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Van Gastel A. Drug-Induced Insomnia and Excessive Sleepiness. Sleep Med Clin 2022; 17:471-484. [PMID: 36150808 DOI: 10.1016/j.jsmc.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Undesirable side effects of insomnia and/or sleepiness may occur with many prescribed drugs, psychotropics as well as non-psychotropics. These central nervous system effects can be explained by the interactions of the drug with any of the numerous neurotransmitters and receptors that are involved in sleep and wakefulness. Also a close - sometimes bidirectional - relationship between disease and (disturbed) sleep/wakefulness is often present e.g. in chronic pain; drug effects may lead this vicious circle in both ways. Besides the importance for health and quality of life, effects on sleep or waking function can be a potential source of non-compliance.
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Affiliation(s)
- Ann Van Gastel
- Multidisciplinary Sleep Disorders Centre and University Department of Psychiatry, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Antwerp, Belgium; Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (UA), Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.
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Skeldon AC, Dijk DJ, Meyer N, Wulff K. Extracting Circadian and Sleep Parameters from Longitudinal Data in Schizophrenia for the Design of Pragmatic Light Interventions. Schizophr Bull 2021; 48:447-456. [PMID: 34757401 PMCID: PMC8886588 DOI: 10.1093/schbul/sbab124] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Sleep and circadian rhythm dysfunction is prevalent in schizophrenia, is associated with distress and poorer clinical status, yet remains an under-recognized therapeutic target. The development of new therapies requires the identification of the primary drivers of these abnormalities. Understanding of the regulation of sleep-wake timing is now sufficiently advanced for mathematical model-based analyses to identify the relative contribution of endogenous circadian processes, behavioral or environmental influences on sleep-wake disturbance and guide the development of personalized treatments. Here, we have elucidated factors underlying disturbed sleep-wake timing by applying a predictive mathematical model for the interaction of light and the circadian and homeostatic regulation of sleep to actigraphy, light, and melatonin profiles from 20 schizophrenia patients and 21 age-matched healthy unemployed controls, and designed interventions which restored sleep-circadian function. Compared to controls, those with schizophrenia slept longer, had more variable sleep timing, and received significantly fewer hours of bright light (light > 500 lux), which was associated with greater variance in sleep timing. Combining the model with the objective data revealed that non 24-h sleep could be best explained by reduced light exposure rather than differences in intrinsic circadian period. Modeling implied that late sleep offset and non 24-h sleep timing in schizophrenia can be normalized by changes in environmental light-dark profiles, without imposing major lifestyle changes. Aberrant timing and intensity of light exposure patterns are likely causal factors in sleep timing disturbances in schizophrenia. Implementing our new model-data framework in clinical practice could deliver personalized and acceptable light-dark interventions that normalize sleep-wake timing.
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Affiliation(s)
- Anne C Skeldon
- Department of Mathematics, Faculty of Engineering and Physical Sciences, University of Surrey, GuildfordUK,UK Dementia Research Institute Care Research & Technology Centre, at Imperial College London and the University of Surrey, Guildford,UK,To whom correspondence should be addressed; Department of Mathematics, University of Surrey, Guildford, GU2 7XH, UK; tel +44 1483 688761, e-mail:
| | - Derk-Jan Dijk
- UK Dementia Research Institute Care Research & Technology Centre, at Imperial College London and the University of Surrey, Guildford,UK,Surrey Sleep Research Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford,UK
| | - Nicholas Meyer
- Department of Psychosis Studies, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, >London, UK,Insomnia and Behavioural Sleep Medicine Clinic, University College London Hospitals NHS Foundation Trust, London, UK
| | - Katharina Wulff
