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Objective
Characterizing sleep in patients with schizophrenia, schizoaffective disorder, bipolar disorder, and psychotic depression.
Methods
This cross-sectional questionnaire study is based on the SUPER study sample, which is part of the Stanley Global Neuropsychiatric Genomics Initiative. The study is a multicentre, nationwide Finnish study cons...
Citations
... The participants of this study have previously participated in the Finnish SUPER study investigating the genetic mechanisms of psychotic disorders, have answered the sleep symptoms part of its questionnaire 18 and have given consent for subsequent contact. The aim is to recruit 84-120 patients from Psychosis Outpatient Clinics at the health services of HUS and the City of Helsinki, where Open access patients are receiving ongoing and long-term treatment and rehabilitation. ...
... A five-point Likert scale is used to rate each item (eg, 0=no problem and 4=very severe problem), yielding a total score ranging from 0 to 28. The total score is interpreted as follows: absence of insomnia (0-7), subthreshold insomnia (8)(9)(10)(11)(12)(13)(14), moderate insomnia (15)(16)(17)(18)(19)(20)(21) and severe insomnia (22)(23)(24)(25)(26)(27)(28). The ISI has demonstrated good internal consistency and test-retest reliability. ...
... 37 40 A strength of this ongoing study is that the participants have previously participated in the Finnish SUPER Survey, which investigates the genetic mechanisms of psychotic disorders (n=8623) and sleep characteristics and symptoms assessed by questionnaire. 18 In the analysis phase, the research data from this study can be combined with the data collected in the SUPER study. Repetition questions, for example, on the quality and features of sleep and subjective functioning, allow patients to assess the persistence of qualitative features of sleep. ...
Introduction
Insomnia is a common symptom among patients with schizophrenia and schizoaffective disorder, negatively impacting symptom severity, functioning and well-being; however, it is rarely the direct focus of treatment. The main recommended treatment for insomnia is cognitive behavioural therapy (CBT-I). There is some evidence that CBT-I can also be used to treat insomnia in patients with schizophrenia, but only a few randomised controlled trials (RCTs) have been published. The aim of this ongoing RCT is to determine whether we can alleviate symptoms of insomnia and improve the quality of life in patients with schizophrenia and schizoaffective disorder through CBT-I delivered via the internet or in a group mode.
Methods and analyses
The aim of this study is to recruit 84–120 outpatients from the Psychosis Clinics of Helsinki University Hospital and the City of Helsinki Health Services. The main inclusion criteria are a diagnosis of schizophrenia or schizoaffective disorder and self-reported sleep problems. The study will be performed on a cyclic basis, with a target of 12–24 patients per cycle. Participants are randomly assigned into three groups: (1) a group receiving only treatment as usual (TAU), (2) internet-based individual therapy for insomnia (iCBT-I)+TAU or (3) group therapy for insomnia (GCBT-I) conducted via a virtual platform+TAU. The primary outcome measures are quantitative changes in the Insomnia Severity Index score and/or changes in health-related quality of life using the 15D quality of life measure. Secondary outcomes include self-reported variables for sleep, health, stress and the severity of psychotic and depressive symptoms; objective outcomes include actigraphy and bed sensor data to evaluate circadian rhythms and motor activity. Outcome measures are assessed at baseline and after the treatment period at weeks 12, 24 and 36.
Ethics and dissemination
The Coordinating Ethics Committee of the Hospital District of Helsinki and Uusimaa, Finland, approved the study protocol. The results will be published in peer-reviewed journals.
Trial registration number
NCT04144231.
... We have previously shown in this large, nationwide sample of patients with psychotic disorders, that the patients have more sleep problems, including both insomnia and hypersomnia symptoms, than the general population. (Cederlöf et al., 2022) In this study, we aim to explore how commonly used antipsychotics, namely clozapine, olanzapine, quetiapine, aripiprazole, and risperidone, are related to subjective sleep problems in patients with schizophrenia. We also aim to investigate how combinations of two antipsychotic medications and using no antipsychotic medications relate to sleep problems. ...
