Effects of chlorpromazine on sleep quality, clinical and emotional measures among patients with schizophrenia

As We Were and As We Should Be, Combined Exercise Training in Adults With Schizophrenia: CORTEX-SP Study Part II

OBJECTIVE

To determine the changes in health-related quality of life (HRQoL) and sleep quality following a supervised combined exercise (EX) program compared to a Treatment-As-Usual (TAU) and to analyze the relationship between the differences in cardiorespiratory fitness (CRF) and HRQoL domains in people with schizophrenia (SZ).

METHODS

The SZ (n = 112, 41.3 ± 10.4 year) was randomly assigned into a TAU control group (n = 53) or EX-group (n = 59, 3 days/week). The 36-item Short-Form Health Survey questionnaire assessed HRQoL and the sleep quality analysis (accelerometry).

RESULTS

After the intervention (20 weeks), physical functioning (∆ = 12.9%), general health (∆ = 15.3%), mental health (∆ = 8.3%), physical component summary (PCS) (∆ = 5.1%), and sleep efficiency (∆ = 1.9%) increased (p < 0.05) in the EX, with no significant changes in the TAU for any domains studied. There were significant differences between groups whose EX showed improvements (p < 0.05) compared to TAU in physical functioning, general health, PCS, and sleep efficiency. A greater CRF was associated with better values in physical functioning, role-physical, bodily pain, general health, vitality, and PCS after the exercise program in SZ.

CONCLUSIONS

A 20-week supervised combined exercise intervention program for SZ increased sleep efficiency and physical functioning, general and mental health, and PCS scores. This could lead to a critical HRQoL change from how they were to how they should be.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03509597.

Sleep Problems, Suicidal Ideation, and Psychopathology in First-Episode Psychosis

BACKGROUND AND HYPOTHESIS

Insomnia occurs frequently in the clinical course of schizophrenia. A growing literature has found associations between insomnia, suicidal ideation and behavior, and psychopathology in schizophrenia. We explored associations between sleep problems, suicidal ideation, and psychopathology in a cohort of patients with first-episode psychosis.

STUDY DESIGN

We performed a secondary analysis of data for n = 403 subjects with data from the Recovery After an Initial Schizophrenia Episode study using regression models.

STUDY RESULTS

The prevalence of sleep problems and suicidal ideation at baseline was 57% and 15%, respectively. After controlling for potential confounders, in the study baseline sleep problems were associated with increased odds of suicidal ideation with evidence of a dose-dependent relationship (OR = 2.25, 95% CI 1.15-4.41, P = .018). Over 24 months, sleep problems at any time point were associated with an over 3-fold increased odds of concurrent suicidal ideation (OR = 3.21, 95% CI 1.45-7.14, P = .004). Subjects with persistent sleep problems were almost 14 times more likely to endorse suicidal ideation at least once over the study than those without sleep problems (OR = 13.8, 95% CI 6.5-53.4, P < .001). Sleep problems were also a predictor of higher Positive and Negative Syndrome Scale total (β = 0.13-0.22), positive (β = 0.14-0.25), and general (β = 0.16-0.27) subscale scores at baseline and multiple follow-up visits (P < .01 for each).

CONCLUSIONS

Sleep problems are highly prevalent and associated with suicidal ideation and greater psychopathology in first-episode psychosis. Formal assessment and treatment of insomnia appear relevant to the clinical care of patients with psychosis as a predictor of suicidal ideation and symptom severity.

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

PURPOSE OF REVIEW

Insomnia is common in schizophrenia. Insomnia has been associated with suicidal ideation and behavior, as well as greater severity of psychopathology, in schizophrenia. This review performs a meta-analysis of associations between insomnia, suicide, and psychopathology in patients with schizophrenia.

RECENT FINDINGS

We searched major electronic databases from inception until November 2022 for studies of insomnia, suicide, and psychopathology in patients with schizophrenia. Random effects meta-analysis calculating odds ratios (ORs, for suicide) and effect sizes (ESs, for psychopathology) and 95% confidence intervals (CIs) were performed. Ten studies met the inclusion criteria, comprising 3428 patients with schizophrenia. Insomnia was associated with a significant increased odds of suicidal ideation (OR = 1.84, 95% CI 1.28-2.65, P  < 0.01) and suicide attempt or death (OR = 5.83, 95% CI 1.61-2.96, P  < 0.01). Insomnia was also associated with total (ES = 0.16, 95% CI 0.09-0.23, P  < 0.01), positive (ES = 0.14, 95% CI 0.08-0.20, P  = 0.02), and general (ES = 0.17, 95% CI 0.08-0.27, P  < 0.01) psychopathology. In meta-regression analyses, BMI was negatively associated with suicidal ideation. Otherwise, age, sex, and study year were all unrelated to the associations.

