The link between sleep disturbances and suicidal thoughts and behaviors in remitted bipolar I patients

The Impact of Homeostatic and Circadian Sleep Processes on Non-Suicidal Self-Injury and Suicide Urges in Borderline Personality Disorder

OBJECTIVE

Borderline personality disorder (BPD) involves high rates of non-suicidal self-injury (NSSI) and suicidal behaviors, which are often preceded by urges. Disrupted sleep processes have been linked to NSSI and suicidal behaviors. However, it is unclear which specific sleep processes influence NSSI and suicide urges at rest (i.e., baseline) or in response to distress (i.e., reactivity) in BPD, and thus require targeting in BPD-specific interventions. This study examined whether two distinct homeostatic sleep processes (i.e., total sleep time [TST] and time in bed [TIB]), and one circadian sleep process (i.e., chronotype, or tendencies toward early versus late bed and rise times) predict baseline NSSI and suicide urges and urge reactivity in BPD.

METHODS

Forty adults with BPD completed a seven-day sleep diary to measure average TST and TIB. They then completed a questionnaire to measure chronotype and underwent an experiment wherein they rated NSSI and suicide urges at baseline and following an emotion induction.

RESULTS

Generalized estimating equations revealed that higher TST was associated with lower baseline NSSI urges, and lower suicide urge reactivity. Additionally, higher TIB predicted higher NSSI urge reactivity.

CONCLUSIONS

Sleep deprivation and extended time in bed may increase proclivity toward NSSI and/or suicide. Targeting these variables in BPD interventions may ultimately facilitate the reduction of NSSI and suicidal acts. HighlightsHigher total sleep time predicts lower baseline NSSI urges, suicide urge reactivityHigher time in bed predicts higher NSSI urge reactivityReducing sleep deprivation in BPD may facilitate reductions in suicide, NSSI urges.

The significance of sleep quality in euthymic bipolar patients from Nigeria

Background

Bipolar disorder is highly under-researched in Africa. Existing studies show that racial/ethnic disparities exist for sleep quality. Poor sleep quality in bipolar disorder causes significant morbidity and mortality even during periods of euthymia.

Aim

This study aimed to assess sleep quality and its correlates amongst euthymic patients with bipolar I disorder from Nigeria.

Setting

The study was carried out in a teaching hospital, and state hospital, in Ibadan, Nigeria.

Method

This cross-sectional study was conducted amongst 76 euthymic bipolar patients aged between 18 and 60 years, meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnostic criteria for bipolar disorder. Euthymia was defined as having a score of ≤ 5 on the Young Mania Rating Scale and < 8 on the Hamilton Depression Rating Scale. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI).

Results

A total of 37 (48.7%) participants had poor quality sleep. Sleep quality was associated with marital status (p = 0.013) and suicide plan (p = 0.047). Participants with good sleep quality had higher total sleep duration, lower time to fall asleep (sleep latency), better subjective quality of sleep, were less likely to use sleep medications and had less daytime dysfunction than participants with poor sleep quality. All p-values were < 0.05. Subjective quality of sleep, ongoing use of sleep medication, daytime dysfunction were independently associated with poor sleep quality.

Conclusion

Poor sleep quality frequently persists during euthymic periods in patients with bipolar disorder. The correlates identified can be targeted for intervention during treatment.

The association of childhood trauma, lifetime stressful events and general psychopathological symptoms in euthymic bipolar patients and healthy subjects

BACKGROUND

Psychopathological symptoms during euthymia in Bipolar Disorder (BD) affect quality of life and predispose to the occurrence of new acute episodes, however only few studies investigated potential risk-factors. This study aims to explore the association between childhood trauma (CT), lifetime stressful events (SLEs) and psychopathological symptoms in BD patients during euthymia and controls (HC).

METHODS

A total of 261 participants (93 euthymic patients with BD, 168 HC) were enrolled. Generalized linear models and multiple logistic models were used to assess the association among the Symptom Check List-90-R (SCL-90-R), the Infancy Trauma Interview, the Paykel Life Events Scale.

RESULTS

The rate of participants reporting CT was higher in BD (n=47; 53%) than HC (n=43; 30%) (p=0.001). The experience of neglect was strongly related to BD (OR 6.5; p=0.003). CT was associated to higher scores on the SCL-90-R subscales (all the subscales except Phobia). No effects of the interaction between CT and diagnosis were found on SCL-90-R. Finally, there was a main effect of CT on lifetime SLEs (p<.001), that was not associated with diagnosis (p=0.833), nor with the interaction between CT and diagnosis (p=0.624).

LIMITATIONS

The cross-sectional design does not allow causal inferences; the exclusion of subjects reporting medical or psychiatric comorbidity limits generalizability.

CONCLUSIONS

CT was associated both to psychopathological symptoms during euthymia and the lifetime SLEs, thus it may represent a vulnerability factor influencing the course of BD. Overall, these data contribute to overcome the limited evidences documenting the influence of environmental factors on euthymic phase in BD.

Sleep Quality in Caregivers of Older Patients with Schizophrenia Spectrum and Bipolar Disorders: A Case-Control Study

OBJECTIVES

Prior literature has documented the global burden of serious mental illnesses. The present study aimed to compare the sleep quality in caregivers of older patients with schizophrenia spectrum and bipolar disorders with control participants who did not serve as caregivers.

METHODS

We performed a case-controlled, cross-sectional study among family caregivers of older patients with psychotic disorders in Razi Hospital, Tunisia. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index Scale (PSQI).

RESULTS

Fifty caregivers of older patients (≥ 60 years) with schizophrenia spectrum and bipolar disorders, and 50 matched controls were enrolled. The three sub-dimensions of the PSQI, namely subjective sleep quality, sleep duration, and sleep efficiency, as well as overall PSQI scores, were worse for caregiver participants. Hierarchical multiple regression analyses predicting PSQI scores revealed that caregivers' age and marital status were the only significant predictors in the final model.

CONCLUSIONS

Older adults with severe mental disorders constitute a vulnerable population which generates a significant burden of care, and impacts their caregivers' subjective sleep quality.

CLINICAL IMPLICATIONS

Family interventions, including sleep interventions, should be considered as an integral component of treatment for serious mental illnesses. When promoting sleep quality, older and single caregivers should be targeted.