Major depressive disorder (MDD) is frequently accompanied by sleep disturbance. Regarding diurnal preference (chronotype), sleep problems and low mood have been associated with evening orientation. Considering diurnal preference, we investigated subjective restorative value of sleep and actigraphy sleep parameters together with mood assessments twice a day, i.e. in the morning and evening, during weekdays and weekends in MDD psychiatric inpatients and healthy controls (HCs). The restorative value of sleep was higher during the weekend in HC, and bedtimes and risetimes were delayed during the weekend compared to weekdays in HC and MDD. Morning mood affected subjective sleep ratings in both groups, while association with symptom severity (BDI) in MDD remained insignificant. In HC, better evening mood was associated with later bedtimes. Regarding the chronotype in HC, evening orientation was associated with relatively low restorative value of sleep during weekdays, and morning orientation was associated with relatively higher actigraphy sleep efficiency during weekdays compared to weekend. In MDD, an association of evening orientation with later rise times could be observed, while no chronotype dependent effect emerged regarding the restorative value of sleep or sleep efficiency. Our results emphasize that research on sleep in MDD should incorporate weekdays as well as weekends, chronotype assessment, and measures of morning and evening mood, as these can be associated with ratings of the subjective restorative value of sleep (i.e. in our study, better morning mood was associated with higher restorative values), but also with behavioral sleep parameters (i.e. in our study, more positive evening mood was associated with later bedtimes). Potentially, the restorative value of sleep in MDD evening types can be improved by maintaining a regular sleep schedule, which needs to be investigated in an experimental design.

Demenzen sind häufig von Schlafstörungen begleitet, wobei deren Diagnostik mit subjektiven Verfahren diskrepant zu objektiven Methoden ausfallen kann. Die Häufigkeit und klinischen Charakteristika von Patienten, deren subjektive Schlafeffizienz als unbeeinträchtigt erlebt wird und mit einer objektiv auffälligen Schlafeffizienz im Sinne einer Überschätzung kontrastiert, wurde an einer Gedächtnissprechstunde untersucht. An 2 aufeinanderfolgenden Tagen wurde eine leitlinienorientierte Demenzdiagnostik (inkl. Mini-Mental Status Examination, MMSE, und Clinical Dementia Rating, CDR) umgesetzt, ergänzt um eine subjektive (Pittsburgh Sleep Quality Index, PSQI) und objektive (Aktigraphie einer Nacht) Erfassung des Schlafs. Eine Überschätzung der Schlafeffizienz war definiert als eine subjektive Schlafeffizienz (SSE) ≥85

Experimental studies highlight profound effects of sleep disruptions on pain, showing that sleep deprivation (SD) leads to hyperalgesic pain changes. On the other hand, given that sleep helps normalizing bodily functions, a crucial role of restorative sleep in the overnight restoration of the pain system seems likely. Thus, a systematic review of experimental studies on effects of recovery sleep (RS; subsequently to SD) on pain was performed with the aim to check whether RS resets hyperalgesic pain changes occurring due to SD. Empirical animal and human studies including SD-paradigms, RS and pain assessments were searched in three databases (PubMed, Web of Science, PsycINFO) using a predefined algorithm. 29 studies were included in this review. Most results indicated a reset of enhanced pain sensitivity and vulnerability following RS, especially when total SD was implemented and pressure pain or painful symptoms (human studies) were assessed. Further research should focus on whether and how recovery is altered in chronic pain patients, as this yields implications for pain treatment by enhancing or stabilizing RS.

Depression risk is associated with a late chronotype pattern often described as an 'evening chronotype'. Fluctuations in mood over consecutive days have not yet been measured according to chronotype in in-patients with depression. A total of 30 in-patients with depression and 32 healthy controls matched for gender and age completed a chronotype questionnaire and twice-daily ratings on mood for 10 consecutive days (registered in the German Clinical Trials Register: DRKS00010215). The in-patients had Saturdays and Sundays as hospital-leave days. The relationship between chronotype and daily mood was mediated by the weekday-weekend schedule with higher levels of negative affect in the evening-chronotype patient subgroup at weekends. Results are discussed with respect to a probably advantageous standardised clinical setting with early morning routines, especially for patients with evening chronotypes.

