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5 New Questions on Sleep Disorders and Psychosis
Sleep disruption is often overlooked in treatment planning for patients with psychotic disorders. Recent research provides insights in this 5-question quiz.
Sleep disruption is often overlooked in treatment planning for patients with psychotic disorders. Recent research provides insights in this 5-question quiz.
Question 1. Sleep disturbances, including insomnia, in patients with schizophrenia are associated with:
A. Suicidal ideation, suicide attempt, and completed suicide
B. Severity of psychopathology
C. Quality of life
D. All of the above
The correct answer is D.
Sleep disruption is a frequently undetected symptom in patients with psychotic disorders throughout the course of illness: “The association between sleep disturbances and suicidal risk underscores the need for enhanced clinical attention and intervention on sleep disturbances in patients with schizophrenia.” Li SX, Lam SP, Zhang J, et al. Sleep disturbances and suicide risk in an 8-year longitudinal study of schizophrenia-spectrum disorders. Sleep. 2016;39:1275–1282.
“Insomnia is associated with suicidal ideation, lifetime suicide attempt, and greater psychopathology in patients with schizophrenia. Our findings suggest that formal assessment of insomnia may be germane to the clinical care of patients with schizophrenia as a marker of suicide risk and symptom severity.” Miller BJ, Parker CB, Rapaport MH, et al. Insomnia and suicidal ideation in non-affective psychosis. Sleep. 2018 [Epub ahead of print],
In a study of 20 men post-suicide, researchers found that “suicide attempts, hopelessness and self-devaluation were the three variables most strongly associated with completed suicide. However, a number of variables were identified which may constitute risk factors, some of which have not been identified in the past.” One of those variables was insomnia (OR = 12.66; 95%CI = 0.95/14.02). Pompili M, Lester D, Grispini A, et al. Completed suicide in schizophrenia: Evidence from a case-control study. Psychiatry Research. 2009;167:251–257.
2. Which of the following is the most prevalent comorbid sleep disorder in patients with early psychosis?
A. Nightmares
B. Restless leg syndrome
C. Bruxism
D. Sleep paralysis
The correct answer is A.
In one study, “Insomnia was the most prevalent sleep disorder but nightmare disorder was also found to be common, often severe, yet predominantly not discussed with the care team. A recent student survey found that only 11% of individuals with severe nightmares had discussed them with a health care provider, and those who believed nightmare disorders were untreatable (67.3%) were less likely to report them. It is possible that a lack of awareness regarding the treatability of nightmares might also affect reporting by individuals with psychosis.” -Reeve S, Sheaves B, Freeman D. Sleep Disorders in Early Psychosis: Incidence, Severity, and Association With Clinical Symptoms. Schizophr Bull. 2018 [Epub ahead of print].
Question 3. All of the following sleep disturbances predict psychotic-like experiences in adolescents, independent of depressive symptoms, EXCEPT:
A. Excessive daytime somnolence
B. Insomnia
C. Probable cataplexy
D. Significant snoring
The correct answer is D.
In a study investigating adolescents with sleep disturbance and psychotic-like experiences (PLEs) among adolescents, “Insomnia and EDS [excessive daytime somnolence] were found to predict PLEs in adolescents, independent of depression. Our findings suggest that adolescents complaining of insomnia or sleepiness may require further assessment regarding potential risk of psychosis.” -Lee YJ, Cho S-J, Cho IH, et al. The relationship between psychotic-like experiences and sleep disturbances in adolescents. Sleep Medicine. 2012;13:1021–1027.
Question 4. Higher levels of which of the following inflammatory markers are associated with worse sleep quality in community-dwelling outpatients with schizophrenia?
A. C-reactive Protein
B. Tumor Necrosis Factor-alpha
C. Interleukin-6
D. Interleukin-10
E. A and C
F. B and D
The correct answer is E.
In a recent study, “worse sleep quality was associated with increased levels of pro-inflammatory markers (high-sensitivity C-reactive protein and interleukin-6) in persons with schizophrenia, even when accounting for age, sex, psychopathology, and cognition. Women with schizophrenia had significantly worse sleep disturbances and elevated levels of pro-inflammatory markers compared to men with schizophrenia.” -Lee EE, Ancoli-Israel A, Eyler LT, et al. Sleep Disturbances and Inflammatory Biomarkers in Schizophrenia: Focus on Sex Differences. Am J Geriatr Psychiatry. 2019;27:21-31.
Question 5. Which of the following types of insomnia is associated with an increased prevalence of the metabolic syndrome in patients with schizophrenia?
A. Initial insomnia
B. Middle insomnia
C. Terminal insomnia
D. None of the above
The correct answer is E.
In a study of metabolic syndrome in patients with schizophrenia, researchers “found that three depressive symptoms were significantly associated with metabolic syndrome in patients with schizophrenia, including depressed mood, middle insomnia, and retardation. Therefore, to properly evaluate metabolic risk in patients with schizophrenia, waist circumference and screening for depression should be done during follow-up clinic visits.” -Suttajit S, Pilakanta S. Prevalence of metabolic syndrome and its association with depression in patients with schizophrenia. Neuropsychiatr Dis Treatment. 2013;9:941-946.