Without sleep, the emotional centers of the brain dramatically overreact to negative experiences, reveals a new brain imaging study in the October 23rd issue of Current Biology, a publication of Cell Press. The reason for that hyperactive emotional response in sleep-deprived people stems from a shutdown of the prefrontal lobe—a region that normally keeps emotions under control.

The new study from Harvard Medical School and the University of California, Berkeley is the first to explain, at the neural level, what seems to be a universal phenomenon: that sleep loss leads to emotionally irrational behavior, according to the researchers. The findings might also offer some insight into the clinical connection between sleep disruptions and psychiatric disorders.

“This adds to the critical list of sleep’s benefits,” said Matthew Walker, from the University of California, Berkeley. “Sleep appears to restore our emotional brain circuits, and in doing so prepares us for the next day’s challenges and social interactions. Most importantly, this study demonstrates the dangers of not sleeping enough. Sleep deprivation fractures the brain mechanisms that regulate key aspects of our mental health. The bottom line is that sleep is not a luxury that we can optionally choose to take whenever we like. It is a biological necessity, and without it, there is only so far the band will stretch before it snaps, with both cognitive and emotional consequences.”

Scientists have known that sleep deprivation impairs a range of bodily functions, including the immune system and metabolism, as well as brain processes, such as learning and memory, the researchers explained. Yet, evidence for the role of sleep in governing our emotional brain state had remained surprisingly scarce, they noted.

In the new study, Walker’s team assigned 26 healthy people to either a sleep-deprivation group—in which participants were kept awake for about 35 hours—or a normal sleep group. On the following day, the study subjects’ brains were scanned by functional magnetic resonance imaging (fMRI), which measures brain activity on the basis of blood flow, while viewing 100 images. The images were at first emotionally neutral, but became increasingly aversive over time.

“We had predicted a potential increase in the emotional reaction from the brain [in people deprived of sleep], but the size of the increase truly surprised us,” Walker said of the study’s findings. “The emotional centers of the brain were over 60% more reactive under conditions of sleep deprivation than in subjects who had obtained a normal night of sleep. It is almost as though, without sleep, the brain reverts back to a more primitive pattern of activity, becoming unable to put emotional experiences into context and produce controlled, appropriate responses.

“While it is early days,” he added, “clinical evidence has shown that some form of sleep disruption is present in almost all psychiatric disorders. These findings may offer new mechanisms as to why, and provide novel insights into how we can understand and even treat these disorders at a brain level.”

A tendency to extract messages from meaningless noise could be an early sign of schizophrenia, according to a study by Yale School of Medicine researchers.

The study this month in the British Journal of Psychiatry reported on 43 participants diagnosed with “prodromal symptoms”— meaning they exhibited early warning signs of psychosis such as social withdrawal, mild perceptual alterations, or misinterpretation of social cues. Participants in the study were randomly assigned to take the anti-psychotic medication olanzapine or a placebo, and then symptoms and neuropsychological function were assessed for up to two years.

During the “babble task,” participants listened with headphones to overlapping recordings of six speakers reading neutral texts, which made the words virtually incomprehensible. The participants were asked to repeat any words or phrases that they heard. Only four words—“increase,” “children,” “A-OK,” and “Republican”—were consistently reproduced.

Eighty percent of the participants who “heard” phrases of four or more words in length went on to develop a schizophrenia-related illness during times that they were not taking olanzapine, said the lead author, Ralph Hoffman, M.D., associate professor of psychiatry. In contrast, only six percent of those in the study converted to schizophrenia-related illness if the phrases “heard” were less than three words in length. “A tendency to extract message-like meaning from meaningless sensory information can, over time, produce a ‘matrix of unreality’ that triggers the initial psychotic phase of schizophrenia-spectrum disorders,” Hoffman said.

He said further research is needed because of the small size of this study. However, if these findings are verified, Hoffman added, they could provide an inexpensive tool for identifying those individuals with early warning signs of schizophrenia who would most likely benefit from preventive drug therapy.