SUMMARY

Insomnia is associated with suicide and psychopathology in schizophrenia. Formal assessment and treatment of insomnia appears relevant to the clinical care of schizophrenia.

Insomnia, suicidal ideation, and psychopathology in Chinese patients with chronic schizophrenia

OBJECTIVES

Insomnia occurs frequently in the clinical course of schizophrenia. A growing literature has found associations between insomnia, suicidal ideation, and psychopathology in patients with schizophrenia. We explored these associations in a cross-sectional study of a large sample of patients with chronic schizophrenia in China. We hypothesized that insomnia would be associated with an increased odds of current suicidal ideation and higher current psychopathology scores.

METHODS

We recruited 328 inpatients with chronic schizophrenia, all of whom were prescribed psychotropics. We investigated relationships between current insomnia, suicidal ideation over the past two weeks, and current psychopathology for subjects using regression models.

RESULTS

After controlling for multiple potential confounding factors, current insomnia was an indicator of a significant, 2.5-fold increased odds of suicidal ideation (OR = 2.56, 95% CI 1.10-5.95, p = 0.029). Insomnia was also a significant indicator of lifetime suicide attempt (OR = 1.07) as well as higher Positive and Negative Syndrome Scale total (β = 0.134, p = 0.017), positive (β = 0.154, p = 0.006) and general (β = 0.145, p = 0.010) subscale scores.

CONCLUSION

Insomnia is associated with suicidal ideation, lifetime suicide attempt, and higher psychopathology scores in inpatients with chronic schizophrenia. Formal assessment of insomnia appears relevant to the clinical care of patients with schizophrenia as an indicator of suicidal thinking and behavior, depression, and symptom severity.

Major depression, sleep, hostility and body mass index are associated with impaired quality of life in schizophrenia. Results from the FACE-SZ cohort

BACKGROUND

Impaired Quality of life (QoL) in schizophrenia has been mostly associated with psychotic and mood symptomatology, insight and functioning so far.

AIMS

QoL levels remain unsatisfactory due to other factors we aim to explore.

METHOD

We have explored sleep quality with the Pittsburgh Sleep Quality Index, hostility with the Buss&Perry questionnaire, major depression with the Positive and Negative Syndrome Scale depressive factor, functioning with the Global Assessment of Functioning scale and weight gain with body mass index in addition to other classical QoL-associated factors.

RESULTS

559 patients (mean age=31 (SD 9) years, 74% male sex) were included in the national FACE-SZ cohort. Impaired QoL has been significantly associated with respectively major depression, impaired sleep quality, increased hostility, impaired functioning and impaired insight independently of age, sex, treatments, tobacco smoking and body mass index. Major depression was associated with impaired psychological and physical well-being, and impaired self-esteem. Impaired sleep quality has been associated with impaired psychological and physical well-being and sentimental life. Hostility has been associated with impaired psychological well-being and self-esteem, impaired friends' relationships and impaired autonomy. Weight was associated with impaired physical well-being. Tobacco smoking was associated with higher level of friends' relationships.

CONCLUSIONS

Major depression, sleep, hostility, and weight gain have been identified as potential targets to improve QoL in schizophrenia and should be implemented in the recommendations for good practice to optimize schizophrenia care.

Differential effects of selective serotonin reuptake inhibitors on paraoxonase-1 enzyme activity: An in vitro study

Paraoxonase-I (PON1) is a calcium-dependent hydrolytic enzyme, plays an important role in most antioxidant properties related to high-density lipoprotein (HDL). Antidepressant drugs are commonly employed in treatment of mood disorders and anxiety treatment. In this study, human serum PON1 was purified using simple reproducible procedures and the effects of some antidepressant drugs on its activity were determined. It was found that mirtazapine, aripiprazole, escitalopram, and risperidone exhibited potential inhibitory properties on the purified PON1 activity with IC₅₀ values in the range of 115.50-231.00 μM and K_i values in the range of 41.66 ± 4.27 μM-276.36 ± 35.28 μM. Both risperidone and escitalopram inhibited PON1 activity competitively, while both aripiprazole and mirtazapine inhibited PON1 activity non-competitively. Chlorpromazine did not affect PON1 activity. Usage of drugs with significant biological activity may be hazardous in some cases.