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Open accessJournal ArticleDOI: 10.1080/15402002.2020.1722127

The Effect of Self-Reported REM Behavior Disorder Symptomology on Intrusive Memories in Post-Traumatic Stress Disorder.

04 Mar 2021-Behavioral Sleep Medicine (Taylor & Francis)-Vol. 19, Iss: 2, pp 178-191
Abstract: Background: PTSD is characterised by severe sleep disturbances, which is increasingly recognised to in many cases consist of similar symptomology to sleep disorders such as REM Behaviour Disorder (RBD). The present study aimed to investigate whether different aspects of sleep quality influence intrusive memory development and whether PTSD status moderates this relationship.Participants and Methods: 34 PTSD, 52 trauma-exposed (TE) and 42 non-trauma exposed (NTE) participants completed an emotional memory task, where they viewed 60 images (20 positive, 20 negative and 20 neutral) and, two days later, reported how many intrusive memories they had of each valence category. Participants also completed three measures of sleep quality: the Pittsburgh Sleep Quality Index, the REM Behaviour Disorder Screening Questionnaire and total hours slept before each session.Results: The PTSD group reported poorer sleep quality than both TE and NTE groups on all three measures, and significantly more negative intrusive memories than the NTE group. Mediation analyses revealed that self-reported RBD symptomology before the second session mediated the relationship between PTSD status and intrusive memories. Follow-up moderation analyses revealed that self-reported RBD symptomology before the second session was only a significant predictor of intrusion in the PTSD group, though with a small effect size.Conclusions: These findings suggest that RBD symptomology is an indicator of consolidation of intrusive memories in PTSD but not trauma-exposed or healthy participants, which supports the relevance of characterising RBD in PTSD.

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Open accessJournal ArticleDOI: 10.1186/S13054-020-2797-7
Shuo Wang1, Hui-Ning Xin, Chiang Chung Lim Vico2, Jinhua Liao1  +3 moreInstitutions (2)
06 Mar 2020-Critical Care
Abstract: Although studies on the effectiveness of the use of ICU diaries on psychiatric disorders and quality of life have been published, the results still seem to be controversial. The study aimed to determine the effects of using an ICU diary on psychiatric disorders, sleep quality, and quality of life (QoL) in adult ICU survivors in China. One hundred and twenty-six patients who underwent a scheduled cardiac surgery and were expected to stay ≥ 24 h in ICU were randomized to two groups (63 in each group). The patients in the intervention group received the use of ICU diaries during the period of post-ICU follow-up, while the patients in the control group received usual care without ICU diaries. The primary outcome was significant PTSD symptoms (Chinese version of Impact of Event Scale-Revised, IES-R; total score ≥ 35 was defined as significant PTSD symptoms) and its severity in patients 3 months post-ICU. The secondary outcomes included memories of the ICU at 1 month, QoL (Medical Outcomes Study 36-item Short-Form, SF-36), sleep quality (Pittsburgh Sleep Quality Index Questionnaire, PSQI), anxiety, and depression symptoms (Hospital Anxiety and Depression Scale, HADS) at 3 months. Eighty-five and 83 patients completed the follow-up interviews at 1 month and 3 months post-ICU, respectively. Significant PTSD symptoms were reported by 6 of 41 (14.63%) in the intervention group vs 9 of 42 (21.43%) in the control group (risk difference, − 9% [95% CI, − 2% to 21%], P = 0.10). There was no significant differences between groups in IES-R score, symptoms of intrusion, symptoms of avoidance, numbers of memories of feeling and delusional memories, SF-36 score and anxiety score (P > 0.05), while significant differences were found in symptom of hyperarousal score, numbers of factual memories and PSQI score (P < 0.05). No adverse effect was reported. Using an ICU diary is not useful for preventing PTSD symptoms and anxiety symptoms and preserving the quality of life of the patients at 3 months post-ICU, while it significantly improves the survivor’s factual memory of ICU and sleep quality, and prevents the hyperarousal symptom. Chinese Clinical Trial Registry, ChiCTR-IOR-16009109, registered on 28 August 2016

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10 Citations


Journal ArticleDOI: 10.5664/JCSM.8758
Daniel A. Barone1Institutions (1)
Abstract: Dream enactment behavior is a phenomenon demonstrated in patients with post-traumatic stress disorder, rapid eye movement sleep behavior disorder, as well as with a more recently described conditio...