You may not be fully dressed without a smile, but a look of horror will make a faster first impression. Vanderbilt University researchers have discovered that the brain becomes aware of fearful faces more quickly than those showing other emotions. "There are reasons to believe that the brain has evolved mechanisms to detect things in the environment that signal threat. One of those signals is a look of fear," David Zald, associate professor of psychology and a co-author of the new study, said. "We believe that the brain can detect certain cues even before we are aware of them, so that we can direct our attention to potentially threatening situations in our environment." Randolph Blake, Centennial Professor of Psychology, and Eunice Yang, doctoral student, were co-authors of the study, which will appear in the November 2007 issue of Emotion.

The researchers set out to determine if we become aware of fearful, neutral or happy expressions at the same speed, or if one of these expressions reaches our awareness faster than the others. To do this, they needed to find a way to slow down the speed at which subjects processed facial information -- which usually takes less than 40 milliseconds. At those high speeds it is difficult to tell which images rise to awareness the fastest.

Yang, the lead author of the study, realized that a technique being used in Blake's lab might provide a solution to the problem. The technique, continuous flash suppression, keeps people from becoming aware of what they are seeing for up to 10 seconds. Using this technique, the team had research subjects look at a screen through a viewer, similar to the eyepieces on a microscope, which allowed different images to be presented to each eye. Many images were rapidly presented to one eye while a static image of a face was presented to the other. The multiple images served as visual 'noise,' suppressing the image of the face. The subjects indicated when they first became aware of seeing a face, enabling the researchers to determine if the expression on the face had any impact on how quickly the subject became aware of it.

The team found that subjects became aware of faces that had fearful expressions before neutral or happy faces. They believe a brain area called the amygdala, which shortcuts the normal brain pathway for processing visual images, is responsible. "The amygdala receives information before it goes to the cortex, which is where most visual information goes first. We think the amygdala has some crude ability to process stimuli and that it can cue some other visual areas to what they need to focus on," Zald said.

Zald and his colleagues believe the eyes of the fearful face play a key role. "Fearful eyes are a particular shape, where you get more of the whites of the eye showing," he said."That may be the sort of simple feature that the amygdala can pick up on, because it's only getting a fairly crude representation. That fearful eye may be something that's relatively hardwired in there."

A surprising finding was that subjects perceived happy faces the slowest. "What we believe is happening is that the happy faces signal safety. If something is safe, you don't have to pay attention to it," Zald said.

Next, the researchers will explore how this information influences our behavior. "We are interested in now exploring what this means for behavior," Yang said. "Since these expressions are being processed without our awareness, do they affect our behavior and our decision making? If so, how?"

What's wrong with being shy, and just when and how did bashfulness and other ordinary human behaviors in children and adults become psychiatric disorders treatable with powerful, potentially dangerous drugs, asks a Northwestern University scholar in a new book that already is creating waves in the mental health community.

In "Shyness: How Normal Behavior Became a Sickness" (October 2007), Northwestern's Christopher Lane chronicles the "highly unscientific and often arbitrary way" in which widespread revisions were made to "The Diagnostic and Statistical Manual of Mental Disorders" (DSM), a publication known as the bible of psychiatry that is consulted daily by insurance companies, courts, prisons and schools as well as by physicians and mental health workers.

"The number of mental disorders the general population might exhibit leaped from 180 in 1968 to more than 350 in 1994," notes Lane, Northwestern's Herman and Beulah Pearce Miller Research Professor. In a book that calls into doubt the facade of objective research behind psychiatry's revolution, Lane questions the rationale for the changes, and whether all of them were necessary and suitably precise.

By labeling shyness and other human traits as mental conditions with a biological cause, the doors were opened wide to a pharmaceutical industry ready to provide a pill for every alleged chemical imbalance or biological problem, the author says.

