We reviewed the literature on sleep in psychiatric disorders and evaluated the data by meta-analysis, a statistical method designed to combine data from different studies. A total of 177 studies with data from 7151 patients and controls were reviewed. Most psychiatric groups showed significantly reduced sleep efficiency and total sleep time, accounted for by decrements in non-rapid eye movement sleep. Rapid eye movement sleep time was relatively preserved in all groups, and percentage of rapid eye movement sleep was increased in affective disorders. Reduction in rapid eye movement sleep latency was seen in affective disorders but occurred in other categories as well. Although no single sleep variable appeared to have absolute specificity for any particular psychiatric disorder, patterns of sleep disturbances associated with categories of psychiatric illnesses were observed. Overall, findings for patients with affective disorders differed most frequently and significantly from those for normal controls.

Sleep and Psychiatric Disorders: A Meta-analysis

• Fifty-six prevalence surveys of tardive dyskinesia (TD) in neuroleptic-treated patients are reviewed, yielding an average prevalence of 20% as compared with 5% prevalence of "spontaneous" dyskinesia in 19 samples of untreated individuals. Reported prevalence has increased during the past two decades and is not attributable simply to the more widespread use of rating scales. Controlled studies of a variety of risk factors are reviewed and suggest that advancing age and, to a lesser extent, female sex are the two variables most consistently associated with increased prevalence. There are relatively few data supporting the assumption that the risk of TD development continues to increase with increasing neuroleptic exposure, CNS dysfunction, or exposure to antiparkinsonism medication.

Tardive dyskinesia: prevalence and risk factors, 1959 to 1979.

The mechanisms responsible for the production of major extrapyramidal side-effects (parkinsonism, akathisia, acute dystonic reactions, chronic tardive dyskinesias) are reviewed in the light of the complex effects of these drugs on cerebral dopamine systems.

The pathophysiology of extrapyramidal side-effects of neuroleptic drugs.

We analyzed data from 76 selected studies on prevalence of tardive dyskinesia (TD), published through 1989. The primary focus was on gender differences. The overall prevalence of TD in the 39,187 patients included in these reports was 24.2 percent, and prevalence was significantly higher in women (26.6%) than in men (21.6%). The gender difference in TD prevalence appeared to narrow intriguingly in more recent studies. Overall, the TD prevalence seemed to reach its peak in the 50-70-year-old age group in men and continued to rise after age 70 in women. Also, women tended to have more severe TD than men. Spontaneous dyskinesia too was found to be more common in women. The material was also analyzed for cultural differences by comparing studies in four continents: North America, Europe, Africa, and Asia. Although grouping together studies from different countries in a continent into a single group is somewhat problematic, we found that Asian patients had lower prevalence of TD than North American, European, and African patients. Limitations of our review (including differences among studies in diagnostic criteria, observer bias, etc.) as well as possible explanations for the reported differences in the risk for TD are discussed.

Gender Differences in Tardive Dyskinesia: A Critical Review of the Literature

Molecular actions and therapeutic potential of lithium in preclinical and clinical studies of CNS disorders.

In the part II of an epidemiological study on tardive dyskinesia performed on the same sample of 332 chronic schizophrenic patients (142 males and 190 females), the authors come to the conclusion that the prevalence of tardive dyskinesia is significantly higher if the mean age was higher at the beginning of treatment with sedative or incisive neuroleptics, their combinations (cocktails) and added antiparkinsonian drugs. Age seems to be the most important factor in the prevalence of tardive dyskinesia. The mean longer duration of "incisive" free intervals significantly decreases the prevalence of tardive dyskinesia. Other factors analysed in our sample, especially the total amount of neuroleptics administered, the type of neuroleptics and the mean duration of neuroleptic treatment, do not play a significant role in the prevalence of tardive dyskinesia.

Epidemiology of tardive dyskinesia Part I.

Influence of the antiparkinsonian drugs on the plasma level of neuroleptics.

Studies on the action of certain pharmacological agents on tardive dyskinesia and on the rabbit syndrome.

A double-blind crossover study on the effects of deanol and lithium carbonate was conducted on a sample of 29 chronic schizophrenic patients with tardive dyskinesia In addition to his usual treatment

Deanol, Lithium and Placebo in the Treatment of Tardive Dyskinesia

The influence of amitriptyline on the plasma level of various neuroleptics was studied in 25 chronic schizophrenic patients. The study lasted 20 weeks. Patients were kept first 4 weeks on their former neuroleptic medication, with amitriptyline added for 12 subsequent weeks, and withdrawn during the last 4 weeks when only the neuroleptic medication was continued unchanged. The plasma level of neuroleptics was assayed by gas-liquid chromatography, once weekly throughout the study. The amitriptyline plasma level was also evaluated once weekly during the 12 weeks of its administration. The mean neuroleptic plasma values for each 4-week period were pooled together in three groups: aliphatic, piperdine and piperazine phenothiazine derivatives. Amitriptyline provoked some increase of the plasma level of all phenothiazine derivatives. This augmentation was significant only transitorily, however. The putative mechanisms of this neuroleptic tricyclic antidepressant interaction are discussed.

Pires P

Papers

Epidemiology of tardive dyskinesia Part I.

Influence of the antiparkinsonian drugs on the plasma level of neuroleptics.

Studies on the action of certain pharmacological agents on tardive dyskinesia and on the rabbit syndrome.

Deanol, Lithium and Placebo in the Treatment of Tardive Dyskinesia

Pharmacokinetic interaction between amitriptyline and neuroleptics.