Inhalt

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   ACKNOWLEDGEMENT
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   LIST OF TABLES
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   LIST OF FIGURES
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   Figure 1.1 Sleep cycle associated with whole night sleep……………………..…...41
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   Figure 1.2 Picture of K-complex in sleep EEG………………….…….……………..43
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   Figure 1.3 Picture of sleep spindle in sleep EEG……………………….…………...44
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   Figure 1.4 Sleep EEG and Wave Patterns of Different Stages……..………………45
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   Figure 1.5 Physiological Restorations during Sleep………….………………….....46
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   Figure 2.1 Model of the Tower of London Test…………..…………………………80
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   Figure 2.2 Picture Representing Placement of Electrodes.………………………...83
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   Figure 2.4 Wave Patterns of Different Sleep Stages…………………………..…….85
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   Figure 2.5 Shows Sleep Laboratory……………………..……………………………88
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   Figure 3.1 Distribution of Diagnostic Subtypes of
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   Schizophrenia Patients………………………………………………...….94
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   Figure 3.2 PANSS Mean Scores of Schizophrenia Patients…………………..…....94
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   Abbreviations
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   APA - American Psychiatric Association
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   CHAPTER 1
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  INTRODUCTION
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  1.1 Schizophrenia
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   1.1.1 Evolution and Origins of the Concept of Schizophrenia
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   Table 1.1 Eugen Bleuler’s four As
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   Table 1.2 Schneiderian First-Rank Symptoms
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   1.1.2 Symptoms of Schizophrenia
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  1.1.3 Diagnosis of Schizophrenia – Modern Classifications
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   1.1.4 DSM-IV versus ICD-10 Classification Systems
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  1.1.5 Subtypes of Schizophrenia
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   1.1.5.1 Paranoid Schizophrenia
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   1.1.5.2 Disorganized type
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   1.1.5.3 Catatonic type
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   1.1.5.4 Undifferentiated type
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   1.1.5.5 Residual type
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   1.1.5.6 Schizophreniform Disorder
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   1.1.5.7 Schizoaffective Disorder
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   1.1.6 Phases of Schizophrenia
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  1.1.7 Epidemiology of Schizophrenia
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   1.1.7.1 Prevalence
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   1.1.7.2 Gender, Age and Cultural Features
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   1.1.7.3 Comorbidity
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  1.1.8 Etiology of Schizophrenia
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   1.1.8.1 Biological Explanations
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   1.1.8.2 Structural and Functional Brain Abnormalities
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   1.1.8.3 Neurotransmitters
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   1.1.8.4 Genetic Explanations
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   1.1.8.5 Family and Twin Studies
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   1.1.8.6 Adoption Studies
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   1.1.8.7 High-Risk Design
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   1.1.8.8 Studies of Biological Markers
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   1.1.8.9 Biological Stressors and Vulnerability
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   1.1.8.10 Psychosocial Factors
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  1.2 Schizophrenia and Neurocognitive Dysfunction
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   1.2.1 Attention Deficits
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   1.2.1.1 Selective Attention Deficits
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   1.2.1.2 Sustained Attention Deficits
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   1.2.2 Memory
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   1.2.3 Executive Functions
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   1.2.4 Discrepancy in Findings on Neurocognitive Impairment in Schizophrenia
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   1.2.5 Cognitive Impairment and Functional Outcomes in Schizophrenia
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  1.3 Sleep
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   1.3.1 Polysomnography
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   1.3.2 Sleep Stages and Scoring
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   Table 1.6 Old Terminology of Sleep Stages used by Loomis et al (1937)
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   Table 1.7 Dement & Kleitman Classification of Sleep Stages.
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   Figure 1.1 Sleep Cycle Associated With Whole Night Sleep
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   Table 1.8 Rechtschaffen & Kales (1968) Scoring Sleep Stages
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   1.3.2.1 Microstructures of Sleep EEG
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   1.3.2.1.1 K-complexes
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  Figure 1.2 Picture of K-complex in sleep EEG
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   1.3.2.1.2 Neurophysiology of the K-complexes
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   1.3.2.1.3 Spindles
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   Figure 1.3 Picture of sleep spindle in sleep EEG
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   1.3.2.1.4 Neurophysiology of Spindles
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  1.3.3 Functions of Sleep
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   1.3.3.1 Restoration Theory
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   Figure 1.5 Physiological Restorations during Sleep (Oswald, 1966; Oswald
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   & Adam, 1984)
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   1.3.3.2 Ecological Theory
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   1.4 Sleep and Schizophrenia
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  Early Studies in Sleep and Schizophrenia
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  1.4.1 Polysomnographic Features in Schizophrenia
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   1.4.1.1 Sleep Continuity
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   Number of Wakening and Wake after Sleep Onset
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   1.4.1.1.1 Total Sleep Time
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   1.4.1.1.2 Sleep Efficiency
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   1.4.1.1.3 Sleep Onset Latency
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  1.4.1.2 Sleep Architecture
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   1.4.1.2.1 Slow Wave Sleep
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   1.4.1.3 Stage REM
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  1.4.1.4 REM Sleep Measures
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   1.4.1.4.1 REM Sleep Latency
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   Table 1.9 Review on Sleep EEG Abnormalities in Patients with Schizophrenia.