- Departments of Radiation Sciences and Molecular Biology, Umea University, Umea, Sweden,Wallenberg Centre for Molecular Medicine (WCMM), Umea University, Umea, Sweden
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Reeve S, Sheaves B, Freeman D. Excessive sleepiness in patients with psychosis: An initial investigation. PLoS One 2021; 16:e0245301. [PMID: 33449971 PMCID: PMC7810297 DOI: 10.1371/journal.pone.0245301] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/24/2020] [Indexed: 01/26/2023] Open
Abstract
Clinical experience indicates that excessive sleepiness and hypersomnia may be a common issue for patients with psychosis. Excessive sleepiness is typically ascribed to the sedating effects of antipsychotic medications but there may be other potential contributors such as sleep disorders and depression. Furthermore, the impact of excessive sleepiness itself on patients' symptoms and general wellbeing is yet to be examined. The current study reports an exploratory cross-sectional between-groups comparison of patients with early psychosis fulfilling criteria assessed in a diagnostic interview for problematic excessive sleepiness (n = 14), compared with those not reporting excessive sleepiness (n = 46). There were no differences between the groups in diagnosis, medication type, or antipsychotic medication dosage. There were no significant group differences in sleep duration. Significantly lower activity levels were found in the excessive sleepiness group. Insomnia and nightmares were common in those reporting excessive sleepiness. No significant differences were found in psychiatric symptoms, although data did indicate more severe cognitive disorganisation and grandiosity, but less severe paranoia and hallucinations, in the excessive sleepiness group. Wide confidence intervals and small sample size mean that care should be taken interpreting these results. Overall, this study indicates that excessive sleepiness may not be solely related to medication but also to low levels of activity and other sleep disorders. This is a novel finding that, if replicated, could indicate routes of intervention for this clinical issue. Future research should aim to disentangle directions of effect amongst sleepiness, mood, activity, and psychotic symptoms and investigate possible interventions for excessive sleepiness in psychosis.
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Affiliation(s)
- Sarah Reeve
- Department of Clinical, Educational, and Health Psychology, University College London, London, United Kingdom
| | - Bryony Sheaves
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Daniel Freeman
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
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Sansa G, Gavaldà A, Gaig C, Monreal J, Ercilla G, Casamitjana R, Ribera G, Iranzo A, Santamaria J. Exploring the presence of narcolepsy in patients with schizophrenia. BMC Psychiatry 2016; 16:177. [PMID: 27245445 PMCID: PMC4888670 DOI: 10.1186/s12888-016-0859-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 05/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are several case reports of patients with narcolepsy and schizophrenia, but a systematic examination of the association of both disorders has not been done. The aim of this work is to assess the frequency of narcolepsy with cataplexy in a large consecutive series of adult patients with schizophrenia and schizoaffective disorder. METHODS We screened 366 consecutive patients with schizophrenia or schizoaffective disorder with a sleep questionnaire and the Epworth Sleepines scale (ESS) exploring narcoleptiform symptoms. Those who screened positive were assessed by a sleep specialist, and offered an HLA determination. CSF hypocretin-1 determination was proposed to those who were HLA DQB1*06:02 positive. RESULTS On the screening questionnaire, 17 patients had an ESS score ≥11 without cataplexy, 15 had cataplexy-like symptoms with an ESS score < 11, and four had an ESS score ≥11 plus cataplexy-like symptoms. Of those, 24 patients were evaluated by a sleep specialist. Five of these 24 were HLA DQB1*06:02 positive, and three of these five subjects underwent lumbar puncture showing normal hypocretin-1 levels. CONCLUSIONS Our results suggest that narcolepsy with cataplexy is not an unrecognized disease in adult patients with schizophrenia or schizoaffective disorder.
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Affiliation(s)
- Gemma Sansa
- Neurology Service and Multidisciplinary Sleep Disorders Unit, Hospital Parc Taulí, Sabadell, Spain.
