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Although standing plantar perception training (SPPT) may improve standing postural stability, the underlying neural mechanisms remain unclear. The authors investigated the relationship between regional cortical responses to SPPT using a balance pad and training outcomes in 32 older participants (mean ± SD:72.2 ± 6.0, range:60–87). Regional cortical activity was measured in the bilateral supplementary motor area, primary sensorimotor area, and parietal association area using near-infrared spectroscopy. Postural sway changes were compared before and after SPPT. Changes in two-point plantar discrimination and regional cortical activity during SPPT, associated with standing postural stability improvements, were examined using multiple regression and indicated improved standing postural stability after SPPT (p

A link has been suggested between somatic anxiety (SA) and insomnia in the cognitive model of chronic insomnia. This cross-sectional study examined if the possible link between insomnia symptoms and SA is related to an increased dosage of hypnotics/anxiolytics and poor clinical outcome in residual major depressive disorder (MDD). We studied 72 MDD outpatients, in partial or complete remission, enrolled in a rehabilitation program. Contributory subscales of the Hamilton Depression Rating Scale for residual symptoms were identified using principal component analysis. Unfavorable effects of SA × insomnia interaction on GABAergic pharmacotherapy and the probability of remission were assessed using moderation analysis. Patients with insomnia symptoms (43%) were less likely to achieve remission than those without. Residual symptoms formed the first component, and insomnia symptoms alone formed the second component (R2X = .33, Q2 = .09). The presence of insomnia symptoms was associated with an increase in SA (p = .048) but not with core depression or somatic symptoms. The SA × insomnia interaction was associated not only with increased hypnotic (b = –2.30, p = .014) and anxiolytic (b = 9.78, p = .002) dosages but also with a lower probability of remission (b = 1.18, p = .037). These results suggest a mutual detrimental interaction between SA and insomnia symptoms for maintaining residual MDD. Addressing the link between SA and insomnia symptoms may be important for effectively treating MDD.

BACKGROUND: Temporal processing, crucial to guide behavior toward a goal, may have a role in forming a depressive episode, yet it remains unclear which properties of temporal processing are central to antidepressant response. Production of a short duration oscillates in a circadian manner. Altered circadian organization of physiology and behavior are a hallmark of bipolar disorder. We thus tested whether circadian dynamics of time production associate with treatment response in bipolar disorder. METHODS: Over the three cycles of total sleep deprivation combined with light therapy (chronotherapeutics) in one week, 20 inpatients with a major depressive episode in the course of bipolar disorder produced 10s and rated their subjective mood and vigilance levels repeatedly. RESULTS: Eleven patients (58%) among 19 completers achieved remission. Produced time intervals (PTIs) fluctuated more synchronously with mood levels (r=-0.77) than vigilance levels (r=-0.59) during treatment. A higher degree of shortening of PTIs, but not changes in mood or vigilance levels, during the initial 24-h period of treatment predicted better response (LR χ2=4.58, P=0.032). Strong opposite daily changes for PTIs and mood levels observed at baseline were both attenuated after treatment only in remitters (F=7.25, P=0.015). LIMITATIONS: Potential external confounders that affect time perception were not controlled. CONCLUSIONS: The results are the first to demonstrate an association of the circadian properties of time perception with antidepressant effects of chronotherapeutics and suggest the potential utility of time production in predicting clinical outcome of bipolar depression.

ObjectivesThere are numerous reports on the psychological burden of medical workers after the COVID-19 outbreak; however, no study has examined the influence of developmental characteristics on the mental health of medical workers. The objective of this study was to examine whether the developmental characteristics of medical workers are associated with anxiety and depression after the COVID-19 outbreak.DesignWe conducted an online cross-sectional questionnaire survey in October 2020.Participants and settingThe data of 640 medical workers were analysed. The questionnaire included items on sociodemographic data, changes in their life after the COVID-19 outbreak and symptoms of depression, anxiety, attention-deficit/hyperactivity disorder (ADHD) traits and autism spectrum disorder traits.Main outcomesDepression symptoms were assessed by the Patient Health Questionnaire-9 and anxiety symptoms were assessed by the Generalised Anxiety Disorder-7. A series of hierarchical multiple regression analyses were performed to test the effects of developmental characteristics on depression and anxiety symptoms after controlling for sociodemographic factors and changes in participants’ lives after the COVID-19 outbreak.ResultsIncreases in physical and psychological burden were observed in 49.1% and 78.3% of the subjects, respectively. The results of a multiple regression analysis showed that ADHD traits were significantly associated with both depression (β=0.390, pConclusionGlobally, the burden on medical workers increased. This study suggested that medical workers with higher ADHD traits may need special attention during the COVID-19 pandemic.