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  1.4.1.5 Microstructures of Sleep EEG in Schizophrenia
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   1.4.1.5.1 K-complexes and Schizophrenia
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   1.4.1.5.2 Spindles and Schizophrenia
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   1.4.1.6 Medications and their Effects on Sleep in Schizophrenia
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   1.4.1.7 Discrepancy and Inconsistency in Sleep EEG Findings in Schizophrenia
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   1.4.1.8 Sleep and Quality of Life in Schizophrenia
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  1.5 Sleep and Neurocognitive Function
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   1.5.1 Sleep Deprivation and Cognitive Performance
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   1.5.2 Sleep and Memory
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   1.5.3 Sleep and Problem Solving
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   1.6 Aim of the Study
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   1.6.1 Hypotheses
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   Title of the Study: Sleep and problem solving in schizophrenia.
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   Methodology
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   2.1 Place and Period of Study
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   2.2 Participants
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   2.2.1 Schizophrenia Patients
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   Table 2.1 Demographic Data of Schizophrenia Patients
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   Table 2.2 Clinical Characteristics of Schizophrenia Patients (N = 20)
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   2.2.2 Healthy Controls
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   Table 2.3 Demographic Data of Healthy Controls
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   2.3 Research Design
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   Table 2.4 Description of the Research Design
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   Table 2.5 Description of the Groups
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  2.4 Measures
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   2.4.1 Structured Clinical Interview for DSM-IV SCID (Wittchen et al., 1997)
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   2.4.2 Positive and Negative Syndrome Scale – PANSS (Kay et al., 1987)
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   8T2.4.3 Socio - Demographic Profile
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   8TThe socio-demographic data were obtained from all participants.
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   8T2.5 8TNeuropsychological Tests
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   2.5.1 VLMT-Verbal Learning and Memory Test (Helmstaedter at al., 2001)
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   2.5.2 Trail Making Test A & B (Reitan et al., 1979)
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   2.5.3. Multiple Choice Word Comprehension Test (MWT-B; Lehr et al 1989)
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  Table 2.6 Scores for the Multiple Choice Word Fluency Test (MWT-B)
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   2.5.4 Digit Symbol Test (Oswald and Fleischmann., 1986)
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   2.5.5 Controlled Oral Word Association Test (Benton et al., 1983)
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  2.6 Experimental Task
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   2.6.1 Tower of London Test (Shallice et al., 1982)
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   USource:U Adapted from Psychology Press, Taylor & Francis Group, London
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   http://www.psypress.com/grome/figures/fig%209.7.jpg
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  The scores are the number of solved tasks and total time taken to complete the Tower of London test. The Tower of London test (Shallice et al., 1982) is a widely used test measure of planning, sequencing and problem solving. Two versions of the tes...
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  2.7 Polysomonography
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  2.7.1 Electrode Placement
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   2.7.1.1 EEG Electrode Placement
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   2.7.1.2 EOG Electrode Placement
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   2.7.1.3 EMG Electrode Placement
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  Figure 2.2 Picture Representing Placement of Electrodes
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   2.7.2 Sleep EEG Scoring
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  Figure 2.4 Wave Patterns of Different Sleep Stages
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   2.7.3 Sleep Parameters Examined
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   The sleep parameters studied in the present study are given below in the table 2.7.
