Sleep profiles and CBT-I response in schizophrenia and related psychoses

Chiu, Vivian; Ree, Melissa J.; Janča, Aleksandar; Iyyalol, Rajan; Dragović, Milan; Waters, Flavie

doi:10.1016/j.psychres.2018.07.027

Cited by 47 publications

(37 citation statements)

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“…The elevated variability in sleep duration parameters suggests that in addition to the overall group effect toward longer mean sleep times in both disorders, greater heterogeneity with respect to sleep duration is also observed in clinical populations. This concurs with recent studies demonstrating subtypes differing with respect to sleep duration in schizophrenia patients with insomnia symptoms 24 and in bipolar disorder patients with hypersomnia, 73 , 80 and suggests that insomnia and hypersomnia-type patterns can coexist in some individuals.…”

Section: Discussionsupporting

confidence: 92%

“…Though definitions are imprecise, hypersomnia is receiving increasing attention as a core sleep phenotype in bipolar disorder, 73 but remains under-recognized and rarely addressed in schizophrenia. 24 Importantly, the elevated sleep duration parameters in schizophrenia argue that this phenotype may be equally, if not more prevalent, in schizophrenia. Causes of hypersomnia are poorly understood, but may include greater circadian predisposition for long-sleep duration 74 ; reduced drive for wakefulness arising from longer time in bed; anergia and fatigue associated with depression and the negative symptom dimension 75 ; fewer scheduled daytime occupational and social activities, and use of sleep as a means to escape from distressing symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, there is growing interest in the heterogeneity of sleep phenotypes in psychiatric disorders. For example, latent class analysis of sleep duration in schizophrenia 24 suggested that 3 distinct subtypes exist: those with short-, normal-, and long-sleep durations. A greater diversity of sleep phenotypes in patients would be expected to be reflected in greater variability of sleep parameters in patients than controls.…”

Section: Introductionmentioning

confidence: 99%

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Sleep and Circadian Rhythm Disturbance in Remitted Schizophrenia and Bipolar Disorder: A Systematic Review and Meta-analysis

Meyer

Faulkner

McCutcheon

et al. 2020

Schizophrenia Bulletin

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Background Sleep and circadian rhythm disturbances in schizophrenia are common, but incompletely characterized. We aimed to describe and compare the magnitude and heterogeneity of sleep-circadian alterations in remitted schizophrenia and compare them with those in interepisode bipolar disorder. Methods EMBASE, Medline, and PsycINFO were searched for case–control studies reporting actigraphic parameters in remitted schizophrenia or bipolar disorder. Standardized and absolute mean differences between patients and controls were quantified using Hedges’ g, and patient–control differences in variability were quantified using the mean-scaled coefficient of variation ratio (CVR). A wald-type test compared effect sizes between disorders. Results Thirty studies reporting on 967 patients and 803 controls were included. Compared with controls, both schizophrenia and bipolar groups had significantly longer total sleep time (mean difference [minutes] [95% confidence interval {CI}] = 99.9 [66.8, 133.1] and 31.1 [19.3, 42.9], respectively), time in bed (mean difference = 77.8 [13.7, 142.0] and 50.3 [20.3, 80.3]), but also greater sleep latency (16.5 [6.1, 27.0] and 2.6 [0.5, 4.6]) and reduced motor activity (standardized mean difference [95% CI] = −0.86 [−1.22, −0.51] and −0.75 [−1.20, −0.29]). Effect sizes were significantly greater in schizophrenia compared with the bipolar disorder group for total sleep time, sleep latency, and wake after sleep onset. CVR was significantly elevated in both diagnoses for total sleep time, time in bed, and relative amplitude. Conclusions In both disorders, longer overall sleep duration, but also disturbed initiation, continuity, and reduced motor activity were found. Common, modifiable factors may be associated with these sleep-circadian phenotypes and advocate for further development of transdiagnostic interventions that target them.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sleep and Circadian Rhythm Disturbance in Remitted Schizophrenia and Bipolar Disorder: A Systematic Review and Meta-analysis

Meyer

Faulkner

McCutcheon

et al. 2020

Schizophrenia Bulletin

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“…With respect to subtyping by subjective sleep duration as a predictor of CBT-I efficacy, a recent study by our group54 demonstrated that short sleepers showed a boosted response to CBT-I. Chiu et al55 report a similar finding with CBT-I treatment for ID in patients with schizophrenia and related psychoses. On the other hand, patients with shorter TST were reported to be more likely to drop-out prior to the fourth session, but there are inconsistencies across studies 56–58.…”