| | - Alba Gavaldà
- Neuropsychology Department, Neurology Service. Hospital Parc Taulí, Sabadell, Spain
| | - Carles Gaig
- Neurology Service and Multidisciplinary Sleep Disorders Unit, Hospital Clínic of Barcelona, Barcelona, Spain
| | - José Monreal
- Psychiatry Service, Hospital Parc Taulí, Sabadell, Spain
| | - Guadalupe Ercilla
- Immunology Laboratory, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Roser Casamitjana
- Biochemistry and Molecular Genetics Laboratory, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic of Barcelona, Barcelona, Spain
| | - Gisela Ribera
- Neurology Service and Multidisciplinary Sleep Disorders Unit, Hospital Parc Taulí, Sabadell, Spain
| | - Alex Iranzo
- Neurology Service and Multidisciplinary Sleep Disorders Unit, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Joan Santamaria
- Neurology Service and Multidisciplinary Sleep Disorders Unit, Hospital Clínic of Barcelona, Barcelona, Spain
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Merenlender-Wagner A, Shemer Z, Touloumi O, Lagoudaki R, Giladi E, Andrieux A, Grigoriadis NC, Gozes I. New horizons in schizophrenia treatment: autophagy protection is coupled with behavioral improvements in a mouse model of schizophrenia. Autophagy 2015; 10:2324-32. [PMID: 25484074 DOI: 10.4161/15548627.2014.984274] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Autophagy plays a key role in the pathophysiology of schizophrenia as manifested by a 40% decrease in BECN1/Beclin 1 mRNA in postmortem hippocampal tissues relative to controls. This decrease was coupled with the deregulation of the essential ADNP (activity-dependent neuroprotector homeobox), a binding partner of MAP1LC3B/LC3B (microtubule-associated protein 1 light chain 3 β) another major constituent of autophagy. The drug candidate NAP (davunetide), a peptide fragment from ADNP, enhanced the ADNP-LC3B interaction. Parallel genetic studies have linked allelic variation in the gene encoding MAP6/STOP (microtubule-associated protein 6) to schizophrenia, along with altered MAP6/STOP protein expression in the schizophrenic brain and schizophrenic-like behaviors in Map6-deficient mice. In this study, for the first time, we reveal significant decreases in hippocampal Becn1 mRNA and reversal by NAP but not by the antipsychotic clozapine (CLZ) in Map6-deficient (Map6(+/-)) mice. Normalization of Becn1 expression by NAP was coupled with behavioral protection against hyperlocomotion and cognitive deficits measured in the object recognition test. CLZ reduced hyperlocomotion below control levels and did not significantly affect object recognition. The combination of CLZ and NAP resulted in normalized outcome behaviors. Phase II clinical studies have shown NAP-dependent augmentation of functional activities of daily living coupled with brain protection. The current studies provide a new mechanistic pathway and a novel avenue for drug development.
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Key Words
- ADNP, activity-dependent neuroprotector homeobox (human)
- Adnp, activity-dependent neuroprotective protein (mouse)
- Adnp2 (mouse), ADNP2 (human), ADNP homeobox 2
- Becn1 (mouse), BECN1 (human), Beclin 1, autophagy-related
- CLZ, clozapine
- HUGO gene nomenclature committee database)
- Hprt/Hprt1, hypoxanthine phosphoribosyl transferase
- MGI database)
- Map1lc3b (mouse), MAP1LC3B (human), microtubule-associated protein 1 light chain 3 β
- Map6 (mouse), MAP6 (human), microtubule-associated protein 6
- NAP (davunetide); object recognition
- activity-dependent neuroprotective protein (ADNP
- activity-dependent neuroprotector homeobox (ADNP
- hyperactivity; immunohistochemistry
- microtubule-associated protein 6 (MAP6)/stable tubule only polypeptide (STOP) deficiency
- real-time PCR
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Affiliation(s)
- Avia Merenlender-Wagner
- a The Adams Super Center for Brain Studies; The Lily and Avraham Gildor Chair for the Investigation of Growth Factors; The Elton Laboratory for Neuroendocrinology; Department of Human Molecular Genetics and Biochemistry; Sagol School of Neuroscience; Sackler Faculty of Medicine ; Tel Aviv University ; Tel Aviv ; Israel
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Reeve S, Sheaves B, Freeman D. The role of sleep dysfunction in the occurrence of delusions and hallucinations: A systematic review. Clin Psychol Rev 2015; 42:96-115. [PMID: 26407540 PMCID: PMC4786636 DOI: 10.1016/j.cpr.2015.09.001] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/24/2015] [Accepted: 09/03/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Sleep dysfunction is extremely common in patients with schizophrenia. Recent research indicates that sleep dysfunction may contribute to psychotic experiences such as delusions and hallucinations. OBJECTIVES The review aims to evaluate the evidence for a relationship between sleep dysfunction and individual psychotic experiences, make links between the theoretical understanding of each, and highlight areas for future research. METHOD A systematic search was conducted to identify studies investigating sleep and psychotic experiences across clinical and non-clinical populations. RESULTS 66 papers were identified. This literature robustly supports the co-occurrence of sleep dysfunction and psychotic experiences, particularly insomnia with paranoia. Sleep dysfunction predicting subsequent psychotic experiences receives support from epidemiological surveys, research on the transition to psychosis, and relapse studies. There is also evidence that reducing sleep elicits psychotic experiences in non-clinical individuals, and that improving sleep in individuals with psychosis may lessen psychotic experiences. Anxiety and depression consistently arise as (partial) mediators of the sleep and psychosis relationship. CONCLUSION Studies are needed that: determine the types of sleep dysfunction linked to individual psychotic experiences; establish a causal connection between sleep and psychotic experiences; and assess treatments for sleep dysfunction in patients with non-affective psychotic disorders such as schizophrenia.
