Journal ArticleDOI
Sleep disturbances in patients with schizophrenia : impact and effect of antipsychotics.
TLDR
It appears possible that the high-potency drugs exert their effects on sleep in schizophrenic patients, for the most part, in an indirect way by suppressing stressful psychotic symptomatology.Abstract:
Difficulties initiating or maintaining sleep are frequently encountered in patients with schizophrenia. Disturbed sleep can be found in 30–80% of schizophrenic patients, depending on the degree of psychotic symptomatology. Measured by polysomnography, reduced sleep efficiency and total sleep time, as well as increased sleep latency, are found in most patients with schizophrenia and appear to be an important part of the pathophysiology of this disorder. Some studies also reported alterations of stage 2 sleep, slow-wave sleep (SWS) and rapid eye movement (REM) sleep variables, i.e. reduced REM latency and REM density. A number of sleep parameters, such as the amount of SWS and the REM latency, are significantly correlated to clinical variables, including severity of illness, positive symptoms, negative symptoms, outcome, neurocognitive impairment and brain structure. Concerning specific sleep disorders, there is some evidence that schizophrenic patients carry a higher risk of experiencing a sleep-related breathing disorder, especially those demonstrating the known risk factors, including being overweight but also long-term use of antipsychotics. However, it is still unclear whether periodic leg movements in sleep or restless legs syndrome (RLS) are found with a higher or lower prevalence in schizophrenic patients than in healthy controls. There are no consistent effects of first-generation antipsychotics on measuresof sleep continuity and sleep structure, including the percentage of sleep stages or sleep and REM latency in healthy controls. In contrast to first-generation antipsychotics, the studied atypical antipsychotics (clozapine, olanzapine, quetiapine, risperidone, ziprasidone and paliperidone) demonstrate a relatively consistent effect on measures of sleep continuity, with an increase in either total sleep time (TST) or sleep efficiency, and individually varying effects on other sleep parameters, such as an increase in REM latency observed for olanzapine, quetiapine and ziprasidone, and an increase in SWS documented for olanzapine and ziprasidone in healthy subjects. The treatment of schizophrenic patients with first-generation antipsychotics is consistently associated with an increase in TST and sleep efficiency, and mostly an increase in REM latency, whereas the influence on specific sleep stages is more variable. On the other hand, withdrawal of such treatment is followed by a change in sleep structure mainly in the opposite direction, indicating a deterioration of sleep quality. On the background of the rather inconsistent effects of first-generation antipsychotics observed in healthy subjects, it appears possible that the high-potency drugs exert their effects on sleep in schizophrenic patients, for the most part, in an indirect way by suppressing stressful psychotic symptomatology. In contrast, the available data concerning second-generation antipsychotics (clozapine, olanzapine, risperidone and paliperidone) demonstrate a relatively consistent effect on measures of sleep continuity in patients and healthy subjects, with an increase in TST and sleep efficiency or a decrease in wakefulness. Additionally, clozapine and olanzapine demonstrate comparable influences on other sleep variables, such as SWS or REM density, in controls and schizophrenic patients. Possibly, the effects of second-generation antipsychotics observed on sleep in healthy subjects and schizophrenic patients might involve the action of these drugs on symptomatology, such as depression, cognitive impairment, and negative and positive symptoms. Specific sleep disorders, such as RLS, sleep-related breathing disorders, night-eating syndrome, somnambulism and rhythm disorders have been described as possible adverse effects of antipsychotics and should be considered in the differential diagnosis of disturbed or unrestful sleep in this population.read more
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Journal ArticleDOI
Targets for the Treatment of Insomnia in Veterans With Serious Mental Illness.
Elizabeth A. Klingaman,Julie M. McCarthy,Elana K. Schwartz,Philip R. Gehrman,Melanie E. Bennett +4 more
TL;DR: Testing the role of arousal, dysfunctional cognitions about sleep, and sleep-related behaviors in predicting severity of insomnia in a sample of 60 Veterans who were receiving care in Veterans Health Administration mental health and psychosocial rehabilitation programs found that worry and helplessness about sleep were predictive of insomnia severity.
Journal ArticleDOI
Acupuncture in the treatment of a female patient suffering from chronic schizophrenia and sleep disorders
TL;DR: It is shown that acupuncture might be beneficial in the treatment of sleep disorders in patients suffering from chronic schizophrenia, but future, large, randomized, controlled, clinical trials are needed in order to replicate the present preliminary findings.
Proceedings ArticleDOI
Towards circadian computing: a sensing & intervention framework for BodyClock friendly technology
TL;DR: The research goal is to advance a vision for "circadian computing" --- designing, developing and deploying novel technology that helps to maintain the authors' innate biological rhythms to prevent relapse and provide circadian interventions for bipolar and schizophrenic patients.
Journal ArticleDOI
A phenomenological inquiry into the experience of sleep: Perspectives of US military veterans with insomnia and serious mental illness.
TL;DR: Existing models of insomnia development and maintenance are extended, and phenomena previously unidentified in this underserved veteran population are illumination, as well as new research directions for enhancing therapeutic efficacy.
Journal ArticleDOI
A Flexible-Dose Study of Paliperidone ER in Patients With Nonacute Schizophrenia Previously Treated Unsuccessfully With Oral Olanzapine.
Moshe Kotler,Nesrin Dilbaz,Fernanda Rosa,Periklis Paterakis,Vihra Milanova,Smulevich Ab,Marjolein Lahaye,Andreas Schreiner +7 more
TL;DR: Paliperidone ER flexibly-dosed over 6 months was well tolerated and associated with a meaningful clinical response in patients with nonacute schizophrenia who had previously been unsuccessfully treated with oral olanzapine.
References
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Journal ArticleDOI
The Positive and Negative Syndrome Scale (PANSS) for Schizophrenia
TL;DR: Review of five studies involving the PANSS provided evidence of its criterion-related validity with antecedent, genealogical, and concurrent measures, its predictive validity, its drug sensitivity, and its utility for both typological and dimensional assessment.
Journal ArticleDOI
The Brief Psychiatric Rating Scale
John E. Overall,Donald R. Gorham +1 more
TL;DR: The Brief Psychiatric Rating Scale (BRS) as mentioned in this paper was developed to provide a rapid assessment technique particularly suited to the evaluation of patient change, and it is recommended for use where efficiency, speed, and economy are important considerations.
Journal ArticleDOI
Antipsychotic-Induced Weight Gain: A Comprehensive Research Synthesis
David B. Allison,Janet L. Mentore,Moonseong Heo,L.P. Chandler,Joseph C. Cappelleri,Ming C. Infante,Peter J. Weiden +6 more
TL;DR: Among the newer antipsychotic agents, clozapine appears to have the greatest potential to induce weight gain, and ziprasidone the least, and the differences among newer agents may affect compliance with medication and health risk.
Journal ArticleDOI
Regularly occurring periods of eye motility, and concomitant phenomena, during sleep.
TL;DR: A method of gravimetric planimetry by standard photographs offers a means to study the course of surface wounds more accurately than by clinical observation or by the pictorial record alone.