Skip to main content
Top
Published in: BMC Psychiatry 1/2004

Open Access 01-12-2004 | Case report

Increased deep sleep in a medication-free, detoxified female offender with schizophrenia, alcoholism and a history of attempted homicide: Case report

Authors: Nina Lindberg, Pekka Tani, Pirjo Takala, Eila Sailas, Hanna Putkonen, Markku Eronen, Matti Virkkunen

Published in: BMC Psychiatry | Issue 1/2004

Login to get access

Abstract

Background

Psychiatric sleep research has attempted to identify diagnostically sensitive and specific sleep patterns associated with particular disorders. Both schizophrenia and alcoholism are typically characterized by a severe sleep disturbance associated with decreased amounts of slow wave sleep, the physiologically significant, refreshing part of the sleep. Antisocial behaviour with severe aggression, on the contrary, has been reported to associate with increased deep sleep reflecting either specific brain pathology or a delay in the normal development of sleep patterns. The authors are not aware of previous sleep studies in patients with both schizophrenia and antisocial personality disorder.

Case presentation

The aim of the present case-study was to characterize the sleep architecture of a violent, medication-free and detoxified female offender with schizophrenia, alcoholism and features of antisocial personality disorder using polysomnography. The controls consisted of three healthy, age-matched women with no history of physical violence. The offender's sleep architecture was otherwise very typical for patients with schizophrenia and/or alcoholism, but an extremely high amount of deep sleep was observed in her sleep recording.

