People with early psychosis (those who have had only a single episode of psychosis) who experience persistent sleep problems are nearly 14 times as likely to report suicidal ideation as those with early psychosis who do not experience sleep problems, according to a report in Schizophrenia Bulletin.
“[I]nsomnia may represent an important treatment target in psychosis,” wrote Brian J. Miller, M.D., Ph.D., of Augusta University and colleagues. Additionally, the “findings provide … evidence that formal assessment and treatment of insomnia and sleep disturbance is relevant to the clinical care of patients with early psychosis as a predictor of suicidal ideation and symptom severity.”
By some estimates, up to 50% of people with schizophrenia will experience insomnia over the course of their illness. Several studies have also pointed to associations between insomnia and more severe symptoms of schizophrenia. Miller and colleagues wanted to know if the same was true of people experiencing early psychosis.
The researchers analyzed data from 403 people who had participated in the Recovery After an Initial Schizophrenia Episode (RAISE) trial—a large-scale research initiative testing coordinated specialty care treatments for reducing symptoms and improving quality of life for patients with first-episode psychosis. The participants were aged 15 to 40 years; had been diagnosed with schizophrenia, schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, or psychotic disorder not otherwise specified; had experienced only one episode of psychosis; and had taken antipsychotics for no longer than six months.
Miller and colleagues were particularly interested in what the available data from the RAISE trial might reveal of the relationships between sleep problems, suicidal ideation, and psychopathology at baseline as well as at months 6, 12, 18, and 24. At each time point, participants were assessed for insomnia and suicidal ideation using the Calgary Depression Scale for Schizophrenia (questions included “Do you wake earlier in the morning than is normal for you?” and “Have you felt that life isn’t worth living?”). The participants were also evaluated using the Positive and Negative Syndrome Scale (PANSS).
Over the two-year period, the prevalence of sleep problems among RAISE participants ranged from 40% to 57%, and the prevalence of suicidal ideation ranged from 5% to 15%. Additional findings from the study included the following:
- Sleep problems were associated with significantly increased odds of suicidal ideation at baseline and 18 months.
- Sleep problems at any time point were associated with an over a threefold increased odds of suicidal ideation.
- Sleep problems were associated with higher PANSS total, positive, and general psychopathology scores at baseline and all follow-up visits.
The authors concluded, “Our findings provide additional evidence that formal assessment and treatment of insomnia and sleep disturbance is relevant to the clinical care of patients with early psychosis as a predictor of suicidal ideation and symptom severity. They also underscore the need for comprehensive suicide risk assessment in patients with early psychosis.”
For related information, see the American Journal of Psychiatry article “Sleep Abnormalities in Schizophrenia: State of the Art and Next Steps.”
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