Cognitive impairments are well documented in major depressive disorder (MDD), however, they cannot be fully explained by depressive symptom severity. We investigated how diurnal preference and sleep quality affect cognitive function in MDD. In 34 inpatients with current MDD and 29 healthy controls (HC), we obtained diurnal preference (Morningness-Eveningness Questionnaire, MEQ) and subjective sleep quality (Pittsburgh Sleep Quality Index, PSQI). Further, current mood and neuropsychological performance (Trail Making Test, TMT, part A and B) were assessed in the evening and in the following morning. Patients with MDD performed worse than HC on the TMT-B (particularly requiring executive function), but not on the TMT-A (assessing foremost visuomotor processing speed). In general, participants with evening preference (MEQ-score median split) performed poorer on the TMT than participants with morning preference. Subgroup analyses within MDD confirmed the negative effect of evening preference on the TMT. In addition, patients with severely impaired sleep quality (PSQI > 10) performed cognitively worse than patients with normal to moderately impaired sleep quality (PSQI ≤ 10). The results were largely independent of current mood state. Our findings suggest that evening preference and severely impaired sleep quality independently contribute to cognitive impairment in MDD.

BACKGROUND:In memory clinics, biomarker-based diagnostic tools for early detection and differential diagnosis of dementia are increasingly important, even if their acceptance by patients is relatively low.OBJECTIVE:The aim of study was to examine whether sociodemographic and clinical features of memory clinic patients are associated with acceptance of lumbar puncture (LP). Of particular interest was the patients' self-perception of memory decline (subjective memory impairment, SMI) accompanied by related concerns that might affect decision to consent to LP.METHODS:Consecutive patients were examined in a day-care hospital on two consecutive days in order to implement a diagnostic procedure based on the S3 guideline "Dementia" including offer of LP. We assessed demographic and clinical variables such as depression, anxiety, neurocognitive performance and dementia severity (Clinical Dementia Rating, CDR). Furthermore, patients were interviewed about perceived memory decline and were classified on this basis - independent of their neuropsychological results - into three groups: no SMI, SMI without concerns or SMI with concerns.RESULTS:Of 44 patients (73.8 ± 8.3 years; 27 f/17 m; CDR < 1: n = 16, CDR = 1: n = 28), 29 had SMI with concerns. These patients tended to be younger and had a higher level of education than those who did not report SMI (n = 7) and those perceiving SMI without concerns (n = 8). Furthermore, patients without SMI more frequently had a dementia syndrome. Patients who agreed to lumbar puncture (n = 23) were - compared to patients refusing LP (n = 17; 4 patients had to be excluded because of medical contraindication for immediate LP) - more likely male, had significantly more frequent SMI with concerns and performed poorer on declarative memory tasks. Binary regression analysis yielded SMI with concerns, a more impaired memory performance and male sex as significant predictors for consenting to LP.CONCLUSIONS:The study provides evidence that patient characteristics such as subjective and objective memory impairment as well as sex may affect the likelihood to consent to a generally less accepted biomarker-based dementia diagnostic procedure such as LP.