Conclusions

The finding strengthens the view that severe aggression is related to an abnormal sleep pattern with increased deep sleep. The authors were able to observe this phenomenon in an antisocially behaving, violent female offender with schizophrenia and alcohol dependence, the latter disorders previously reported to be associated with low levels of slow wave sleep. New studies are, however, needed to confirm and explain this preliminary finding.
Literature
1.
go back to reference Eisner M: Long-term historical trends in violent crime. Crime and Justice. 2003, 30: 83-142.CrossRef Eisner M: Long-term historical trends in violent crime. Crime and Justice. 2003, 30: 83-142.CrossRef
2.
go back to reference Rodge S, Hougen HP, Poulsen K: Homicide by sharp force in two scandinavian capitals. Forensic Sci Int. 2000, 109: 135-145. 10.1016/S0379-0738(99)00230-3.CrossRef Rodge S, Hougen HP, Poulsen K: Homicide by sharp force in two scandinavian capitals. Forensic Sci Int. 2000, 109: 135-145. 10.1016/S0379-0738(99)00230-3.CrossRef
3.
go back to reference Lewis DO, Yeager CA, Cobham-Portorreal CS, Klein N, Showalter C, Anthony A: A follow-up of female delinquents: maternal contributions to the perpetuation of deviance. J Am Acad Child Adolesc Psychiatry. 1991, 30: 197-201.CrossRefPubMed Lewis DO, Yeager CA, Cobham-Portorreal CS, Klein N, Showalter C, Anthony A: A follow-up of female delinquents: maternal contributions to the perpetuation of deviance. J Am Acad Child Adolesc Psychiatry. 1991, 30: 197-201.CrossRefPubMed
4.
go back to reference Pajer KA: What happens to "bad" girls? A review of the adult outcomes of antisocial adolescent girls. Am J Psychiatry. 1998, 155: 862-870.CrossRefPubMed Pajer KA: What happens to "bad" girls? A review of the adult outcomes of antisocial adolescent girls. Am J Psychiatry. 1998, 155: 862-870.CrossRefPubMed
5.
go back to reference Putkonen H, Collander J, Honkasalo M-L, Lonnqvist J: Finnish female homicide offenders 1982–1992. J Forensic Psychiatry. 1998, 9: 672-684.CrossRef Putkonen H, Collander J, Honkasalo M-L, Lonnqvist J: Finnish female homicide offenders 1982–1992. J Forensic Psychiatry. 1998, 9: 672-684.CrossRef
6.
go back to reference Eronen M, Hakola P, Tiihonen J: Mental disorders and homicidal behavior in Finland. Arch Gen Psychiatry. 1996, 53: 497-501.CrossRefPubMed Eronen M, Hakola P, Tiihonen J: Mental disorders and homicidal behavior in Finland. Arch Gen Psychiatry. 1996, 53: 497-501.CrossRefPubMed
7.
go back to reference Ito T, Miller N, Pollock V: Alcohol and aggression: a meta-analysis of the moderating effects of inhibitory cues, triggering events, and self-focused attention. Psychol Bull. 1996, 120: 60-82. 10.1037//0033-2909.120.1.60.CrossRefPubMed Ito T, Miller N, Pollock V: Alcohol and aggression: a meta-analysis of the moderating effects of inhibitory cues, triggering events, and self-focused attention. Psychol Bull. 1996, 120: 60-82. 10.1037//0033-2909.120.1.60.CrossRefPubMed
8.
go back to reference Eronen M: Mental disorders and homicidal behavior in female subjects. Am J Psychiatry. 1995, 152: 1216-1218.CrossRefPubMed Eronen M: Mental disorders and homicidal behavior in female subjects. Am J Psychiatry. 1995, 152: 1216-1218.CrossRefPubMed
9.
go back to reference Mueser KT, Drake RE, Ackerson TH, Alterman AI, Miles KM, Noordsy DL: Antisocial personality disorder, conduct disorder, and substance abuse in schizophrenia. J Abnorm Psychol. 1997, 106: 473-477. 10.1037//0021-843X.106.3.473.CrossRefPubMed Mueser KT, Drake RE, Ackerson TH, Alterman AI, Miles KM, Noordsy DL: Antisocial personality disorder, conduct disorder, and substance abuse in schizophrenia. J Abnorm Psychol. 1997, 106: 473-477. 10.1037//0021-843X.106.3.473.CrossRefPubMed
10.
go back to reference Benson KL, Zarcone VP: Schizophrenia. In Principles and Practice of Sleep Medicine. Edited by: Kryger MH, Roth T, Dement WC. 2000, Philadelphia: WB Saunders Company, 1159-1167. 3 Benson KL, Zarcone VP: Schizophrenia. In Principles and Practice of Sleep Medicine. Edited by: Kryger MH, Roth T, Dement WC. 2000, Philadelphia: WB Saunders Company, 1159-1167. 3
11.
go back to reference Gillin JC, Drummond SPA: Medication and Substance Abuse. In Principles and Practice of Sleep Medicine. Edited by: Kryger MH, Roth T, Dement WC. 2000, Philadelphia: WB Saunders Company, 1176-1195. 3 Gillin JC, Drummond SPA: Medication and Substance Abuse. In Principles and Practice of Sleep Medicine. Edited by: Kryger MH, Roth T, Dement WC. 2000, Philadelphia: WB Saunders Company, 1176-1195. 3
