Meta-analysis of insomnia, suicide, and psychopathology in schizophrenia

Miller, Brian J.; McCall, William Vaughn

doi:10.1097/yco.0000000000000856

Cited by 13 publications

(10 citation statements)

References 60 publications

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“…Consistent with prior findings, 18 our studies highlighted that insomnia was independently associated with suicide ideation in patients with chronic schizophrenia. Childhood maltreatment was positively associated with insomnia.…”

Section: Discussionsupporting

confidence: 93%

“…54,55 Research has indicated that individuals with depressive symptoms often experience challenges in social functioning and have lower quality of life, which may consequently elevate the risk of suicide ideation. 56 Insomnia mediated the relationship between childhood maltreatment and suicide ideation Consistent with prior findings, 18 our studies highlighted that insomnia was independently associated with suicide ideation in patients with chronic schizophrenia. Childhood maltreatment was positively associated with insomnia.…”

Section: Association Between Suicide Ideation and Childhood Maltreatm...supporting

confidence: 90%

“…Insomnia is a common and perilous comorbidity in schizophrenia. 18 It is closely associated with both childhood maltreatment 19 and higher suicide ideation in individuals with schizophrenia. 20 Emerging studies suggest that insomnia might serve as a potential mediator linking childhood maltreatment and suicide ideation.…”

Section: Insomnia As a Potential Mediator Between Childhood Maltreatm...mentioning

confidence: 99%

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Association between childhood maltreatment and suicidal ideation among Chinese patients with chronic schizophrenia: the mediating role of insomnia

Hao,

Peng,

Wang

et al. 2024

BJPsych open

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Background Childhood maltreatment is a well-established transdiagnostic risk factor for suicidal ideation; however, previous studies on their association in schizophrenia have produced highly varied results. Moreover, the mechanism linking childhood maltreatment and suicide ideation remains unclear in schizophrenia. Aims This cross-sectional study aimed to investigate the association between childhood maltreatment and suicide ideation in people with schizophrenia and tested whether insomnia mediated this relationship. Method Positive and Negative Syndrome Scale (PANSS), Insomnia Severity Index (ISI), Childhood Trauma Questionnaire – Short Form and Beck Suicidal Ideation Inventory were employed. Logistic regression and mediation analysis were performed. Results (a) The prevalence of suicide ideation, insomnia, sexual abuse, emotional neglect, emotional abuse, physical abuse and physical neglect was 10% (n = 61), 18% (n = 111), 11% (n = 68), 25% (n = 153), 6.3% (n = 39), 17% (n = 106) and 39% (n = 239), respectively. In all, 52% (n = 320) reported childhood maltreatment; (b) patients with suicide ideation demonstrated higher insomnia and childhood maltreatment. PANSS depression factor, ISI, lifetime suicidal attempts and emotional abuse were independently associated with suicide ideation; (c) insomnia partially mediated the effects of emotional abuse and emotional neglect on suicide ideation, and insomnia completely mediated the effects of physical neglect and physical abuse on suicide ideation. Conclusion Our study calls for formal assessments for childhood maltreatment and insomnia in schizophrenia, which might help identify suicide ideation early. In addition, interventions targeting insomnia might help reduce suicide ideation among people with schizophrenia who experience childhood maltreatment.

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Section: Discussionsupporting

confidence: 93%

Section: Association Between Suicide Ideation and Childhood Maltreatm...supporting

confidence: 90%

Section: Insomnia As a Potential Mediator Between Childhood Maltreatm...mentioning

confidence: 99%

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Association between childhood maltreatment and suicidal ideation among Chinese patients with chronic schizophrenia: the mediating role of insomnia

Hao,

Peng,

Wang

et al. 2024

BJPsych open

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“…Identified risk factors for hospitalization to a psychiatric ward were not only psychiatric conditions, such as depression and sleep disturbance, but also physical conditions such as constipation and EPS. Our findings support a previous study that depression increases the risk of hospitalization and rehospitalization in patients with schizophrenia [ 17 ] and a previous systematic review that reported that sleep disturbance was associated with positive symptoms and poor clinical outcome [ 22 ]. EPS and constipation are common side effects of antipsychotic medication.…”

Section: Discussionsupporting

confidence: 92%

Factors associated with death, hospitalization, resignation, and sick leave from work among patients with schizophrenia in Japan: a nested case–control study using a large claims database

