ساختار خواب در زنان آدمکش با اختلال شخصیت ضد اجتماعی ؛ یک مطالعه مقدماتی

Abstract The aim of the present study was to characterize sleep in severely violent women with antisocial personality disorder (ASP) as the primary diagnosis. Participants for this preliminary study were three drug-free female offenders ordered to undergo a forensic mental examination in a maximum security state mental hospital after committing homicide or attempted homicide. Ten healthy age- and gender-matched controls consisted of hospital staff with no history of physical violence. The most striking finding was the increased amount of slow wave sleep, particularly the deepest sleep stage, S4, in women with ASP. This finding is in agreement with previously reported results in habitually violent male criminals with ASP. Severe female aggression seems to be associated with profound changes in sleep architecture. Whether this reflects specific brain pathology, or a delay in the normal development of sleep patterns in the course of aging, needs to be clarified. From the perspective of sleep research, the biological correlates of severe impulsive violence seem to be similar in both sexes.

Psychiatry Research Volume 145, Issue 1, 29 November 2006, Pages 67–73 Cover image Sleep architecture in homicidal women with antisocial personality disorder—a preliminary study Nina Lindberga, b, , , Pekka Tania, b, Eila Sailasb, Hanna Putkonenb, c, Pirjo Takalac, Anna-Sofia Urrilaa, Markku Eronenc, Matti Virkkunenb Show more doi:10.1016/j.psychres.2005.10.014 Get rights and content Abstract The aim of the present study was to characterize sleep in severely violent women with antisocial personality disorder (ASP) as the primary diagnosis. Participants for this preliminary study were three drug-free female offenders ordered to undergo a forensic mental examination in a maximum security state mental hospital after committing homicide or attempted homicide. Ten healthy age- and gender-matched controls consisted of hospital staff with no history of physical violence. The most striking finding was the increased amount of slow wave sleep, particularly the deepest sleep stage, S4, in women with ASP. This finding is in agreement with previously reported results in habitually violent male criminals with ASP. Severe female aggression seems to be associated with profound changes in sleep architecture. Whether this reflects specific brain pathology, or a delay in the normal development of sleep patterns in the course of aging, needs to be clarified. From the perspective of sleep research, the biological correlates of severe impulsive violence seem to be similar in both sexes. Keywords Antisocial personality disorder; Women; Homicide; Sleep; Polysomnography 1. Introduction Female violent behavior has been less studied than that of men. This is partly because women commit fewer crimes than men (Harvey et al., 1992, Steffensmeier and Allan, 1996 and Eisner, 2003), but also because female aggression is typically carried out in private and domestic areas (Rogde et al., 2000). It has also been postulated that the idealization of motherhood, the social taboo of female violence and the consequent denial thereof have possibly minimized concern with the phenomenon (Motz, 2001). As a symptom, female aggression overlaps with a number of psychiatric disorders, but it is commonly associated with personality disorders, in particular antisocial (ASP) and borderline personality disorders (BPD), and substance abuse (Arseneault et al., 2000, Putkonen et al., 2001 and Nestor, 2002). Pooled data indicate that one in five female prisoners has ASP (Fazel and Danesh, 2002) and the risk for homicide has been reported to be exceptionally high in women with ASP (Eronen et al., 1996). During the last decade there has been growing evidence of central nervous system dysfunction in severe aggressive behavior (Virkkunen et al., 1994 and Soderstrom et al., 2000), but it is still unclear whether aggression in women is affected by the same biological mechanisms as in men. Human sleep consists of two main components: rapid eye movement (REM) and non-REM sleep, the latter is divided into stages 1–4 (S1–S4). Stage 3 sleep (S3) and stage 4 sleep (S4) in non-REM sleep are defined as slow wave sleep (SWS), also called delta or deep sleep. In normal sleep, REM and non-REM periods alternate cyclically. Although the exact functions of the different sleep stages are not known, it is generally accepted that SWS is the physiologically significant, refreshing part of sleep. Feelings of unwellness, either somatic or psychiatric, are frequently associated with decreased SWS. On the contrary, habitually violent, homicidal male offenders with ASP have been reported to show increased amounts of SWS, particularly S4 sleep, as compared with age-matched healthy men (Lindberg et al., 2003a). Furthermore, offenders with severe conduct disorder had higher amounts of S4 sleep than did men with only mild or moderate conduct disorder (Lindberg et al., 2003b). It is still unclear, whether the impulsive, aggressive behavior in women is affected by the same biological mechanisms as in men. From the perspective of sleep research, an interesting question is whether the exceptional deep sleep phenomenon reported in men with ASP can be seen also in antisocial women. The aim of the present study was to characterize the sleep architecture of highly violent women with ASP as compared with healthy female controls.

