Objectives:This guideline provides recommendations for the clinical management of schizophrenia and related disorders for health professionals working in Australia and New Zealand. It aims to encou...

https://journals.sagepub.com/doi/pdf/10.1177/0004867416641195

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders

OBJECTIVE\nPatients with first-episode psychosis have a high prevalence of tobacco use. We aimed to examine the prevalence and course of tobacco use during early psychosis using meta-analysis.\n\n\nDATA SOURCES\nSystematic search of MEDLINE (1948-2011), Embase (1947-2011), CINAHL (1984-2011), PsycINFO (1967-2011), and ISI Web of Science (1900-2011) using the search terms [psychosis OR schizophrenia] AND [tobacco OR smoking OR nicotine].\n\n\nSTUDY SELECTION\nWe located 10 studies reporting the age at initiation of daily tobacco use and the age at onset of psychosis, 31 studies reporting prevalence of tobacco use in patients with first-episode psychosis, 10 studies comparing smoking to age-/gender-matched controls, and 7 studies reporting prevalence of tobacco use at intervals after treatment.\n\n\nDATA EXTRACTION\nThe following data were extracted: age at initiation of daily tobacco use and at onset of psychosis, the proportion of patients with first-episode psychosis who used tobacco, the proportion of the general population who used tobacco, and the proportion of patients with psychosis who used tobacco at various intervals after initiation of antipsychotic treatment.\n\n\nRESULTS\nThe pooled estimate for the interval between initiation of tobacco use and the onset of psychosis was 5.3 years (standardized mean difference = 0.85). The estimated prevalence of tobacco users in first episode of psychosis is 58.9% (95% CI, 54.3%-63.4%). There is a strong association between first-episode psychosis and tobacco use (OR = 6.04; 95% CI, 3.03-12.02) compared with healthy controls. The prevalence of tobacco use at intervals between 6 and 120 months after treatment remained unchanged (OR = 0.996; 95% CI, 0.907-1.094).\n\n\nCONCLUSIONS\nPatients with first-episode psychosis tend to have smoked for some years prior to the onset of psychosis, have high prevalence of tobacco use at the time of presenting for treatment, and are much more likely to smoke than aged-matched controls. Their apparent difficulty in quitting has implications for tobacco cessation programs and efforts to reduce cardiovascular disease among people with mental illness.

tobacco use before, at and after first episode psychosis: A systematic meta-analysis : c66

Sleep disturbance is known to be associated with psychosis, but sleep disorders (eg, insomnia, nightmare disorder, sleep apnea) have rarely been investigated. We aimed to provide the first detailed assessment of sleep disorders and their correlates in patients with early psychosis. Sixty outpatients aged between 18 and 30 with nonaffective psychosis were assessed for sleep disorder presence, severity, and treatment using a structured diagnostic interview, sleep diaries, and actigraphy. Psychotic experiences, mood, and psychological wellbeing were also measured. Forty-eight patients (80%) had at least one sleep disorder, with insomnia and nightmare disorder being the most common. Comorbidity of sleep disorders within this group was high, with an average of 3.3 sleep disorders per patient. Over half of the sleep disorders had been discussed with a clinician but almost three-quarters had received no treatment. Treatment according to clinical guidelines was rare, occurring in only 8% of cases (n = 13). Sleep disorders were significantly associated with increased psychotic experiences, depression, anxiety, fatigue, and lower quality of life. Sleep disorders are very common in patients with psychosis, may have wide-ranging negative effects, and merit routine assessment and treatment in psychiatric practice.

Sleep Disorders in Early Psychosis: Incidence, Severity, and Association With Clinical Symptoms.

Disturbances of sleep quality, timing and structure and their relationship with other neuropsychiatric symptoms in Alzheimer's disease and schizophrenia: Insights from studies in patient populations and animal models.

Sleep is an important feature in mental illness. Smartphones can be used to assess and monitor sleep, yet there is little prior application of this approach in depressive, anxiety, or psychotic disorders. We review uses of smartphones and wearable devices for sleep research in patients with these conditions. To date, most studies consist of pilot evaluations demonstrating feasibility and acceptability of monitoring sleep using smartphones and wearable devices among individuals with psychiatric disorders. Promising findings show early associations between behaviors and sleep parameters and agreement between clinic-based assessments, active smartphone data capture, and passively collected data. Few studies report improvement in sleep or mental health outcomes. Success of smartphone-based sleep assessments and interventions requires emphasis on promoting long-term adherence, exploring possibilities of adaptive and personalized systems to predict risk/relapse, and determining impact of sleep monitoring on improving patients’ quality of life and clinically meaningful outcomes.

/pdf/smartphone-based-tracking-of-sleep-in-depression-anxiety-and-hcf2043t9x.pdf

Smartphone-Based Tracking of Sleep in Depression, Anxiety, and Psychotic Disorders.

Obstructive sleep apnea and schizophrenia: A systematic review to inform clinical practice.

Objectives:Obstructive sleep apnoea (OSA) may be more common in people with schizophrenia compared to the general population, but the relative prevalence is unknown. Here, we determine the relative...

Obstructive sleep apnoea is more prevalent in men with schizophrenia compared to general population controls: results of a matched cohort study.

Cognition in schizophrenia improves with treatment of severe obstructive sleep apnoea: A pilot study

Objectives: We aimed to assess the incidence of obstructive sleep apnoea (OSA) in people with schizophrenia, to explore clinical associates with OSA and how well OSA screening tools perform in this population. Methods:
 All patients registered in a community outpatient Clozapine clinic, between January 2014 and March 2016, were consecutively approached to participate. Participants were screened for OSA using at home multichannel polysomnography (PSG) and were diagnosed with OSA if the apnoea-hypopnoea index (AHI) was >10 events/hr. Univariate comparison of participants to determine whether AHI > 10 events/hr was associated with demographic factors, anthropometric measures and psychiatric symptoms and cognition was performed. The sensitivity, specificity, positive predictive value and negative predictive value of the commonly used sleep symptoms scales and OSA screening tools were also determined. Results:
 Thirty participants were recruited, 24 men and 6 women. Mean age was 38.8 (range: 25–60), and mean body mass index (BMI) was 35.7 (range 19.9–62.1). The proportion of participants with OSA (AHI > 10 events/hr) was 40%, 18 (60%) had no OSA, 4 (13%) had mild OSA (AHI 10.1–20), zero participants had moderate OSA (AHI 20.1–30) and 8 (27%) had severe OSA (AHI > 30). Diagnosis of OSA was significantly associated with increased weight, BMI, neck circumference and systolic blood pressure. Diagnosis of OSA was not significantly associated with Positive and Negative Symptoms Scale, Montgomery Asperger’s Depression Rating Scale, Personal and Social Performance scale or Brief Assessment of Cognition for Schizophrenia scores. All OSA screening tools demonstrated poor sensitivity and specificity for a diagnosis of OSA. Conclusion:
 OSA was highly prevalent in this cohort of people with schizophrenia and was associated with traditional anthropometric OSA risk factors.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0790966720000117

Madhu Chandratilleke

Papers

Obstructive sleep apnea and schizophrenia: A systematic review to inform clinical practice.

Obstructive sleep apnoea is more prevalent in men with schizophrenia compared to general population controls: results of a matched cohort study.

Cognition in schizophrenia improves with treatment of severe obstructive sleep apnoea: A pilot study

Pilot cohort study of obstructive sleep apnoea in community-dwelling people with schizophrenia.