Increased deep sleep in a medication-free, detoxified female offender with schizophrenia, alcoholism and a history of attempted homicide: effect of concomitant administration of quetiapine and citalopram.
BACKGROUND
An increased amount of deep sleep has been shown to be associated with antisocial personality disorder. This phenomenon has also been observed in a habitually violent female offender with schizophrenia and alcohol dependence.


OBJECTIVE
To evaluate sleep patterns in this patient and compare them with those of healthy, pro-social women of similar age, and in the same patient over time after treatment.


METHODS
Multiple measures of sleep were taken over two consecutive nights with the presenting patient and with three age-matched healthy women. One year after the patient was established on atypical antipsychotic (quetiapine), and antidepressant (SSRI) medication (citalopram) her sleep evaluation was repeated. In each case only the second night's recordings were used in analyses.


RESULTS
The patient differed significantly from the three healthy women on most sleep measures. After a year on the medication, the patient's sleep had improved and the non-REM sleep measures had come into the normal range. She had also shown a sustained clinical and behavioural improvement.


CONCLUSIONS
The literature suggests that both drugs had a part to play in the improvements in sleep, symptomatology and behaviour. The possibility that improvement in deep sleep is secondary to citalopram and that it is this that was specifically associated with violence reduction seems worthy of further study.
Institute of Biomedicine, Department of Physiology, University of Helsinki, Helsinki, Finland. nina.lindberg@pp3.inet.fi
Nina
N
Lindberg
Pekka
P
Tani
Pirjo
P
Takala
Eila
E
Sailas
Hanna
H
Putkonen
Markku
M
Eronen
Matti
M
Virkkunen
D000328:Adult; D000374:Aggression / Q000187:drug effects / Q000523:psychology; D000437:Alcoholism / Q000523:psychology / Q000534:rehabilitation*; D018687:Antidepressive Agents, Second-Generation / Q000008:administration & dosage* / Q000009:adverse effects; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000987:Antisocial Personality Disorder / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D015283:Citalopram / Q000008:administration & dosage* / Q000009:adverse effects; D015897:Comorbidity; D003987:Dibenzothiazepines / Q000008:administration & dosage* / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D006708:Homicide / Q000517:prevention & control / Q000523:psychology*; D006801:Humans; D008134:Long-Term Care; D017286:Polysomnography / Q000187:drug effects; D000069348:Quetiapine Fumarate; D012016:Reference Values; D012559:Schizophrenia / Q000534:rehabilitation*; D012890:Sleep / Q000187:drug effects*; D014754:Violence / Q000517:prevention & control / Q000523:psychology
D018687:Antidepressive Agents, Second-Generation; D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D015283:Citalopram; D000069348:Quetiapine Fumarate