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Topics: REM sleep behavior disorder (72%), Parasomnia (68%), Nightmare (65%) ... show more

4 Citations


Open accessJournal ArticleDOI: 10.1007/S40675-020-00200-Z
01 Jun 2021-
Abstract: It is important to examine what effect sleep has after an emotional experience. More knowledge about this topic could help inform us whether there are any potential sleep interventions that could help make sure that memories of negative emotional experiences are processed in the most adaptive manner possible. Findings on the role of sleep in altering reactivity to emotional stimuli have been highly varied, with significant findings in opposite directions. A new exciting development in the field is several studies finding that sleep seems to make memories of negative experiences less intrusive. This review has mainly aimed to give an overview of the field, and of which issues need to be resolved. We argue for there being a strong need for standardization of how data are analyzed and presented, as well as for better methods for determining to what extent the effects of sleep are specific for a particular memory, or represent general changes in emotional reactivity.

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Topics: Intrusiveness (53%)

1 Citations


Journal ArticleDOI: 10.1016/J.SMRV.2021.101501
Maya T Schenker1, Luke J. Ney2, Lisa N Miller1, Kim L Felmingham1  +2 moreInstitutions (2)
Abstract: Sleep may contribute to the long-lasting consolidation and processing of emotional memories. Experimental fear conditioning and extinction paradigms model the development, maintenance, and treatment of anxiety disorders. The literature provides compelling evidence for the involvement of rapid eye movement (REM) sleep in the consolidation of such memories. This meta-analysis correlated polysomnographic sleep findings with psychophysiological reactivity to the danger (CS+) and safety stimuli (CS-), to clarify the specific role of sleep stages before and after fear conditioning, extinction learning and extinction recall. Overall, there was evidence that more pre-learning sleep stage two and less slow wave sleep was associated with higher psychophysiological reactivity to the safety stimulus during extinction learning. Preliminary evidence found here support the role of REM sleep during the post-extinction consolidation sleep phase in clinical populations with disrupted sleep, but not in healthy controls. Furthermore, the meta-regressions found that sex moderated the associations between sleep and psychophysiological reactivity throughout the paradigm providing evidence for diverging correlations in male and females. Specifically, increased post-extinction REM was associated with poorer extinction and safety recall in females while the opposite was found in males. These results have implications for future research in the role of sleep in emotional memory processing.

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Topics: Sleep Stages (70%), Slow-wave sleep (65%), Rapid eye movement sleep (58%) ... show more

1 Citations


Open accessJournal ArticleDOI: 10.1016/J.NEUBIOREV.2021.11.040
Luke J. Ney1, Kevin M. Crombie2, Leah M. Mayo3, Kim L Felmingham4  +2 moreInstitutions (5)
Abstract: The endocannabinoid system is known to be involved in mechanisms relevant to PTSD aetiology and maintenance, though this understanding is mostly based on animal models of the disorder. Here we review how human paradigms can successfully translate animal findings to human subjects, with the view that substantially increased insight into the effect of endocannabinoid signalling on stress responding, emotional and intrusive memories, and fear extinction can be gained using modern paradigms and methods for assessing the state of the endocannabinoid system in PTSD.