Bright light (BL) therapy is clinically utilized for treatment of sleep–wake disorders through the manipulation of circadian oscillation. It is also extended to depressive disorders including seasonal affective disorder through emotional regulation. Recently, it has been suggested that BL facilitates memory encoding and consolidation via another psychophysiological mechanism of perceptual information processing in the brain. In particular, BL can help to alleviate stress associated with processing of fear memories. In this study, we explored a potential application of BL for treatment of stress-induced and fear circuitry disorders in patients receiving exposure-based cognitive behavioral therapy (CBT). Fourteen patients with panic disorder (PD) or posttraumatic stress disorder (PTSD) were enrolled in a single-blind, randomized control trial to assess BL exposure (8000-lux, 30 min, 9 times, 2 weeks apart) compared to sham light (SL) exposure (800-lux, the same duration and frequency), while patients were concurrently receiving exposure-based CBT. The State Trait Anxiety Index (STAI) and the self-rating version of Montgomery–Asberg Depression Rating Scale (MADRS-S) assessed anxiety-related severity scores before and after therapy. After dropouts, 10 participants remained. STAI and MADRS-S scores showed a significantly greater reduction in the BL group than in the SL group. BL may be an effective augmentative therapy when used with exposure-based CBT for PD and PTSD patients. Future trials with larger sample sizes that are adequately statistically powered are required to confirm these preliminary findings.

Background:Cognitive behavioral therapy for insomnia (CBT-I) is a first-line therapy for insomnia disorders. We assessed changes in discrepancies between subjective and objective sleep measures and correlations between discrepancy changes and clinical insomnia severity for CBT-I in patients with primary insomnia METHODS: Fifty-two outpatients (mean age, 60.3 years; 26 women) with primary insomnia were treated by individual CBT-I (50 min, maximum six sessions, once every 1-2 weeks). One week before and after CBT-I, patients recorded a sleep log and wore an actigraphy device. Subjective and objective time in bed (TIB), total sleep time (TST), sleep-onset latency (SOL), wake time after sleep onset (WASO), and sleep efficiency (SE) were evaluated by averaging 1-week records. Relative values of sleep discrepancy in TIB, TST, SOL, WASO, and SE were calculated for estimating effects of CBT-I. The therapeutic effects were also evaluated using psychological scales before and after CBT-I., Results:Subjective and objective discrepancies in sleep measures decreased by 36, 25, and 37 min in TST, SOL, and WASO, respectively, and 7% in SE (all P < 0.001) after CBT-I. Seven patients transitioned from underestimating SE before CBT-I to overestimating SE after CBT-I. Although CBT-I improved relative values of discrepancy in WASO and SE, alongside ISI, the improvement in insomnia severity only correlated with SOL discrepancy., Conclusions:CBT-I may reduce the discrepancy between subjective and objective sleep measures in patients with primary insomnia. However, a greater therapeutic effect of CBT-I was observed in reducing the ISI, which was slightly influenced by improvements in sleep discrepancies.

Background To date, no previous studies have evaluated the relationship between sleep duration and quality of life (QOL) or depression in the general population after controlling for daytime sleepiness and sleep disturbances. Methods A web-based cross-sectional survey was conducted with 8698 subjects aged 20–69 years. We examined the relationships between weekday sleep duration and daytime sleepiness, sleep disturbance, QOL and depression, using the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index (without the item for sleep duration), 8-item Short Form and Center for Epidemiological Studies Depression Scale (CES-D). Results Daytime sleepiness tended to increase in proportion to shorter weekday sleep durations. Sleep disturbances, physical and mental QOL, and CES-D scores were worse in both the shorter and longer sleep groups compared with the group with 7–8 h of sleep. Hierarchical logistic regression analyses revealed that short sleep duration but not long sleep duration was significantly associated with reduction of both physical and mental QOL, even after controlling for the presence of daytime sleepiness and sleep disturbance. Both short and long sleep duration were independently and significantly correlated with depression after controlling for daytime sleepiness; however, there was no statistically significant association after adjusting for the effects of sleep disturbance. Conclusions The results suggested adverse effects of short sleep but not long sleep on both physical and mental QOL. In addition, the negative impact of specific types of sleep disturbance on depression may be greater than the impact of shortening of sleep duration.

Delayed encephalopathy (DE) affects not only the cerebral white matter and globus pallidus but also the cortex and thalamus. However, it remains unknown whether these brain lesions alter sleep along with clinical manifestations of DE. A 46-year-old man with DE underwent repetitive hyperbaric oxygen therapy. The patient was evaluated by not only neuropsychological and neuroimaging testing but polysomnography over the clinical course. Neurological symptoms improved markedly; however, profound frontal cognitive deficits continued. The polysomnography revealed prolonged absence and delayed recovery of sleep spindles across recordings. Alterations in spindle oscillations in DE could provide further insight into sleep regulatory networks.

s / Brain Stimulation 8 (2015) 360e377 371 Discussion: This novel observation suggests that PFC stimulation via anodal tDCS may help in correcting deficits in antisaccade task performance. These preliminary findings suggest that enhancement of inhibitory function might be one of the mechanisms underlying the ameliorating effect of add-on tDCS on persistent auditory hallucinations in schizophrenia.