12.
go back to reference Goder R, Boigs M, Braun S, Friege L, Fritzer G, Aldenhoff JB, Hinze-Selch D: Impairment of visuospatial memory is associated with decreased slow wave sleep in schizophrenia. J Psychiatr Res. 2004, 38: 591-9. 10.1016/j.jpsychires.2004.04.005.CrossRefPubMed Goder R, Boigs M, Braun S, Friege L, Fritzer G, Aldenhoff JB, Hinze-Selch D: Impairment of visuospatial memory is associated with decreased slow wave sleep in schizophrenia. J Psychiatr Res. 2004, 38: 591-9. 10.1016/j.jpsychires.2004.04.005.CrossRefPubMed
13.
go back to reference Maixner S, Tandon R, Eiser A, Taylor S, DeQuardo JR, Shipley JE: Effects of antipsychotic treatment on polysomnographic measures in schizophrenia: a replication and extension. Am J Psychiatry. 1998, 155: 1600-1602.CrossRefPubMed Maixner S, Tandon R, Eiser A, Taylor S, DeQuardo JR, Shipley JE: Effects of antipsychotic treatment on polysomnographic measures in schizophrenia: a replication and extension. Am J Psychiatry. 1998, 155: 1600-1602.CrossRefPubMed
14.
go back to reference Keshavan MS, Miewald JM, Haas G, Sweeney JA, Ganguli R, Reynolds CF: Slow wave sleep and symptomatology in schizophrenia and related psychotic disorders. J Psychiatr Res. 1995, 29: 303-14. 10.1016/0022-3956(95)00023-X.CrossRefPubMed Keshavan MS, Miewald JM, Haas G, Sweeney JA, Ganguli R, Reynolds CF: Slow wave sleep and symptomatology in schizophrenia and related psychotic disorders. J Psychiatr Res. 1995, 29: 303-14. 10.1016/0022-3956(95)00023-X.CrossRefPubMed
15.
go back to reference Hoffmann R, Hendrickse W, Rush AJ, Armitage R: Slow-wave activity during non-REM sleep in men with schizophrenia and major depressive disorders. Psychiatry Res. 2000, 95: 215-25. 10.1016/S0165-1781(00)00181-5.CrossRefPubMed Hoffmann R, Hendrickse W, Rush AJ, Armitage R: Slow-wave activity during non-REM sleep in men with schizophrenia and major depressive disorders. Psychiatry Res. 2000, 95: 215-25. 10.1016/S0165-1781(00)00181-5.CrossRefPubMed
16.
go back to reference First MB, Spitzer RL, Williams JBW, Gibbon M, Williams JWB: Structured Clinical Interview for DSM-IV Axis I Disorders, Clinical Version (SCID-CV). 1996, Washington DC: American Psychiatric Press First MB, Spitzer RL, Williams JBW, Gibbon M, Williams JWB: Structured Clinical Interview for DSM-IV Axis I Disorders, Clinical Version (SCID-CV). 1996, Washington DC: American Psychiatric Press
17.
go back to reference First MB, Gibbon M, Spitzer RL, Williams JBW, Benjamin L: Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). 1997, Washington DC: American Psychiatric Press First MB, Gibbon M, Spitzer RL, Williams JBW, Benjamin L: Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). 1997, Washington DC: American Psychiatric Press
18.
go back to reference Spitzer RL, Williams JBW, Gibbon M, First MB: Structured Clinical Interview for DSM-III-R, Non-patient Edition (SCID-NP). 1990, Washington DC: American Psychiatric Press Spitzer RL, Williams JBW, Gibbon M, First MB: Structured Clinical Interview for DSM-III-R, Non-patient Edition (SCID-NP). 1990, Washington DC: American Psychiatric Press
19.
go back to reference Rechtschaffen A, Kales A: A Manual of Standardized Terminology, Techniques, and Scoring System for Sleep Stages of Human Subjects. 1968, Washington DC: Department of Health, Education, and Welfare; Rechtschaffen A, Kales A: A Manual of Standardized Terminology, Techniques, and Scoring System for Sleep Stages of Human Subjects. 1968, Washington DC: Department of Health, Education, and Welfare;
20.
go back to reference Tandon R, Shipley JE, Taylor S, Greden JF, Eiser A, deQuardo J, Goodson J: Electroencephalographic sleep abnormalities in schizophrenia. Relationship to positive/ negative symptoms and prior neuroleptic treatment. Arch Gen Psychiatry. 1992, 49: 185-194.CrossRefPubMed Tandon R, Shipley JE, Taylor S, Greden JF, Eiser A, deQuardo J, Goodson J: Electroencephalographic sleep abnormalities in schizophrenia. Relationship to positive/ negative symptoms and prior neuroleptic treatment. Arch Gen Psychiatry. 1992, 49: 185-194.CrossRefPubMed
21.
go back to reference Bliwise DL: Normal Aging. In Principles and Practice of Sleep Medicine. Edited by: Kryger MH, Roth T, Dement WC. 2000, Philadelphia: WB Saunders Company, 26-42. 3 Bliwise DL: Normal Aging. In Principles and Practice of Sleep Medicine. Edited by: Kryger MH, Roth T, Dement WC. 2000, Philadelphia: WB Saunders Company, 26-42. 3
22.