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Open accessJournal ArticleDOI: 10.1016/J.PSYCHRES.2011.06.006
Vijay A. Mittal1, Elaine F. Walker2Institutions (2)
Abstract: Given the recent attention to movement abnormalities in psychosis spectrum disorders (e.g., prodromal/high-risk syndromes, schizophrenia) (Mittal et al., 2008; Pappa and Dazzan, 2009), and an ongoing discussion pertaining to revisions of the Diagnostic and Statistical Manuel of Mental Disorders (DSM) for the upcoming 5th edition, we would like to take this opportunity to highlight an issue concerning the criteria for tic disorders, and how this might affect classification of dyskinesias in psychotic spectrum disorders. Rapid, non-rhythmic, abnormal movements can appear in psychosis spectrum disorders, as well as in a host of commonly co-occurring conditions, including Tourette’s Syndrome and Transient Tic Disorder (Kerbeshian et al., 2009). Confusion can arise when it becomes necessary to determine whether an observed movement (e.g., a sudden head jerk) represents a spontaneous dyskinesia (i.e., spontaneous transient chorea, athetosis, dystonia, ballismus involving muscle groups of the arms, legs, trunk, face, and/or neck) or a tic (i.e., stereotypic or patterned movements defined by the relationship to voluntary movement, acute and chronic time course, and sensory urges). Indeed, dyskinetic movements such as dystonia (i.e., sustained muscle contractions, usually producing twisting and repetitive movements or abnormal postures or positions) closely resemble tics in a patterned appearance, and may only be visually discernable by attending to timing differences (Gilbert, 2006). When turning to the current DSM-IV TR for clarification, the description reads: “Tic Disorders must be distinguished from other types of abnormal movements that may accompany general medical conditions (e.g., Huntington’s disease, stroke, Lesch-Nyhan syndrome, Wilson’s disease, Sydenham’s chorea, multiple sclerosis, postviral encephalitis, head injury) and from abnormal movements that are due to the direct effects of a substance (e.g., a neuroleptic medication)”. However, as it is written, it is unclear if psychosis falls under one such exclusionary medical disorder. The “direct effects of a substance” criteria, referencing neuroleptic medications, further contributes to the uncertainty around this issue. As a result, ruling-out or differentiating tics in psychosis spectrum disorders is at best, a murky endeavor. Historically, the advent of antipsychotic medication in the 1950s has contributed to the confusion about movement signs in psychiatric populations. Because neuroleptic medications produce characteristic movement disorder in some patients (i.e. extrapyramidal side effects), drug-induced movement disturbances have been the focus of research attention in psychotic disorders. However, accumulating data have documented that spontaneous dyskinesias, including choreoathetodic movements, can occur in medication naive adults with schizophrenia spectrum disorders (Pappa and Dazzan, 2009), as well as healthy first-degree relatives of chronically ill schizophrenia patients (McCreadie et al., 2003). Taken together, this suggests that movement abnormalities may reflect pathogenic processes underlying some psychotic disorders (Mittal et al., 2008; Pappa and Dazzan, 2009). More specifically, because spontaneous hyperkinetic movements are believed to reflect abnormal striatal dopamine activity (DeLong and Wichmann, 2007), and dysfunction in this same circuit is also proposed to contribute to psychosis, it is possible that spontaneous dyskinesias serve as an outward manifestation of circuit dysfunction underlying some schizophrenia-spectrum symptoms (Walker, 1994). Further, because these movements precede the clinical onset of psychotic symptoms, sometimes occurring in early childhood (Walker, 1994), and may steadily increase during adolescence among populations at high-risk for schizophrenia (Mittal et al., 2008), observable dyskinesias could reflect a susceptibility that later interacts with environmental and neurodevelopmental factors, in the genesis of psychosis. In adolescents who meet criteria for a prodromal syndrome (i.e., the period preceding formal onset of psychotic disorders characterized by subtle attenuated positive symptoms coupled with a decline in functioning), there is sometimes a history of childhood conditions which are also characterized by suppressible tics or tic like movements (Niendam et al., 2009). On the other hand, differentiating between tics and dyskinesias has also complicated research on childhood disorders such as Tourette syndrome (Kompoliti and Goetz, 1998; Gilbert, 2006). We propose consideration of more explicit and operationalized criteria for differentiating tics and dyskinesias, based on empirically derived understanding of neural mechanisms. Further, revisions of the DSM should allow for the possibility that movement abnormalities might reflect neuropathologic processes underlying the etiology of psychosis for a subgroup of patients. Psychotic disorders might also be included among the medical disorders that are considered a rule-out for tics. Related to this, the reliability of movement assessment needs to be improved, and this may require more training for mental health professionals in movement symptoms. Although standardized assessment of movement and neurological abnormalities is common in research settings, it has been proposed that an examination of neuromotor signs should figure in the assessment of any patient, and be as much a part of the patient assessment as the mental state examination (Picchioni and Dazzan, 2009). To this end it is important for researchers and clinicians to be aware of differentiating characteristics for these two classes of abnormal movement. For example, tics tend to be more complex than myoclonic twitches, and less flowing than choreoathetodic movements (Kompoliti and Goetz, 1998). Patients with tics often describe a sensory premonition or urge to perform a tic, and the ability to postpone tics at the cost of rising inner tension (Gilbert, 2006). For example, one study showed that patients with tic disorders could accurately distinguish tics from other movement abnormalities based on the subjective experience of some voluntary control of tics (Lang, 1991). Another differentiating factor derives from the relationship of the movement in question to other voluntary movements. Tics in one body area rarely occur during purposeful and voluntary movements in that same body area whereas dyskinesia are often exacerbated by voluntary movement (Gilbert, 2006). Finally, it is noteworthy that tics wax and wane in frequency and intensity and migrate in location over time, often becoming more complex and peaking between the ages of 9 and 14 years (Gilbert, 2006). In the case of dyskinesias among youth at-risk for psychosis, there is evidence that the movements tend to increase in severity and frequency as the individual approaches the mean age of conversion to schizophrenia spectrum disorders (Mittal et al., 2008). As revisions to the DSM are currently underway in preparation for the new edition (DSM V), we encourage greater attention to the important, though often subtle, distinctions among subtypes of movement abnormalities and their association with psychiatric syndromes.