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Affiliation(s)
- Sarah Reeve
- Department of Psychiatry, University of Oxford, UK
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Hanken K, Eling P, Hildebrandt H. The representation of inflammatory signals in the brain - a model for subjective fatigue in multiple sclerosis. Front Neurol 2014; 5:264. [PMID: 25566171 PMCID: PMC4263099 DOI: 10.3389/fneur.2014.00264] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 11/24/2014] [Indexed: 01/23/2023] Open
Abstract
In multiple sclerosis (MS) patients, fatigue is rated as one of the most common and disabling symptoms. However, the pathophysiology underlying this fatigue is not yet clear. Several lines of evidence suggest that immunological factors, such as elevated levels of pro-inflammatory cytokines, may contribute to subjective fatigue in MS patients. Pro-inflammatory cytokines represent primary mediators of immune-to-brain-communication, modulating changes in the neurophysiology of the central nervous system. Recently, we proposed a model arguing that fatigue in MS patients is a subjective feeling, which is related to inflammation. Moreover, it implies that fatigue can be measured behaviorally only by applying specific cognitive tasks related to alertness and vigilance. In the present review, we focus on the subjective feeling of MS-related fatigue. We examine the hypothesis that the subjective feeling of MS-related fatigue may be a variant of inflammation-induced sickness behavior, resulting from cytokine-mediated activity changes within brain areas involved in interoception and homeostasis including the insula, the anterior cingulate, and the hypothalamus. We first present studies demonstrating a relationship between pro-inflammatory cytokines and subjective fatigue in healthy individuals, in people with inflammatory disorders, and particularly in MS patients. Subsequently, we discuss studies analyzing the impact of anti-inflammatory treatment on fatigue. In the next part of this review, we present studies on the transmission and neural representation of inflammatory signals, with a special focus on possible neural concomitants of inflammation-induced fatigue. We also present two of our studies on the relationship between local gray and white matter atrophy and fatigue in MS patients. Finally, we discuss some implications of our findings and future perspectives.