Lane, who meticulously and systematically researched the archives of the American Psychiatric Association, uses social anxiety disorder (first dubbed social phobia) as the lens through which to analyze American psychiatry's extraordinary shift in the last 30 years from a psychoanalytic orientation relying on talk therapy to its current emphasis on neuroscience and drugs.

He draws on previously neglected letters and memos written by the framers of the new disorders to argue that DSM revisions to social phobia or social anxiety disorder placed the diagnostic bar too low, turning social anxiety into a mental illness common enough to be considered, according to recent studies, third only to alcoholism and major depression.

The DSM continues to stipulate that social anxiety disorder (SAD) must be "impairing" for a diagnosis to occur. The problem, Lane argues, is that DSM-defined symptoms of impairment in 1980 included fear of eating alone in restaurants, concern about hand trembling while writing checks, fear of public speaking and avoidance of public restrooms.

By 1987 the DSM had removed the key phrase "a compelling desire to avoid," requiring instead only "marked distress," and signs of that could include concern about saying the wrong thing. "Impairment became something largely in the eye of the beholder, and anticipated embarrassment was enough to meet the diagnostic threshold," says Lane.

"That's a ridiculous way to assess a serious mental disorder, with implications for the way we also view childhood traits and development," Lane adds. "But that didn't stop SAD from becoming what Psychology Today dubbed 'the disorder of the 1990s.'"

In addition to providing extensive documentation from the American Psychiatric Association archives, Lane includes previously confidential material from the drug companies themselves that present a worrisome history of the antidepressant Paxil.

That drug came onto the marketplace in 1996 despite the fact that its makers earlier had considered shelving it because of poor performance and early signs of side effects in clinical trials. Using a memo circulated among drug company executives, Lane presents evidence that a lot of information about the drug's poor track record was withheld from the public.

When Paxil became the first drug approved by the Food and Drug Administration for the treatment of social anxiety disorder in 1999, however, its makers launched a $92 million awareness campaign on the theme "Imagine Being Allergic to People." This and other advertising campaigns helped change the way Americans think about anxiety and its treatment.

"Every marketer's dream is to find an unidentified or unknown market and develop it. That's what we were able to do with social anxiety disorder," a product director for the drug told Advertising Age magazine. In 2001, with 25 million new prescriptions written for Paxil, the drug's U.S. sales alone increased by 18 percent from the year before.

Although psychiatrists insist that the line between ordinary shyness and social anxiety disorder (SAD) is sharply defined, Lane points to psychiatric literature that repeatedly confuses them, putting patients at risk of over-diagnosis and unnecessary, sometimes harmful treatment.

A professor of English in Northwestern's Weinberg College of Arts and Sciences, Lane previously directed a psychoanalytic studies program in Emory University's psychiatry department.

Long interested in psychology, he presents evidence of a burgeoning backlash to psychiatry's current trends in the form of analyses of novels including "The Corrections" by Jonathan Franzen and "The Diagnosis" by Alan Lightman, as well as the film "Garden State" by Zach Braff.

Lane was awarded a Guggenheim Fellowship to study psychopharmacology and ethics, and audited medical courses.

He invited psychiatrists and pharmacologists to review his book, particularly a chapter on rebound syndrome. That term refers to a boomerang effect experienced by some patients on discontinuing Paxil that is more intense and dangerous than the turmoil that caused them to take the drug in the first place.

In examining the American Psychiatric Association archives, Lane -- who argues that psychiatry is using drugs with poor track records to treat growing numbers of normal human emotions -- even came across a proposal to establish "chronic complaint disorder," in which people moan about the weather, taxes or the previous night's racetrack results.

"It might be funny," he says, save for the fact that the DSM's next edition, due to be completed in 2012, is likely to establish new categories for apathy, compulsive buying, Internet addiction, binge-eating and compulsive sexual behavior. Don't look for road rage, however. It's already in the DSM, under intermittent explosive disorder.

The combination of extended wakefulness [[e.g., lack of sleep]] and low-dose alcohol has significant adverse effects on a person’s ability to drive, and elevates the risk of getting into a vehicular accident, according to a study published in the October 1 issue of the journal SLEEP.