AIM:Sleep disturbances are prevalent in various dementia subtypes but rarely investigated in early clinical stages. Although memory clinics have become an established institution for the early diagnosis of dementia, sleep assessment is not part of their routine diagnostics. This study aimed to examine whether subjective and objective sleep variables are related to cognitive impairment in patients referred to a memory clinic. METHODS:On two consecutive days, patients underwent routine diagnostic procedures, including a neuropsychological examination (consortium to establish a registry for alzheimer's disease), and had their sleep quality evaluated by the Pittsburgh Sleep Quality Index and overnight hand-wrist actigraphy. RESULTS:Data of 31 patients (age, M ± SEM: 74.1 ± 1.5; 18 women, 13 men; Clinical Dementia Rating: 0-1) were analysed. One had been diagnosed with subjective cognitive impairment, 13 with mild cognitive impairment with or without depression, and 17 with dementia syndrome due to Alzheimer's and/or cerebrovascular disease. Compared to patients with subjective or mild cognitive impairment, dementia patients showed a significantly increased nocturnal acceleration magnitude; other differences in subjective and objective sleep measures were not significant. Comparing patients with subjectively poor (Pittsburgh Sleep Quality Index > 5: n = 9) and good sleep (Pittsburgh Sleep Quality Index ≤ 5: n = 22) yielded no differences in any neuropsychological and clinical variables. In contrast, patients with low actigraphically recorded sleep efficiency (<85%: n = 11) exhibited a significantly more impaired cognitive performance than those in the high sleep efficiency group (≥85%: n = 20). Correlation analyses demonstrated that actigraphically assessed disturbed sleep continuity accompanied by increased night-time motor activity was substantially associated with cognitive impairment. CONCLUSION:This study highlights that objectively assessed, but not self-reported, parameters of disturbed sleep are closely related to cognitive dysfunction in the early stages of dementia of different aetiologies. Possible diagnostic and treatment implications are discussed.

Zusammenfassung Hintergrund In Gedächtnissprechstunden kommt der biomarkergestützten Diagnostik eine zunehmend wichtige Rolle in Früherkennung und Differentialdiagnose von Demenzen zu, wenngleich deren Akzeptanz bei Patienten vergleichsweise niedrig ist. Ziel der Arbeit Es wurde untersucht, ob soziodemographische und klinische Variablen von Patienten einer Gedächtnissprechstunde mit der Adhärenz zur Lumbalpunktion (LP) assoziiert sind. Von besonderem Interesse war die vom Patienten selbst wahrgenommene Verschlechterung des Gedächtnisses (subjektive Gedächtnisbeeinträchtigung, SGB) mit hierauf gerichteter Besorgnis, die einen Einfluss auf die Entscheidung für eine LP ausüben könnte. Methode Konsekutive Patienten wurden einer tagesklinischen Abklärung an zwei aufeinanderfolgenden Tagen zugeführt, um ein an der S3-Leitlinie „Demenzen“ angelehntes diagnostisches Vorgehen inkl. Angebot einer LP umzusetzen. Es wurde Depressivität, Angst, neurokognitive Leistung und der Demenzschweregrad (Clinical Dementia Rating, CDR) erhoben. Ebenso wurden die Patienten zu selbst wahrgenommenen Gedächtnisverschlechterungen interviewt und auf dieser Grundlage – unabhängig ihrer neuropsychologischen Befunde – drei Gruppen zugeordnet: keine SGB, SGB ohne Besorgnis oder SGB mit Besorgnis. Ergebnisse Von 44 Patienten (73,8 ± 8,3 Jahre; 27 w/17 m; CDR < 1: n = 16, CDR = 1: n = 28) zeigten 29 SGB mit Besorgnis. Sie waren tendenziell jünger und hatten einen höheren Bildungsstatus als Patienten ohne SGB (n = 7) und Patienten mit SGB ohne Besorgnis (n = 8). Patienten ohne SGB hatten häufiger ein Demenzsyndrom. Zur LP einwilligende Patienten (n = 23) waren – gegenüber 17 ablehnenden Patienten (4 Patienten wurden aufgrund medizinischer Kontraindikation für unmittelbare LP ausgeschlossen) – tendenziell häufiger männlichen Geschlechts, zeigten signifikant häufiger SGB mit Besorgnis und geringere Leistungen in deklarativen Gedächtnisaufgaben. In einer binär-logistischen Regressionsanalyse verblieben männliches Geschlecht und SGB mit Besorgnis wie auch verminderte Gedächtnisleistungen als bedeutsame Prädiktoren für die Einwilligung zu einer LP. Schlussfolgerung Die Studie deutet darauf hin, dass Patientencharakteristika einer subjektiven – mit Besorgnis einhergehenden – und objektiven Gedächtnisbeeinträchtigung sowie auch das Geschlecht die Einwilligung zu einer invasiven und im Allgemeinen weniger akzeptierten biomarkergestützten Diagnostik wie der LP mitbedingen.