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  Table 2.7 Sleep Parameters Investigated in the Present Study
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   2.8 Procedure
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   2.8.1 Day Testing
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   2.8.2 Night Testing
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  Figure 2.5 Shows Sleep Laboratory
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   2.9 Statistical Data Analyses
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   2.9.1 Descriptive Measures
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   2.9.2 Neuropsychological Test Scores
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   2.9.3.1 Multivariate Analysis of Variance - Schizophrenia Patients versus Healthy Controls
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   2.9.3.2 Multivariate Analysis of Variance - Schizophrenia Patients
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   2.9.3.3 Multivariate Analysis of Variance - Healthy Controls
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   2.9.4.1 Multivariate Analysis of Variance - Day versus Night Interval (Schizophrenia patients vs. healthy controls) Main Analysis
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   2.9.4.2 Multivariate Analysis of Variance - Day versus Night Interval (Schizophrenia Patients)
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   2.9.4.3 Multivariate Analysis of Variance - Day versus Night Interval (Healthy Controls)
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  2.9.5 Sleep EEG Data
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   2.9.5.1 Comparison of Sleep EEG Parameters between Patient Group and Control Group
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   2.9.5.2 Correlation of Sleep EEG Parameters and the Tower of London Measures
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   CHAPTER 3
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  RESULTS
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  3.1 Descriptive Measures
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   3.1.1 Schizophrenia Patients
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   Figure 3.1 Distribution of Diagnostic Subtypes of Schizophrenia patients
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   Figure 3.2 PANSS Mean Scores of Schizophrenia Patients
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   3.1.2 Healthy Controls
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  3.2 Neuropsychological Test Scores
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   3.2.1 Neuropsychological Performance (Schizophrenia Patients versus Healthy Controls)
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   3.2.2 Multiple Choice Word Comprehension Test (MWT-B)
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   3.2.3 Trail Making Test
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   3.2.4 Digit Symbol Test
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   3.2.5 Controlled Oral Word Association Test
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   3.2.6 Verbal Learning and Memory Test –VLMT
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  Summary
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   3.3 Tower of London Test Measures
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   3.3.1 Results of the Multivariate Analysis of Variance for the Measures of the Tower of London - Day versus Night Interval (Patients vs. Healthy Controls)
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   Effects of the MANOVA
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   Main Effects
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   Interaction Effects
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   Effects of the ANOVA
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   Number of Solved Tasks
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   Main Effects
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   Interaction effects
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   There were no significant interaction effects.
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   Total time taken
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   Main effects
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   Interaction effects
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   There were no significant interaction effects.
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   Summary
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   3.3.2 Results of the Multivariate and Univariate Analyses of Variance for the Measures of the Tower of London- Day versus Night Interval (Schizophrenia Patients)
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   Main Effects of the MANOVA
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   Main Effects
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   Interaction Effects
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   Interval by pre-post interaction was not significant.
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   Effects of the ANOVA
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   Number of Solved Tasks
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   Main Effects
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   Interaction Effects
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   Total Time Taken
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   Main Effects
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   Interaction Effects
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   Summary
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   3.3.3 Results of the Multivariate and Univariate Analyses of Variance for the Measures of the Tower of London – Day versus Night Interval (Healthy Controls)
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   Effects in the MANOVA
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   Main Effects
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   Interaction Effects
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   Effects of the ANOVA
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   Number of Solved Tasks
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   Main Effects
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   Interaction Effects
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   Total Time Taken
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   Main Effects
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   Interaction Effects
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  Summary
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   3.4 Sleep EEG Results
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   Table 3.8 Comparison of Sleep EEG Parameters – Schizophrenia Patients vs. Healthy Controls
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   3.4.1 Sleep EEG Parameters (Schizophrenia Patients vs. Healthy Controls)
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  17TSummary
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   3.4.2 Correlation between Sleep Parameters and the Tower of London Test Measures
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   3.4.3 Correlation - Schizophrenia Patients
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   3.4.3.1 Number of Solved Tasks
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   3.4.3.2 Total Time Taken
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  Summary
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   3.4.4 Correlation - Healthy Controls
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   3.4.4.1 Number of Solved Tasks
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   3.4.4.2 Total Time Taken
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   Summary
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   CHAPTER 4
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   DISCUSSION
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   4.1 Neuropsychology
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  Summary
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  4.2 Results of the Tower of London Test Measures
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   4.2.1 Schizophrenia Patients vs. Healthy Controls (Day vs. Night Performance)
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   4.2.2 Schizophrenia Patients (Day Interval vs. Night Interval Performance)
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   4.2.3 Healthy Controls (Day Interval vs. Night Interval Performance)
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   4.3 Comparison of Sleep EEG Parameters – Schizophrenia vs. Healthy Controls
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   Summary
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   4.4 Correlation between Sleep Parameters and the Tower of London Test
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   4.5 Hypotheses and Results at a Glance
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   4.6 Conclusions
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   4.7 Limitations of the Present Study
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   4.8 Future Directions of Research
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   References
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   Appendix A
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   Appendix B
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   Effects of the MANOVA
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   Main Effects
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   Interaction Effects
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   Effects of the ANOVA
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   Number of Solved Tasks
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   Main Effects
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   Total Time Taken
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   Main Effects
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   Interaction Effects
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   Summary
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   Effects of the MANOVA
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   Main Effects
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   Interaction Effects
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   Effects of the ANOVA
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   Number of Solved Tasks
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   Main Effects
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   Interaction effects
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   There were no significant interaction effects.
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   Total Time Taken
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   Main Effects
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   Interaction Effects
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   Summary
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   Effects of the MANOVA
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   Main Effects
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   Interaction Effects
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   Effects of the ANOVA
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   Number of Solved Tasks
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   Main effects
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   Interaction Effects
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   Total Time Taken
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   Main Effects
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   Interaction Effects
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   Summary