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Topics: Tics (65%), Tourette syndrome (62%), Dyskinesia (59%) ... show more

52,117 Citations


Open accessBook
Andrew F. Hayes1Institutions (1)
06 May 2013-
Abstract: I. FUNDAMENTAL CONCEPTS 1. Introduction 1.1. A Scientist in Training 1.2. Questions of Whether, If, How, and When 1.3. Conditional Process Analysis 1.4. Correlation, Causality, and Statistical Modeling 1.5. Statistical Software 1.6. Overview of this Book 1.7. Chapter Summary 2. Simple Linear Regression 2.1. Correlation and Prediction 2.2. The Simple Linear Regression Equation 2.3. Statistical Inference 2.4. Assumptions for Interpretation and Statistical Inference 2.5. Chapter Summary 3. Multiple Linear Regression 3.1. The Multiple Linear Regression Equation 3.2. Partial Association and Statistical Control 3.3. Statistical Inference in Multiple Regression 3.4. Statistical and Conceptual Diagrams 3.5. Chapter Summary II. MEDIATION ANALYSIS 4. The Simple Mediation Model 4.1. The Simple Mediation Model 4.2. Estimation of the Direct, Indirect, and Total Effects of X 4.3. Example with Dichotomous X: The Influence of Presumed Media Influence 4.4. Statistical Inference 4.5. An Example with Continuous X: Economic Stress among Small Business Owners 4.6. Chapter Summary 5. Multiple Mediator Models 5.1. The Parallel Multiple Mediator Model 5.2. Example Using the Presumed Media Influence Study 5.3. Statistical Inference 5.4. The Serial Multiple Mediator Model 5.5. Complementarity and Competition among Mediators 5.6. OLS Regression versus Structural Equation Modeling 5.7. Chapter Summary III. MODERATION ANALYSIS 6. Miscellaneous Topics in Mediation Analysis 6.1. What About Baron and Kenny? 6.2. Confounding and Causal Order 6.3. Effect Size 6.4. Multiple Xs or Ys: Analyze Separately or Simultaneously? 6.5. Reporting a Mediation Analysis 6.6. Chapter Summary 7. Fundamentals of Moderation Analysis 7.1. Conditional and Unconditional Effects 7.2. An Example: Sex Discrimination in the Workplace 7.3. Visualizing Moderation 7.4. Probing an Interaction 7.5. Chapter Summary 8. Extending Moderation Analysis Principles 8.1. Moderation Involving a Dichotomous Moderator 8.2. Interaction between Two Quantitative Variables 8.3. Hierarchical versus Simultaneous Variable Entry 8.4. The Equivalence between Moderated Regression Analysis and a 2 x 2 Factorial Analysis of Variance 8.5. Chapter Summary 9. Miscellaneous Topics in Moderation Analysis 9.1. Truths and Myths about Mean Centering 9.2. The Estimation and Interpretation of Standardized Regression Coefficients in a Moderation Analysis 9.3. Artificial Categorization and Subgroups Analysis 9.4. More Than One Moderator 9.5. Reporting a Moderation Analysis 9.6. Chapter Summary IV. CONDITIONAL PROCESS ANALYSIS 10. Conditional Process Analysis 10.1. Examples of Conditional Process Models in the Literature 10.2. Conditional Direct and Indirect Effects 10.3. Example: Hiding Your Feelings from Your Work Team 10.4. Statistical Inference 10.5. Conditional Process Analysis in PROCESS 10.6. Chapter Summary 11. Further Examples of Conditional Process Analysis 11.1. Revisiting the Sexual Discrimination Study 11.2. Moderation of the Direct and Indirect Effects in a Conditional Process Model 11.3. Visualizing the Direct and Indirect Effects 11.4. Mediated Moderation 11.5. Chapter Summary 12. Miscellaneous Topics in Conditional Process Analysis 12.1. A Strategy for Approaching Your Analysis 12.2. Can a Variable Simultaneously Mediate and Moderate Another Variable's Effect? 12.3. Comparing Conditional Indirect Effects and a Formal Test of Moderated Mediation 12.4. The Pitfalls of Subgroups Analysis 12.5. Writing about Conditional Process Modeling 12.6. Chapter Summary Appendix A. Using PROCESS Appendix B. Monte Carlo Confidence Intervals in SPSS and SAS