Depressionen treten im höheren Alter häufig auf, werden aber oftmals nicht diagnostiziert und unangemessen behandelt. Wenngleich psychotherapeutische Interventionen zur Behandlung älterer depressiver Patienten als effektiv gelten, werden diese im stationären Setting weiterhin selten angewandt. Zudem stellt deren Behandlung auf Spezialstationen mit psychotherapeutischem Schwerpunkt eher die Ausnahme dar. Vor diesem Hintergrund wurde ein multiprofessionelles verhaltenstherapeutisches Programm (MVT) für depressive Patienten im höheren Lebensalter entwickelt. Das MVT basiert auf spezifischen, modular angelegten gruppentherapeutischen Interventionen, die um einzeltherapeutische Maßnahmen ergänzt werden. Da die Durchführung spezifischer Gruppentherapien (Psychotherapie, Training sozialer Fertigkeiten, Entspannungstraining, euthyme Verfahren, achtsamkeitsbasierte Techniken) verschiedenen Berufsgruppen zugeordnet ist, sind berufsgruppenübergreifende Behandlungsplanungen von zentraler Bedeutung. Erste Evaluationen verschiedener Programmkomponenten belegen die hohe Akzeptanz des MVT durch die Patienten und unterstreichen, dass multimodale stationäre Psychotherapiekonzepte für ältere Depressive umsetzbar sind. Weitere Forschung ist notwendig, um die klinische Wirksamkeit von Psychotherapie bei älteren depressiven Patienten im stationären Setting zu untersuchen.

Depressive disorders are frequently accompanied by cognitive deficits. Studies investigating the relation between severity of depression and cognitive impairment yielded inconsistent results. A potential role of sleep disturbances for cognitive deficits in depressive patients is rarely investigated.

Sleep disturbances are prevalent in various dementia subtypes, but rarely investigated in early stages. The study aimed to examine subjective and objective sleep variables in their relation to cognitive impairment in patients referred to memory clinic. On two consecutive days, patients underwent routine diagnostic procedures including a neuropsychological examination, the Pittsburgh Sleep Quality Index (PSQI) evaluating sleep quality as well as an overnight actigraphy. 31 patients were analyzed: n = 1 with subjective cognitive impairment (SCI), n = 13 with mild cognitive impairment (MCI) with or without depression, n = 17 with dementia due to Alzheimer's and/or vascular disease. Dementia patients showed – compared to those with SCI and MCI – an increased nocturnal acceleration magnitude, whereas other differences in both subjective and objective sleep measures remained non-significant. Comparing patients with PSQI> 5 (“poor sleep”, n = 9) vs. PSQI≤5 (“good sleep”, n = 22) yielded no differences in any neuropsychological and clinical variables. Patients with low actigraphic sleep efficiency (n = 11< 85%) compared with the high sleep efficiency group (n = 20≥85%) exhibited a more impaired cognitive performance. Correlation analyses demonstrated that actigraphic assessed disturbed sleep continuity was associated to cognitive deficits. Our findings highlight the functional role of sleep disturbances in early dementia, which appear to be more detectable by actigraphy than by self-reports.

Objective: Depression in old age is common but patients are rarely treated in specialized units implementing a psychotherapeutic treatment approach. Methods: A multiprofessional behavioral therapy program (MVT) for inpatient treatment of depressive elderlies was conceptualized, implemented and evaluated at a specialized unit of a hospital for psychiatry and psychotherapy. Results: Preliminary analyses indicated that various behavioral group interventions were well accepted by patients. Conclusions: The implementation of a psychotherapeutic therapy program specifically designed for depressed elderly inpatients is feasible and could be more broadly applied to improve clinical practice for this patient group.

