The relationship between sleep disorders and (reactive) aggression in forensic psychiatric patients.

A large group of psychiatric patients has complaints about their sleep. Despite
the fact that these sleep disorders are most often a result or symptom of the
psychiatric disorder (review: Abad and Guileminault, 2005), recent insights
strongly suggest sleep disorders should be treated in addition to treatment of
the psychiatric disorder. This may have a positive effect on the coarse of the
psychiatric disorder and possibly prevents relapse (for example: Krakow et al.,
2001; Fava et al., 2006).
Treatment of sleep disorders in forensic psychiatric patients could even be of
greater importance. A lack of sleep is associated with emotional instability.
Studies in young, healthy people show that a poor quality of sleep is
associated with anger/hostility (Pilcher et al., 1997) and superficial sleep
with impulsiveness and aggression (Schubert., 1977). Sleep deprivation is
associated with a higher rate of aggression (Roth el al., 1976). A group of
sexual offenders with sleep apnoea showed less subjective aggression and
hostility after treatment of their sleeping disorder (Booth et al., 2006). A
lower quality of sleep is associated with a higher rate of aggression,
impulsivity and hostility in a group of male young delinquents (Ireland and
Culpin, 2006). Some neurological evidence comes from an fMRI study in young
healthy objects which showed evidence for a stronger emotional response to
negative stimuli after lack of sleep (Yoo et al., 2007). There seems to be an
association between quality and quantity of sleep and aggression. Sleep
disorders thus may be a risk factor for impulsive aggressive behavior. Even
though this may have important implications for the forensic psychiatry, the
relationship between sleep and aggression has never been studied in forensic
psychiatric patients.

Abad VC, Guileminault C. Sleep and psychiatry. Dialogues in Clinical
Neuroscience (2005) 7: 291-303.

Booth BD, Federoff JP, Curry SD, Douglass AB. Sleep apnea as a possible factor
contributing to agression in sex offenders. Journal of Forensic Science (2006)
51: 1178-1181.

Fava M, McCall WV, Krystal A, Wessel T, Rubens R, Caron J, Amato D, Roth T.
Eszopiclone Co-administered with fluoxetine in patients with insomnia
coexisting with major depressive disorder. Biological Psychiatry (2006) 59:
1052-1060.

Ireland JL, Culpin VC. The relationship between sleeping problems and
aggression, anger, and impulsivity in a population of juvenile and young
offenders. Journal of Adolescent Health (2006) 38: 649-655.

Krakow B, Hollifield M, Johnston L, Koss M, Schrader R, Warner TD, Tandberg D,
Lauriello J, McBride L, Cutchen L, Cheng D, Emmons S, Germain A, Melendrez D,
Sandoval D, Prince H. Imagery rehearsal therapy for chronic nightmares in
sexual assault survivors with posttraumatic stress disorder. A randomized
controlled trial. JAMA (2001) 286: 537-545.

Pilcher JJ, Ginter DR, Sadowsky B. Sleep quality versus quantity: relationships
between sleep and measures of health: well-being and sleepiness in college
students. Journal of Psychosomatic Research (1997) 42: 583-596.

Roth T, Kramer M, Lutz T. The effects of sleep deprivation on mood. Psychiatric
Journal University Ottawa (1976) 1: 136-139.

Schubert FC. Personality traits and polygraphic sleepparameters. Waking
Sleeping (1977) 1: 165-170.

Yoo SS, Gujar N, Hu P, Jolesz FA, Walker MP. The human emotional brain without
sleep - a prefrontal amygdala disconnect. Current Biology (2007) 17: R877-R878.

The primary objective of this study is to examine the relationship between
sleep disorders and (reactive) aggression in forensic psychiatric patients in
the Forensic Psychiatric Center Dr. S. van Mesdag in Groningen.
In addition to this, epidemiologic numbers of sleep disorders in forensic
psychiatric patients will be generated, next to data on type of sleep disorders
and treatment of sleep disorders in forensic psychiatric patients. The question
which psychiatric disorders relate to sleep problems in forensic psychiatric
patients will also be examined.

The project will last approximately 10 months, in which 6 months are reserved
for collection of data. In a group of forensic psychiatric patients each
subject will be evaluated once with 4 subjective questionnaires about sleep and
aggression/impulsivity and a personal interview with one of the researchers.
The latter will focus on quality of sleep during life, possible origins of
sleep disorders, comparison of current sleep and sleep during detention time,
current quality of sleep, sleep hygiene, and possible effects from current
treatment for sleep disorders. In addition, information about basic data as age
and sex, the DSM-IV-TR diagnosis, current use of medication and scores on the
last risk assessment (HKT-30) will be obtained from the medical file.
There are no medications, medical instruments or psychosocial interventions
involved in this study.

Not applicable.