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Topics: Moderated mediation (62%), Regression analysis (57%), Mediation (statistics) (57%) ... show more

26,130 Citations


Journal ArticleDOI: 10.1016/0165-1781(89)90047-4
Abstract: Despite the prevalence of sleep complaints among psychiatric patients, few questionnaires have been specifically designed to measure sleep quality in clinical populations. The Pittsburgh Sleep Quality Index (PSQI) is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Nineteen individual items generate seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score. Clinical and clinimetric properties of the PSQI were assessed over an 18-month period with "good" sleepers (healthy subjects, n = 52) and "poor" sleepers (depressed patients, n = 54; sleep-disorder patients, n = 62). Acceptable measures of internal homogeneity, consistency (test-retest reliability), and validity were obtained. A global PSQI score greater than 5 yielded a diagnostic sensitivity of 89.6% and specificity of 86.5% (kappa = 0.75, p less than 0.001) in distinguishing good and poor sleepers. The clinimetric and clinical properties of the PSQI suggest its utility both in psychiatric clinical practice and research activities.

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Topics: Pittsburgh Sleep Quality Index (82%), Sleep state misperception (66%), Sleep hygiene (66%) ... show more

18,413 Citations



Journal ArticleDOI: 10.1016/S0005-7967(99)00123-0
Anke Ehlers1, David M. Clark1Institutions (1)
Abstract: Posttraumatic stress disorder (PTSD) is a common reaction to traumatic events. Many people recover in the ensuing months, but in a significant subgroup the symptoms persist, often for years. A cognitive model of persistence of PTSD is proposed. It is suggested that PTSD becomes persistent when individuals process the trauma in a way that leads to a sense of serious, current threat. The sense of threat arises as a consequence of: (1) excessively negative appraisals of the trauma and/or its sequelae and (2) a disturbance of autobiographical memory characterised by poor elaboration and contextualization, strong associative memory and strong perceptual priming. Change in the negative appraisals and the trauma memory are prevented by a series of problematic behavioural and cognitive strategies. The model is consistent with the main clinical features of PTSD, helps explain several apparently puzzling phenomena and provides a framework for treatment by identifying three key targets for change. Recent studies have provided preliminary support for several aspects of the model.

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Topics: Autobiographical memory (55%), Intrusive thought (54%), Cognitive therapy (54%) ... show more

4,488 Citations


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