Zusammenfassung. Die Beziehung zwischen kognitiven Defiziten und Schlafstörungen depressiver Patienten wurde bisher wenig untersucht. Stationär behandelte depressive Patienten beantworteten Fragebögen zur Depressivität und Schlafqualität (Pittsburgh Sleep Quality Inventory, PSQI), gefolgt von neuropsychologischen Untersuchungen zu attentional-exekutiven Funktionsleistungen (Trail Making Test: TMT-A, TMT-B) an Tag 1 (abends) und Tag 2 (morgens). Patienten mit schweren Schlafstörungen (PSQI > 10, n = 8) erbrachten gegenüber Patienten mit maximal moderat ausgeprägten Schlafstörungen (PSQI ≤ 10, n = 8) signifikant geringere Leistungen im Rahmen des TMT-A und TMT-B. Signifikante positive Korrelationen zwischen dem Globalwert des PSQI und der TMT-B-Bearbeitungszeit blieben auch unter statistischer Berücksichtigung von Kovariaten erhalten. Diese Ergebnisse unterstreichen die enge Beziehung zwischen kognitiven Dysfunktionen und Schlafstörungen bei depressiven Patienten. Mögliche therapeutische Implikationen werden diskutiert.

Sleep complaints and sleep disturbances are common in depression; however, the association of sleep duration and subjective sleep quality has been rarely investigated. Thus, subjective sleep quality and sleep duration were analyzed in depressed inpatients. Questionnaire data comprising clinical and sleep-related questions were sampled over a one-year period from adult inpatients with depressive syndromes. Sleep duration and items related to sleep quality were analyzed by means of group comparisons (sleep duration categories) and correlation analyses. Data of 154 patients (age 58.2±17.0 years, 63.6% women) were analyzed. Mean sleep duration was 7.2±2.1 h (16.9% of patients were below and 7.1% above age-specific recommendations), 25–40% of patients reported almost always daytime sleepiness, non-restorative sleep, attention deficits, or memory complaints with significant correlations between all variables (P<0.05). Sleep duration and sleep quality indicators showed significant curvilinear associations (quadratic contrast, P<0.05); i.e. extremely low and high sleep durations were associated with unfavorable sleep quality and subjective cognitive impairment. Non-recommended low or high sleep durations occur in a substantial proportion of patients with depression, and both were associated with poor sleep quality and subjectively impaired cognitive functions. Clinicians should be aware of these relationships. During hospitalization, a more individualized sleep–wake schedule should be applied.

Sleep complaints and sleep disturbances are highly prevalent in patients with psychiatric disorders. During hospitalization the patients’ condition may be even worse but little is known about the subjective sleep quality in psychiatric hospitals. Thus, we have investigated subjective sleep quality and mean sleep duration in patients with different psychiatric disorders at the end of hospitalization. For a period of one year, inpatients of a psychiatric hospital with diagnosis of substance use disorder (SUD), schizophrenia (SCZ), or anxiety/depressive disorders (AND) were routinely asked to fill in an easily comprehensible sleep quality questionnaire at the end of their hospitalization. Age, gender, subjective sleep quality, and sleep duration were analyzed; sleep duration was classified according to age-specific recommendations. Data of n=309 patients (age 52.1±17.9y, 56.1% women) were analyzed (n=63 SUD, n=50 SCZ, n=196 AND). Mean sleep duration was 7.0±2.0h; 20.7% of patients had sleep durations below and 4.5% above age-specific recommendations. Non-restorative sleep during hospitalization was reported “almost always” in 38.2% (n=118), and “occasionally” in 30.1% (n=93). Subjective sleep quality was significantly associated with sleep duration (rs=−0.31, P<0.0005), but not with age, gender or diagnostic subgroup. The study showed that a great proportion of patients reported poor subjective sleep quality during hospitalization, regardless of age, gender and psychiatric diagnosis. As sleep quality was significantly associated with short sleep duration, a first step could be to take care to achieve recommended age-specific sleep durations in psychiatric hospitals.