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Affiliation(s)
- Katrin Hanken
- Department of Neurology, Klinikum Bremen-Ost , Bremen , Germany
| | - Paul Eling
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen , Nijmegen , Netherlands
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Daytime sleepiness and EEG abnormalities in patients treated with second generation antipsychotic agents. Pharmacol Rep 2014; 66:1077-82. [PMID: 25443738 DOI: 10.1016/j.pharep.2014.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 05/15/2014] [Accepted: 07/16/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND The aim of this study was to verify whether or not an increased prevalence of excessive daytime sleepiness (EDS) or EEG abnormalities is observed in patients with schizophrenia spectrum disorders (SSD), and to compare the effects of second generation antipsychotics (SGA) on patients' daytime sleepiness level and EEG recordings. METHODS EEG recordings and self-reports of EDS, assessed with Epworth (ESS) and Stanford (SSS) Sleepiness Scales, were compared between 244 patients with SSD and 82 patients with anxiety, personality or behavioral disorders (non-psychotic disorders, NPD). To examine the effects of various SGA, patients treated in monotherapy with aripiprazole, olanzapine, clozapine, risperidone and sertindole were compared. RESULTS A higher prevalence of abnormal EEG recordings was observed in SSD patients. No significant differences in average daytime sleepiness were found between patients with SSD and NPD; however, patients with SSD had longer sleep duration. Aripiprazole treatment was associated with significantly smaller and less frequent EEG abnormalities than treatment with any other SGA, while treatment with clozapine and olanzapine was related to an increased prevalence of severe EEG abnormalities. Patients with SSD treated with SGA in monotherapy were less sleepy than unmedicated patients with NPD. CONCLUSIONS Although antipsychotics may have profound effects on EEG patients with schizophrenia do not have higher daytime sleepiness than patients with anxiety/personality disorders. Patients with schizophrenia may compensate sedative effects of antipsychotic treatment with sleep duration prolongation and report even less sleepiness than non-psychotic patients.
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Abstract
BACKGROUND Current guidance suggests that we should monitor the physical health of people with serious mental illness, and there has been a significant financial investment over recent years to provide this. OBJECTIVES To assess the effectiveness of physical health monitoring, compared with standard care for people with serious mental illness. SEARCH METHODS We searched the Cochrane Schizophrenia Group Trials Register (October 2009, update in October 2012), which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO. SELECTION CRITERIA All randomised clinical trials focusing on physical health monitoring versus standard care, or comparing i) self monitoring versus monitoring by a healthcare professional; ii) simple versus complex monitoring; iii) specific versus non-specific checks; iv) once only versus regular checks; or v) different guidance materials. DATA COLLECTION AND ANALYSIS Initially, review authors (GT, AC, SM) independently screened the search results and identified three studies as possibly fulfilling the review's criteria. On examination, however, all three were subsequently excluded. Forty-two additional citations were identified in October 2012 and screened by two review authors (JX and MW), 11 of which underwent full screening. MAIN RESULTS No relevant randomised trials which assess the effectiveness of physical health monitoring in people with serious mental illness have been completed. We identified one ongoing study. AUTHORS' CONCLUSIONS There is still no evidence from randomised trials to support or refute current guidance and practice. Guidance and practice are based on expert consensus, clinical experience and good intentions rather than high quality evidence.
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Affiliation(s)
- Graeme Tosh
- Rotherham, Doncaster and South Humber NHS Foundation Trust (RDASH)Early Intervention in Psychosis and Community TherapiesSwallownest CourtAughton RoadSwallownestUKS26 4TH
| | - Andrew V Clifton
- University of HuddersfieldSchool of Human and Health SciencesQueensgateHuddersfieldSouth West YorkshireUKHD1 3DH
| | - Jun Xia
- The University of NottinghamCochrane Schizophrenia GroupInstitute of Mental HealthUniversity of Nottingham Innovation Park, Triumph Road,NottinghamUKNG7 2TU
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Kluge M, Schacht A, Himmerich H, Rummel-Kluge C, Wehmeier PM, Dalal M, Hinze-Selch D, Kraus T, Dittmann RW, Pollmächer T, Schuld A. Olanzapine and clozapine differently affect sleep in patients with schizophrenia: results from a double-blind, polysomnographic study and review of the literature. Schizophr Res 2014; 152:255-60. [PMID: 24315135 DOI: 10.1016/j.schres.2013.11.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 11/04/2013] [Accepted: 11/11/2013] [Indexed: 11/18/2022]
Abstract
Schizophrenia is associated with impaired sleep continuity. The second generation antipsychotics clozapine and olanzapine have been reported to improve sleep continuity but also to rarely induce restless legs syndrome (RLS). The aims of this randomized double-blind study were to compare the effects of clozapine and olanzapine on sleep and the occurrence of RLS. Therefore, polysomnographies were recorded and RLS symptoms were assessed in 30 patients with schizophrenia before and after 2, 4 and 6 weeks of treatment with either clozapine or olanzapine. Treatment with both antipsychotics increased total sleep time, sleep period time and sleep efficiency and decreased sleep onset latency. These changes were similar in both groups, occurred during the first 2 treatment weeks and were sustained. For example, sleep efficiency increased from 83% (olanzapine) and 82% (clozapine) at baseline to 95% at week 2 and 97% at week 6 in both treatment groups. Sleep architecture was differently affected: clozapine caused a significantly stronger increase of stage 2 sleep (44%) than olanzapine (11%) but olanzapine a significantly stronger increase of REM-sleep. Olanzapine caused an 80% increase of slow wave sleep whereas clozapine caused a 6% decrease. No patient reported any of 4 RLS defining symptoms at baseline. During treatment, 1 patient of each group reported at one visit all 4 symptoms, i.e. met the diagnosis of an RLS. In conclusion, sleep continuity similarly improved and sleep architecture changed more physiologically with olanzapine. Neither of the antipsychotics induced RLS symptoms that were clinically relevant.