go back to reference Carskadon MA, Dement WC: Normal Human Sleep: An Overview. In Principles and Practice of Sleep Medicine. Edited by: Kryger MH, Roth T, Dement WC. 2000, Philadelphia: WB Saunders Company, 15-25. 3 Carskadon MA, Dement WC: Normal Human Sleep: An Overview. In Principles and Practice of Sleep Medicine. Edited by: Kryger MH, Roth T, Dement WC. 2000, Philadelphia: WB Saunders Company, 15-25. 3
24.
go back to reference Kaufman Y, Tzischinsky O, Epstein R, Etzioni A, Lavie P, Pillar G: Long-term disturbances in adolescents after minor head injury. Pediatr Neurol. 2001, 24: 129-134. 10.1016/S0887-8994(00)00254-X.CrossRefPubMed Kaufman Y, Tzischinsky O, Epstein R, Etzioni A, Lavie P, Pillar G: Long-term disturbances in adolescents after minor head injury. Pediatr Neurol. 2001, 24: 129-134. 10.1016/S0887-8994(00)00254-X.CrossRefPubMed
25.
go back to reference Lindberg N, Tani P, Appelberg B, Stenberg D, Naukkarinen H, Rimón R, Porkka-Heiskanen T, Virkkunen M: Sleep among habitually violent offenders with antisocial personality disorder. Neuropsychobiology. 2003, 47: 198-205. 10.1159/000071215.CrossRefPubMed Lindberg N, Tani P, Appelberg B, Stenberg D, Naukkarinen H, Rimón R, Porkka-Heiskanen T, Virkkunen M: Sleep among habitually violent offenders with antisocial personality disorder. Neuropsychobiology. 2003, 47: 198-205. 10.1159/000071215.CrossRefPubMed
26.
go back to reference Lindberg N, Tani P, Appelberg B, Naukkarinen H, Rimón R, Porkka-Heiskanen T, Virkkunen M: Human impulsive aggression: a sleep research perspective. J Psychiatr Research. 2003, 37: 313-324. 10.1016/S0022-3956(03)00041-4.CrossRef Lindberg N, Tani P, Appelberg B, Naukkarinen H, Rimón R, Porkka-Heiskanen T, Virkkunen M: Human impulsive aggression: a sleep research perspective. J Psychiatr Research. 2003, 37: 313-324. 10.1016/S0022-3956(03)00041-4.CrossRef
27.
go back to reference Coble PA, Taska LS, Kupfer DJ, Kazdin AE, Unis A, French N: EEG sleep "abnormalities" in preadolescent boys with a diagnosis of conduct disorder. J Am Acad Child Psychiatry. 1984, 23: 438-447.CrossRefPubMed Coble PA, Taska LS, Kupfer DJ, Kazdin AE, Unis A, French N: EEG sleep "abnormalities" in preadolescent boys with a diagnosis of conduct disorder. J Am Acad Child Psychiatry. 1984, 23: 438-447.CrossRefPubMed
28.
go back to reference Ramos Platon MJ, Bueno AV, Sierra JE, Kales S: Hypnopolygraphic alterations in attention deficit disorder (ADD) children. Int J Neurosci. 1990, 53: 87-101.CrossRefPubMed Ramos Platon MJ, Bueno AV, Sierra JE, Kales S: Hypnopolygraphic alterations in attention deficit disorder (ADD) children. Int J Neurosci. 1990, 53: 87-101.CrossRefPubMed
29.
go back to reference Chengappa KN, Vasile J, Levine J, Ulrich R, Baker R, Gopalani A, Schooler N: Clozapine: its impact on aggressive behaviour among patients in a state psychiatric hospital. Schizophr Res. 2002, 53: 1-6. 10.1016/S0920-9964(00)00175-4.CrossRefPubMed Chengappa KN, Vasile J, Levine J, Ulrich R, Baker R, Gopalani A, Schooler N: Clozapine: its impact on aggressive behaviour among patients in a state psychiatric hospital. Schizophr Res. 2002, 53: 1-6. 10.1016/S0920-9964(00)00175-4.CrossRefPubMed
30.
go back to reference Touyz SW, Beumont PJ, Saayman GS, Zabow T: A psychophysiological investigation of the short-term effects of clozapine upon sleep parameters of normal young adults. Biol Psychiatry. 1977, 12: 801-822.PubMed Touyz SW, Beumont PJ, Saayman GS, Zabow T: A psychophysiological investigation of the short-term effects of clozapine upon sleep parameters of normal young adults. Biol Psychiatry. 1977, 12: 801-822.PubMed
31.
go back to reference Hinze-Selch D, Mullington J, Orth A, Lauer CJ, Pollmächer T: Effects of clozapine on sleep: a longitudinal study. Biol Psychiatry. 1997, 42: 260-266. 10.1016/S0006-3223(96)00347-2.CrossRefPubMed Hinze-Selch D, Mullington J, Orth A, Lauer CJ, Pollmächer T: Effects of clozapine on sleep: a longitudinal study. Biol Psychiatry. 1997, 42: 260-266. 10.1016/S0006-3223(96)00347-2.CrossRefPubMed
Metadata
Title
Increased deep sleep in a medication-free, detoxified female offender with schizophrenia, alcoholism and a history of attempted homicide: Case report
Authors
Nina Lindberg
Pekka Tani
Pirjo Takala
Eila Sailas
Hanna Putkonen
Markku Eronen
Matti Virkkunen
Publication date
01-12-2004
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2004
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/1471-244X-4-35

Other articles of this Issue 1/2004

BMC Psychiatry 1/2004 Go to the issue