The stable and persisting preference for activities in the late evening (i.e. eveningness) is associated with a higher risk for depression, suicidality, and non-remission in major depression. The present study investigated symptom patterns in hospitalized patients with depressive syndromes in relation to morningness-eveningness (chronotypes). Depressive symptoms (Beck Depression Inventory [BDI-II]) and chronotype (German version of the Morningness-Eveningness Questionnaire [D-MEQ]) were assessed after admission and before discharge in inpatients with mainly major depression. Group differences of BDI-II single items and three BDI-II factors (cognitive, affective, somatic) between patients divided at the D-MEQ sample median into "morning preference" (MP) and "evening preference" (EP) were calculated. Data from 64 consecutively admitted patients (31MP/33EP) were analyzed. Both groups (MP/EP) were comparable regarding age, sex, diagnosis, length of stay, and subjective sleep quality, BDI-II scores were significantly higher in EP than in MP at admission. At admission and discharge, cognitive symptoms were significantly more pronounced in EP vs. MP; non-significant differences between EP and MP were found for affective and somatic symptoms. The results underline the importance of the trait-like chronotype for severity and symptomatology in patients with depressive disorders. The patients' chronotype should be taken into account in diagnostics and treatment of depressive disorders.

Background Chronotype and insomnia have been related to the development and to an unfavourable course of depression. However, the mutual relationship of both risk factors is as yet unclear, especially in acute, clinically manifest depressive disorders. Aims The present study was carried out to elucidate the separate direct and indirect influence of chronotype and poor sleep quality on depression severity in patients hospitalized for depression. Methods Depression severity (BDI-II), chronotype (Morningness-Eveningness Questionnaire), and subjective sleep quality (Pittsburgh Sleep Quality Index total score) were assessed concurrently in inpatients with a depressive syndrome and insomnia during routine treatment. Correlations, multiple regression and bootstrapping methods for testing mediation models were applied to assess the independent direct and indirect effects of chronotype and sleep quality on depression severity, after adjusting for effects of age and gender. Results Data from 57 consecutively admitted patients (88% with major depression) were analyzed (68% women, mean age 41 +/- 13 years). Significant correlations between morningness-eveningness (p<0.05) or sleep quality (p<0.01) and depression severity were found; in a multiple regression model comprising chronotype, sleep quality, age and gender, only chronotype (p<0.05) and sleep disturbances (p<0.01) remained as independent significant concurrent predictors of depression severity (R-2 = 0.184, p<0.01). Two mediation models revealed no significant results. Conclusions Eveningness and poor subjective sleep quality were independently and directly associated with higher depression severity in inpatients with depressive syndromes. Chronotype and sleep quality should be taken into account not only in risk assessment and prevention but also in hospitalized patients to develop and improve treatment options.

Introduction: Poor sleep is common in depression, has been shown to precede acute episodes, and persists during remission. Circadian abnormalities are involved in the pathogenesis of depression and are one of the prominent factors underlying sleep disturbances. Therefore, we studied the relation between circadian preferences (chronotype) and sleep quality in patients with affective disorders accompanied by clinically relevant insomnia. Methods: Forty-eight inpatients (29 f/19 m; age: 42.5 ± 14.2 years) with mainly depressive disorders (ICD-10: F32/33) and co-occurring insomnia complaints (Pittsburgh Sleep Questionnaire Index, PSQI global sore ≥ 5) completed the Morningness-Eveningness Questionnaire (MEQ) and the Beck Depression Inventory-II (BDI). Results: Patients were classified as 12 evening types, 25 intermediate types, and 11 morning types. Chronotypes did not differ in BDI-II, but substantial age differences were found: evening types were younger than intermediate types (p < 0.05) and morning types (p < 0.01). When compared with evening types or intermediate types, morning types showed a shorter sleep duration as assessed by the PSQI (each p < 0.05). Correlation analyses revealed a positive relationship between MEQ scores and the PSQI subscale sleep efficiency (the higher the MEQ score towards morningness, the lower the sleep efficiency) (p < 0.05), although this association was found to be mediated by age. Evening types exhibited a tendency towards a longer sleep latency (p < 0.1).