The study, authored by Mark E. Howard, PhD, of the Institute for Breathing and Sleep in Heidelberg, Victoria, Australia, focused on 19 volunteer professional drivers, who participated in a driving simulation and the Psychomotor Vigilance Task. The subjects were measured in a rested state (12-15 hours awake) and after extended wakefulness (18-21 hours awake) during two sessions. Alcohol was administered during one session, with performance measured at blood alcohol concentrations (BAC) of 0.00 percent, 0.03 percent and 0.05 percent in a non-sleep deprived state, and at 0.03 percent after extended wakefulness (at 1 a.m. and at 3 a.m.). During the second session, tests were performed at the same times without alcohol.

According to the results, extended wakefulness, combined with low-dose alcohol (0.03 percent BAC), resulted in more lapses and greater variation in lane position and speed than did a BAC of 0.05 percent in a rested state.

“In addition to alcohol, sleepiness also increases the risk of road crashes. It is estimated that 15 to 30 percent of traffic accidents are directly related to driver sleepiness, as determined by crash circumstances. Although there are conclusive data regarding the separate effects of alcohol and sleepiness on driving, in real-life situations it is common for these two conditions to occur simultaneously (alcohol-related accidents occur more commonly in the early hours of the morning). The combination of legal low-dose alcohol and extended wakefulness results in impairment worse than that at an alcohol level known to increase accident risk. Avoiding alcohol when driving after extended wakefulness may reduce accident risk,” said Dr. Howard.

Those who think they might have a sleep disorder are urged to discuss their problem with their primary care physician, who will issue a referral to a sleep specialist.

Timing of media exposure plays a vital role in outcomes

Daily television viewing for two or more hours in early childhood can lead to behavioral problems and poor social skills, according to a study of children 2.5 to 5.5 years of age conducted by researchers at the Johns Hopkins Bloomberg School of Public Health. The Hopkins researchers found that the impact of TV viewing on a child’s behavior and social skills varied by the age at which the viewing occurred. More importantly, heavy television viewing that decreased over time was not associated with behavior or social problems. The American Academy of Pediatrics recommends that children under age 2 watch no television while children age 2 and older are limited to no more than two hours of daily viewing. The study is published in the October 2007 issue of Pediatrics.

“A number of studies have demonstrated negative effects of heavy television viewing. However, timing of exposure is an important consideration as reducing viewing to acceptable levels can reduce the risk of behavioral and social problems,” said Kamila Mistry, MPH, lead author of the study and a doctoral candidate in the Bloomberg School’s Department of Population, Family and Reproductive Health.

For the study, the research team analyzed data for 2,707 children collected from the Healthy Steps for Young Children national evaluation. Parents were surveyed about their child’s television viewing habits and behavior at 2.5 and at 5.5 years of age.

Sixteen percent of parents reported that their children watched two hours or more of television daily at 2.5 years of age (early exposure), while 15 percent reported that their children watched two hours or more of television daily at 5.5 years of age (concurrent exposure). One in five parents reported that their children watched two hours or more of television daily at both 2.5 years and at 5.5 years of age (sustained exposure). Sustained exposure to television was associated with behavioral problems. However, early exposure that was subsequently reduced was not a risk for behavior problems. Concurrent viewing was associated with fewer social skills, while sustained and early viewing had less of an impact on social skill development.

The study also found that having a television in the child’s bedroom at 5.5 years of age was associated with behavioral problems, poor social skills and poor sleep. Forty-one percent of the children included in the study had a television in his or her bedroom.

“Children who reduced their viewing by 5.5 years of age were not at greater risk for behavior and social problems,” said Cynthia Minkovitz, MD, MPP, senior author of the study and associate professor with the School’s Department of Population, Family and Reproductive Health. “It is vital for clinicians to emphasize the importance of reducing television viewing in early childhood among those children with early use.”