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Aktivität und Tag-Nachtrhythmus bei Patienten mit Depression und Schizophrenie: Eine Pilotstudie zur Anwendung der Aktimetrie bei psychiatrischen Patienten

Actography in patients with depression and schizophrenia: A pilot study on circadian rhythm and sleep in psychiatric patients

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Zusammenfassung

Fragestellung

Störungen des Schlafs und der cirkadianen Rhythmik sind bei psychiatrischen Patienten, insbesondere bei Patienten mit Depression und Schizophrenie häufig zu finden. Die Aktographie bietet eine Methode, um diese Störungen objektiv und quantifizierbar zu erfassen.

Patienten und Methodik

In der vorliegenden Pilotstudie wurden sechs Patienten, vier mit Depression und zwei mit Schizophrenie diagnostiziert nach DSM-IV mit der Aktographie untersucht. Die depressiven Patienten wurden in zwei Subgruppen anhand der Hamilton Depressions Scores unterteilt, in eine leicht depressive (HAMD<18) und eine schwer depressive Gruppe (HAMD>18). Alle Patienten wurde über 72 Stunden kontinuierlich mit einem Aktimeter abgeleitet. Die Psychopathologie wurde mit verschiedenen Ratingskalen erhoben. Diese Prozedur wurde bei den schwer depressiven Patienten nach vierwöchiger konstanter Therapie wiederholt.

Ergebnisse

Patienten mit Schizophrenie wiesen die höchste Gesamtaktivität und die geringste Tag-/Nachtaktivitätsratio auf. Bei diesen Patienten lagen stark gestörte cirkadiane Aktivitätsrhythmen vor, mit aktiven Phasen auch während der Nacht. Gegenüber den depressiven Patienten war auch der Schlaf dieser Patienten in nahezu allen Parametern stärker gestört. Die leicht depressiven Patienten unterschieden sich von den schwer depressiven durch ein höheres Tagesaktivitätsniveau und ein größeres Verhältnis der Aktivitäten Tag/ Nacht. Nach vierwöchiger Behandlung nahm die Tag-Nachtaktivitätsratio zu, wodurch sich ein Hinweis zur Normalisierung des Tag-Nachtrhythmus ergibt.

Schlussfolgerung

Die Aktographie erscheint in dieser Pilotstudie als hilfreiche und leicht anwendbare Methode zur Messung von Aktivität, circadianen Aktivitätsrhythmen und der Schlafkontinuität bei Patienten mit Schizophrenie und Depression. Die Methode könnte psychiatrischen Patienten liefern und somit auch zur Verbesserung der Diagnostik und zur Evaluation des Therapieverlaufs eingesetzt werden.

Summary

Question of the Study

Disturbances of the rest-activity rhythm and sleep are frequent in psychiatric patients. A quantitative method for measuring both is provided by actography, which was applied in the present pilot study to examine activity levels, rest-activity rhythm, and sleep in depressive and schizophrenic patients.

Patients and Methods

Six inpatients, four with major depression and two with schizophrenia (DSM-IV criteria), were included. The depressed patients were further divided into two subgroups according to Hamilton depression (HAMD) values (two patients in each group): severely depressed (HAMD>18) and slightly depressed (HAMD<18), respectively. All patients underwent 72-h actographic monitoring and on the second day were evaluated by a number of psychiatric rating scales. The same procedure was repeated after 4 weeks of treatment for the severely depressed patients.

Results

The schizophrenic patients showed the highest night activity and the lowest day/ night activity ratio with irregular activity levels during the day and more active phases also at night, in comparison with the different groups of depressed patients. Concerning the various sleep parameters, the schizophrenic patients were more disturbed in almost all parameters compared with the depressive patients. Among the depressed patients, a clear difference was seen between slightly depressed patients and severely depressed patients. The slightly depressed patients had higher average and day activity levels and a higher day/night activity ratio than the severely depressed patients. After 4 weeks of antidepressant treatment, the severely depressed patients showed an increased day/night activity ratio, suggesting a trend towards a normalization of circadian rhythm.

Conclusion

Actography seems to be a useful and easily applicable method to measure activity levels and rest-activity rhythm disturbances in depressive and schizophrenic patients. The method may provide new information about circadian rhythm in psychiatric patients concerning diagnosis and treatment monitoring and therefore deserves further investigation.

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Authors and Affiliations

  1. Zentrum für Nervenheilkunde, Klinik für Psychiatrie und Psychotherapie, Universitätsklinik Marburg, Rudolf-Bultmann-Str. 8, D-35039, Marburg

    Ulrich Michael Hemmeter, Louise Hamark, Achim Bäcker, Andreas Thum, Rodrigo Rocamora & Jürgen Christian Krieg

  2. Klinik für Innere Medizin, Schwerpunkt Pneumologie, Klinikum der Philipps-Universität Marburg, Marburg, Deutschland

    Thomas Penzel

Authors
  1. Ulrich Michael Hemmeter
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  2. Louise Hamark
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  3. Achim Bäcker
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  4. Andreas Thum
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  5. Rodrigo Rocamora
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  6. Thomas Penzel
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  7. Jürgen Christian Krieg
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Correspondence to Ulrich Michael Hemmeter.

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Hemmeter, U.M., Hamark, L., Bäcker, A. et al. Aktivität und Tag-Nachtrhythmus bei Patienten mit Depression und Schizophrenie: Eine Pilotstudie zur Anwendung der Aktimetrie bei psychiatrischen Patienten. Somnologie 6, 124–132 (2002). https://doi.org/10.1046/j.1439-054X.2002.02185.x

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