Inada,

Saito,

Baba

et al. 2024

BMC Psychiatry

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Background Premature mortality, frequent relapse that easily leads to hospitalization, and discontinuous employment are key challenges for the treatment of schizophrenia. We evaluated risk factors for important clinical outcomes (death, hospitalization, resignation, and sick leave from work) in patients with schizophrenia in Japan. Methods A nested case–control study was conducted for patients with schizophrenia identified in a Japanese claims database. For each outcome, the case was matched with up to four controls of the same age, sex, index year, and enrollment status (employee or dependent family). Potential risk factors were defined by prescriptions or diagnoses within 3 months prior to or in the month of the event. The association among potential risk factors and each outcome was evaluated using multivariable conditional logistic regression analysis with stepwise variable selection. Results The number of cases and eligible patients for each outcome were 144 and 38,451 (death), 1,520 and 35,225 (hospitalization), 811 and 18,770 (resignation), and 4,590 and 18,770 (sick leave), respectively. Depression was a risk factor for death (odds ratio [OR]: 1.92; 95% confidence interval [CI]: 1.12, 3.29), hospitalization (OR: 1.22; 95% CI: 1.05, 1.42), and sick leave from work (OR: 1.46; 95% CI: 1.36, 1.57). Other risk factors for death were hospitalization history, Charlson Comorbidity Index (CCI) score, and prescription for laxatives. Prescriptions for hypnotics, laxatives, and anticholinergics were risk factors for hospitalization. Prescriptions for hypnotics and anticholinergics were risk factors for resignation. CCI score, prescription for hypnotics, laxatives, and antidiabetics were risk factors for sick leave from work. Conclusions Our findings suggest that depression and some physical symptoms, such as constipation and extrapyramidal symptoms, are risk factors for important clinical outcomes in patients with schizophrenia. Attention should be paid to both depression and physical symptoms for the treatment of schizophrenia.

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“…For example, one of the hypotheses of neural mechanisms of psychiatric symptoms of schizophrenia is aberrant dopamine signaling, which is one of the major regulators of sleep and wakefulness ( 142 ). Patients with schizophrenia also have a significant reduction in REM sleep latency and sleep density ( 143 , 144 ) and insomnia is associated with psychopathology of schizophrenia ( 145 ). Additionally, spindle deficits in schizophrenia, particularly in the frontal-parietal and prefrontal areas, are observed in patients on antipsychotics ( 146 – 148 ) and in patients with first-episode psychosis who are antipsychotic-naïve or minimally treated ( 149 ).…”

Section: Sleep Disorders and Disruption Of Circadian Rhythms In Bipol...mentioning

confidence: 99%

Sleep, mood disorders, and the ketogenic diet: potential therapeutic targets for bipolar disorder and schizophrenia

Choi,

Kang,

Kim

et al. 2024

Front. Psychiatry

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Bipolar disorder and schizophrenia are serious psychiatric conditions that cause a significant reduction in quality of life and shortened life expectancy. Treatments including medications and psychosocial support exist, but many people with these disorders still struggle to participate in society and some are resistant to current therapies. Although the exact pathophysiology of bipolar disorder and schizophrenia remains unclear, increasing evidence supports the role of oxidative stress and redox dysregulation as underlying mechanisms. Oxidative stress is an imbalance between the production of reactive oxygen species generated by metabolic processes and antioxidant systems that can cause damage to lipids, proteins, and DNA. Sleep is a critical regulator of metabolic homeostasis and oxidative stress. Disruption of sleep and circadian rhythms contribute to the onset and progression of bipolar disorder and schizophrenia and these disorders often coexist with sleep disorders. Furthermore, sleep deprivation has been associated with increased oxidative stress and worsening mood symptoms. Dysfunctional brain metabolism can be improved by fatty acid derived ketones as the brain readily uses both ketones and glucose as fuel. Ketones have been helpful in many neurological disorders including epilepsy and Alzheimer’s disease. Recent clinical trials using the ketogenic diet suggest positive improvement in symptoms for bipolar disorder and schizophrenia as well. The improvement in psychiatric symptoms from the ketogenic diet is thought to be linked, in part, to restoration of mitochondrial function. These findings encourage further randomized controlled clinical trials, as well as biochemical and mechanistic investigation into the role of metabolism and sleep in psychiatric disorders. This narrative review seeks to clarify the intricate relationship between brain metabolism, sleep, and psychiatric disorders. The review will delve into the initial promising effects of the ketogenic diet on mood stability, examining evidence from both human and animal models of bipolar disorder and schizophrenia. The article concludes with a summary of the current state of affairs and encouragement for future research focused on the role of metabolism and sleep in mood disorders.

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Meta-analysis of insomnia, suicide, and psychopathology in schizophrenia

Cited by 13 publications

References 60 publications

Association between childhood maltreatment and suicidal ideation among Chinese patients with chronic schizophrenia: the mediating role of insomnia

Association between childhood maltreatment and suicidal ideation among Chinese patients with chronic schizophrenia: the mediating role of insomnia

Factors associated with death, hospitalization, resignation, and sick leave from work among patients with schizophrenia in Japan: a nested case–control study using a large claims database

Sleep, mood disorders, and the ketogenic diet: potential therapeutic targets for bipolar disorder and schizophrenia

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