Systematic evaluation of Axis-I DSM diagnoses in delayed sleep phase disorder and evening-type circadian preference

Abstract

Background Alterations in circadian rhythms can have profound effects on mental health. High co-morbidity for psychiatric disorders has been observed in patients with circadian rhythm disorders, such as delayed sleep phase disorder (DSPD) and in those with an evening-type circadian preference. The aim of this study was to systematically determine the prevalence and type of DSM IV AXIS-I disorders in those with DSPD compared to evening-type controls. Methods Forty-eight DSPD and 25 evening-type participants took part in this study. Sleep and wake parameters were assessed with actigraphy, diary and questionnaires (Pittsburgh Sleep Quality Index (PSQI) and Functional Outcomes of Sleep Questionnaire (FOSQ)). Evening-type preference was defined by the Horne-Ostberg questionnaire. DSPD was determined by interview according to International Classification of Sleep Disorders criteria. Current and past diagnosis of psychiatric disorders were assessed with a Structured Clinical Interview for DSM-IV disorders. Results DSPD was associated with a later wake time, longer sleep time, higher PSQI score, lower Horne-Ostberg and FOSQ scores compared to evening-types. There were no significant differences in the prevalence or type of AXIS-I disorders between those with DSPD or evening type preference. Over 70% of participants met criteria for at least one past AXIS-I disorder. Approximately 40% of both the DSPD and evening-types met criteria for a past diagnosis of mood, anxiety (most frequently phobia) or substance use disorders. Evening types were more likely to have a past diagnosis of more that one AXIS-I disorder. Conclusions These results highlight the important link between circadian rhythms and mental disorders. Specifically, an evening circadian chronotype regardless of DSPD status is associated with a risk for anxiety, depressive or substance use disorders.

Circadian Typology and Emotional Intelligence in Healthy Adults

“…Morning-type subjects pay lower attention to emotional states than evening-and neithertype. Taking into account that higher levels of emotional attention are associated with the development of ruminative thoughts, as well as with depressive and anxiety symptomatology (Fernández-Berrocal et al, 2006;Salguero et al, 2013), it would seem that morning-type subjects are in a less vulnerable, or more protective, situation to face these disorders than the neither-and evening-type, as it has been suggested in previous studies (Adan et al, 2012;Hsu et al, 2012;Kitamura et al, 2010;Reid et al, 2012). In addition, circadian typology modulates the results attributed to sex in emotional attention, where only morning-type men showed a lower level and, therefore, the possibility to be more resistant to affective and anxiety problems.…”

Duration and Timing of Sleep are Associated with Repetitive Negative Thinking

“…Similarly, pending replication, making sure that sleep is obtained during the right time of day may be an inexpensive and easily disseminable intervention for individuals bothered by intrusive thoughts. Such interventions would build from evidence that individuals with OCD, depression, and anxiety disorders are at heightened odds for circadian disruptions characterized by an inability to go to sleep until late (delayed sleep phase disorder; DSPD; Mukhopadhyay et al 2008;Turner et al 2007;Abe et al 2011;Reid et al 2012;Schubert and Coles 2013).…”

“…Indeed, many disorders characterized by RNT tend to onset during young adulthood (Kessler et al 2007;Kessler et al 2005), a period also associated with delays in sleep timing (Carskadon 2011;Pelayo et al 1988). Recent studies have documented heightened rates of OCD, depression, and generalized anxiety disorder in individuals with delayed bedtimes (Abe et al 2011;Reid et al 2012;Schubert and Coles 2013). In addition, eveningness (Horne and Ostberg 1976), a trait preference for a sleep/wake schedule that is skewed later in the day, has also been found to be related to measures of mental health (Chelminski et al 1999;Hidalgo et al 2009;Randler 2011).…”

Out of synch with society

“…A South Korean survey of over 300 patients with DSPD with matched controls of normal chronotype suggested that seasonal affective disorder was 3.3 times more prevalent in the DSPD group [26], complementing the earlier concept of the phase-shift hypothesis in winter depression [27]. An investigation of systematic psychiatric evaluations in 73 adults with either DSPD or extreme evening chronotype found 70% to have a diagnosable axis 1 psychiatric disorder according to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders [28].…”