in a cross-sectional online survey conducted in 24 languages during the most intense phase of the lockdown in Europe (22 March to 19 April) in a convenience sample of N = 15,970 adults. Resilience, as an outcome, was conceptualized as good mental health despite stressor exposure and measured as the inverse residual between actual and predicted symptom total score. Preregistered hypotheses (osf.io/r6btn) were tested with multiple regression models and mediation analyses. Results confirmed our primary hypothesis that positive appraisal style (PAS) is positively associated with resilience (p < 0.0001). The resilience factor PAS also partly mediated the positive association between perceived social support and resilience, and its association with resilience was in turn partly mediated by the ability to easily recover from stress (both p < 0.0001). In comparison with other resilience factors, good stress response recovery and positive appraisal specifically of the consequences of the Corona crisis were the strongest factors. Preregistered exploratory subgroup analyses (osf.io/thka9) showed that all tested resilience factors generalize across major socio-demographic categories. This research identifies modifiable protective factors that can be targeted by public mental health efforts in this and in future pandemics

Psycho-social factors associated with mental resilience in the Corona lockdown

The SARS-CoV-2 pandemic is not only a threat to physical health but is also having severe impacts on mental health. While increases in stress-related symptomatology and other adverse psycho-social outcomes as well as their most important risk factors have been described, hardly anything is known about potential protective factors. Resilience refers to the maintenance of mental health despite adversity. In order to gain mechanistic insights about the relationship between described psycho-social resilience factors and resilience specifically in the current crisis, we assessed resilience factors, exposure to Corona crisis-specific and general stressors, as well as internalizing symptoms in a cross-sectional online survey conducted in 24 languages during the most intense phase of the lockdown in Europe (March 22nd to April 19th) in a convenience sample of N=15,970 adults. Resilience, as an outcome, was conceptualized as good mental health despite stressor exposure and measured as the inverse residual between actual and predicted symptom total score. Preregistered hypotheses (osf.io/r6btn) were tested with multiple regression models and mediation analyses. Results confirmed our primary hypothesis that positive appraisal style (PAS) is positively associated with resilience (p&lt;0.0001). The resilience factor PAS also partly mediated the positive association between perceived social support and resilience, and its association with resilience was in turn partly mediated by the ability to easily recover from stress (both p&lt;0.0001). In comparison with other resilience factors, good stress response recovery and positive appraisal specifically of the consequences of the Corona crisis were the strongest factors. Preregistered exploratory subgroup analyses (osf.io/thka9) showed that all tested resilience factors generalize across major socio-demographic categories. This research identifies modifiable protective factors that can be targeted by public mental health efforts in this and in future pandemics

Psycho-social factors associated with mental resilience in the Corona lockdown

Funder: State of Rhineland-Palatinate, Germany (MARP program, DRZ program, Leibniz Institute for Resilience Research)Abstract: The SARS-CoV-2 pandemic is not only a threat to physical health but is also having severe impacts on mental health. Although increases in stress-related symptomatology and other adverse psycho-social outcomes, as well as their most important risk factors have been described, hardly anything is known about potential protective factors. Resilience refers to the maintenance of mental health despite adversity. To gain mechanistic insights about the relationship between described psycho-social resilience factors and resilience specifically in the current crisis, we assessed resilience factors, exposure to Corona crisis-specific and general stressors, as well as internalizing symptoms in a cross-sectional online survey conducted in 24 languages during the most intense phase of the lockdown in Europe (22 March to 19 April) in a convenience sample of N = 15,970 adults. Resilience, as an outcome, was conceptualized as good mental health despite stressor exposure and measured as the inverse residual between actual and predicted symptom total score. Preregistered hypotheses (osf.io/r6btn) were tested with multiple regression models and mediation analyses. Results confirmed our primary hypothesis that positive appraisal style (PAS) is positively associated with resilience (p < 0.0001). The resilience factor PAS also partly mediated the positive association between perceived social support and resilience, and its association with resilience was in turn partly mediated by the ability to easily recover from stress (both p < 0.0001). In comparison with other resilience factors, good stress response recovery and positive appraisal specifically of the consequences of the Corona crisis were the strongest factors. Preregistered exploratory subgroup analyses (osf.io/thka9) showed that all tested resilience factors generalize across major socio-demographic categories. This research identifies modifiable protective factors that can be targeted by public mental health efforts in this and in future pandemics