... The sleep data from Health 2000 has been used by our study group previously to compare sleep in the SUPER sample to the general population. (Cederlöf et al., 2022). ...
... 1 The patients have both increased frequency of insomnia symptoms, such as difficulties initiating sleep (DIS), and early morning awakenings (EMAs), but also hypersomnia symptoms, with some patients simultaneously experiencing long sleep duration (long SD) and fatigue (FAT). [2][3][4] The prevalence of sleep problems varies depending on, for example, the diagnostic group, gender and age. In our previous study, we showed that in this sample of patients with psychotic disorders, women had more sleep problems, and that younger age generally, except for early morning awakenings, is associated with more sleep problems. ...
... Patients with affective disorders had more insomnia symptoms compared to patients with schizophrenia. 3 Poor sleep is associated with worse prognosis and higher relapse risk and symptom severity in patients with psychotic disorders. 1, 5,6 Sleep problems belong to the core symptoms of psychotic disorders, 1 but there have also been findings of a range of both sleep disorders, such as sleep apnea, 7 and lifestyle factors being associated with sleep problems in these patients. ...
... The differences in sleep problems between the diagnostic groups followed the same pattern as in our previous study, 3 where substance use was not considered. Insomnia symptomsmeaning DIS, EMAs, and short SDas well as FAT and poor SQ were generally more common in patients with schizoaffective disorder, bipolar disorder, or psychotic depression, while long SD was most common in patients with schizophrenia. ...
Background
Substance use and sleep problems are common in patients with psychotic disorders, but their associations in these patients have not been evaluated. Our aim was to investigate associations between substance use and sleep problems in a large nationwide cohort of patients with a psychotic disorder.
Study design
This study is part of the Finnish SUPER study, which belongs to the Stanley Global Neuropsychiatric Genomics Initiative. In this cross-sectional, multicenter study, participants (N=8616) were recruited from primary and specialized healthcare. Patients with schizophrenia, schizoaffective disorder, bipolar disorder, and psychotic depression were included. Information on current alcohol (AUDIT-C) and cigarette use as well as on lifetime illicit drug use, including cannabis, benzodiazepines, amphetamines, and opioids, was collected using questionnaires. The sleep outcomes in our logistic regression analysis were short (≤6 h) and long sleep (≥10 h) duration, difficulties initiating asleep, early morning awakenings, fatigue, and poor sleep quality.
Results
Self-reported substance use was associated with a higher prevalence of sleep problems. After adjustments with age, gender, diagnostic group, and living status, hazardous alcohol use (e.g., poor sleep quality odds ratio (OR)= 1.80, 95% CI 1.49-2.16, p<.001), current smoking (short sleep duration OR=1.28, 95% CI 1.08-1.52, p=.005), and lifetime benzodiazepine misuse (difficulties initiating sleep OR=2.00, 95% CI 1.55-2.48, p<.001) were associated with sleep problems.
Conclusions
Substance use was associated with sleep problems. Our findings underline the potential benefits of screening substance use when treating sleep problems in patients with psychotic disorders.
Introduction:
The transition from reproductive to menopausal status constitutes a major rite of passage for women, biologically, psychologically, and socially. For women with a diagnosis of schizophrenia, this stage of life is complicated by worsening psychotic symptoms and diminished effectiveness of antipsychotic drugs. This frequently leads to increased doses and subsequently increased adverse effects.
Areas covered:
The aim of this narrative review is to determine what management changes are needed at this time of life for women with schizophrenia. Searched and highlighted are the areas of sleep, cognition, occupation/employment, psychotic symptoms, side effects of treatment, and non-psychiatric as well as psychiatric co-morbidities which, when not adequately treated, can undermine quality of life and lead to premature death.
Expert opinion:
Many of the problems associated with menopause in women with schizophrenia can be prevented or remediated. Nevertheless, more research addressing the changes that occur in women with schizophrenia from pre- to post-menopause will help to bring clinical attention to this important health issue.