Results For the details of PSG results and sleep diary, see Table 1. The BDI showed mild depressive symptoms in female offenders with ASP, while the controls were symptom free. No significant differences were observed in sleep duration, sleep latency, wake after sleep onset or sleep efficiency between the study groups. Female offenders with ASP had significantly more SWS and S4 sleep than the controls. They also had significantly decreased REM latency as compared with the controls. In the sleep diary, ASP persons retired to bed 45 min earlier and fell asleep 32 min earlier compared with controls. Duration of sleep period and subjective sleep quality were similar in both groups. Table 1. Clinical parameters, polysomnography and sleep diary data (the latter calculated from means of each individual during 1 week preceding polysomnographic recordings) in three female offenders with antisocial personality disorder (ASP 1, 2, 3) and 10 healthy controls (CO) ASP 1 ASP 2 ASP 3 ASP CO T P Median Median 25% 75% Age (years) 34 33 41 34 34 32 38 24 NS BDI (points) 6 13 8 8 0 0 0 36 0.01 Polysomnography data TIB (min) 495 476 480 480 493 481 511 13 NS Sleep lat (min) 43 13 28 28 14 10 32 25 NS SP (min) 452 463 452 452 471 459 492 14 NS Awakenings (n) 4 11 12 11 9 5 9 28 NS WASO (min) 14 35 17 17 18 13 28 20 NS TST (min) 449 428 436 436 451 433 461 15 NS SE (%) 97 92 96 96 96 94 97 21 NS REM lat (min) 50 62 72 62 91 88 94 6 0.01 S1 (%) 2 4 3 3 3 3 4 17 NS S2 (%) 36 37 37 37 53 51 54 17 NS S3 (%) 6 3 2 3 8 6 9 9 0.05 S4 (%) 19 24 30 24 7 6 8 36 0.01 SWS (%) 25 27 32 27 15 13 16 36 0.01 REM (%) 37 32 30 32 30 27 31 32 NS Sleep diary data Time of retiring to bed 22 : 02 21 : 56 21 : 52 21 : 56 22 : 41 22 : 26 22 : 53 6 0.01 Time of falling asleep 22 : 32 22 : 20 22 : 16 22 : 20 22 : 52 22 : 40 23 : 09 6 0.01 Time of waking up 6 : 44 7 : 00 7 : 07 7 : 00 7 : 20 7 : 04 7 : 36 11 NS Sleep quality 7.4 7.4 8.1 7.4 8.1 8.0 8.3 11 NS TIB = time in bed. Sleep lat = sleep latency. SP = sleep period. WASO = wake after sleep onset. TST = total sleep time. SE = sleep efficiency. REM lat = REM latency. S1–S4% = percentage amount of sleep stages S1–S4 (of TST). SWS% = percentage amount of slow wave sleep (of TST). REM% = percentage amount of REM sleep (of TST). BDI = Beck Depression Inventory score. NS = difference not statistically significant. In sleep diary data, military time was used, except for sleep quality, where an arbitrary scale from 4 to 10 (school grades in Finland) was applied. Comparisons were made using the Mann–Whitney rank sum test.