Section: Subjective Sleep Durationmentioning

confidence: 80%

<p>Impact Of Phenotypic Heterogeneity Of Insomnia On The Patients’ Response To Cognitive-Behavioral Therapy For Insomnia: Current Perspectives</p>

Galbiati¹,

Sforza²,

Fasiello³

et al. 2019

NSS

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Insomnia is one of the most common mental disorders and the most frequent sleep disorder encountered in clinical practice, with a prevalence of about 7% in the European population. Insomnia Disorder (ID) is defined as a disturbance of sleep initiation or maintenance, followed by a feeling of non-restorative sleep and several diurnal consequences ranging from occupational and social difficulties to cognitive impairment. Cognitive-Behavioral Therapy for Insomnia (CBT-I) is considered the first-choice therapy for this disorder because its effectiveness has been proven to be greater in the long term with fewer side effects in comparison to pharmacotherapy. Although its effectiveness has been well established, it has been reported that nearly 40% of patients do not achieve remission after treatment. This finding could be the consequence of heterogeneity of ID between patients. It has been proposed that this heterogeneity might be ascribable to indices that are not related to sleep quality and quantity, such as comorbidities, life events, and personality traits. However, several works focused on the role of sleep markers, in particular objective total sleep time, for the phenotypization of ID and treatment response. The aim of this work is to summarize the available scientific literature regarding the impact of ID subtype on CBT-I response.

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“…Patients with classic severe insomnia showed marked improvement in total sleep time while patients suffering from schizophrenia with insomnia and hypersomnia showed reductions in total sleep time. Patients suffering from schizophrenia with insomnia but normal sleep duration had a blunted response to CBT (Chiu et al, 2018). Jauhur et.…”

Section: Psychotherapeutic Approaches To Treating Schizophreniamentioning

confidence: 99%

Schizophrenia: Epidemiology, Causes, Neurobiology, Pathophysiology, and Treatment

Volkan¹

2020

jhms

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Schizophrenia is a severe mental illness that has devastating consequences for those who suffer from the disorder. The epidemiology of schizophrenia indicates that it occurs relatively often, in many different contexts, and in conjunction with other disorders, decreasing quality of life and causing premature death. There has been an enormous amount of research into the causes of schizophrenia and there is now have a much better understanding of the genetic, environmental, and psychological factors that contribute to the disease. While there are numerous ways to understand and conceptualize schizophrenia, a unified picture of the neurobiology, changes in brain structure, cognitive and social-cognitive impairments related to the disorder has yet to emerge. Convulsive therapies and psychosurgery were used unsuccessfully, indiscriminately and without scientific validation in the past to treat schizophrenia. Medical advances including advanced imaging technology have now provided the ability to perform specifically focused neuromodulation and psychosurgery in severe and treatment resistant cases of schizophrenia. While still at a preliminary stage, these approaches have the potential to yield effective treatments in the future. For the last 70 years antipsychotic medication has become the prevailing treatment for schizophrenia. However, many people suffering from the disorder have trouble with side-effects and adhering to a regimen of antipsychotic medication. Newer pharmacological agents are being developed and include not only novel antipsychotic drugs, but anti-inflammatory and immunomodulating agents as well. These new agents, used either alone or in combination, have the potential to improve outcomes for people suffering from schizophrenia. Nevertheless, conclusively better pharmacotherapies will likely not arise until there is better understanding of the pathophysiology underlying schizophrenia. After the development of antipsychotic medication, psychotherapeutic methods for treating schizophrenia fell out of favor, but there is currently some reversal of this trend. The use of newer psychotherapies and modified forms of older therapeutic treatments are not only targeting the symptoms of schizophrenia but are also now focusing on recovery from the disorder. These newer approaches as well as efforts at preventing schizophrenia show promise in reducing the suffering caused by this disease.

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Sleep profiles and CBT-I response in schizophrenia and related psychoses

Cited by 47 publications

References 50 publications

Sleep and Circadian Rhythm Disturbance in Remitted Schizophrenia and Bipolar Disorder: A Systematic Review and Meta-analysis

Sleep and Circadian Rhythm Disturbance in Remitted Schizophrenia and Bipolar Disorder: A Systematic Review and Meta-analysis

<p>Impact Of Phenotypic Heterogeneity Of Insomnia On The Patients’ Response To Cognitive-Behavioral Therapy For Insomnia: Current Perspectives</p>

Schizophrenia: Epidemiology, Causes, Neurobiology, Pathophysiology, and Treatment

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