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Affiliation(s)
- Michael Kluge
- Department of Psychiatry, University of Leipzig, Leipzig, Germany; Max Planck Institute of Psychiatry, Munich, Germany.
| | | | | | | | - Peter M Wehmeier
- Department of Child and Adolescent Psychiatry, Central Institute of Mental Health Mannheim, University of Heidelberg, Germany
| | - Mira Dalal
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Dunja Hinze-Selch
- Fachklinik St. Marienstift, Center for Psychiatric and Psychotherapeutic Treatment for Traumatized Males, Neuenkirchen, Germany
| | - Thomas Kraus
- Frankenalb-Klinik, District Hospital of Psychiatry, Psychotherapy, Psychosomatics and Addiction Rehabilitation, Engelthal, Germany
| | - Ralf W Dittmann
- Department of Child and Adolescent Psychiatry, Central Institute of Mental Health Mannheim, University of Heidelberg, Germany
| | - Thomas Pollmächer
- Max Planck Institute of Psychiatry, Munich, Germany; Klinikum Ingolstadt, Center of Mental Health, Ingolstadt, Germany
| | - Andreas Schuld
- Klinikum Ingolstadt, Center of Mental Health, Ingolstadt, Germany
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Monti JM, BaHammam AS, Pandi-Perumal SR, Bromundt V, Spence DW, Cardinali DP, Brown GM. Sleep and circadian rhythm dysregulation in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2013; 43:209-16. [PMID: 23318689 DOI: 10.1016/j.pnpbp.2012.12.021] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 12/04/2012] [Accepted: 12/27/2012] [Indexed: 12/18/2022]
Abstract
Sleep-onset and maintenance insomnia is a common symptom in schizophrenic patients regardless of either their medication status (drug-naive or previously treated) or the phase of the clinical course (acute or chronic). Regarding sleep architecture, the majority of studies indicate that non-rapid eye movement (NREM), N3 sleep and REM sleep onset latency are reduced in schizophrenia, whereas REM sleep duration tends to remain unchanged. Many of these sleep disturbances in schizophrenia appear to be caused by abnormalities of the circadian system as indicated by misalignments of the endogenous circadian cycle and the sleep-wake cycle. Circadian disruption, sleep onset insomnia and difficulties in maintaining sleep in schizophrenic patients could be partly related to a presumed hyperactivity of the dopaminergic system and dysfunction of the GABAergic system, both associated with core features of schizophrenia and with signaling in sleep and wake promoting brain regions. Since multiple neurotransmitter systems within the CNS can be implicated in sleep disturbances in schizophrenia, the characterization of the neurotransmitter systems involved remains a challenging dilemma.
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Affiliation(s)
- Jaime M Monti
- Department of Pharmacology and Therapeutics, Clinics Hospital, Montevideo, 11600, Uruguay
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Tosh G, Clifton A, Mala S, Bachner M. Physical health care monitoring for people with serious mental illness. Cochrane Database Syst Rev 2010:CD008298. [PMID: 20238365 DOI: 10.1002/14651858.cd008298.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Current guidance suggests that we should monitor the physical health of people with serious mental illness and there has been a significant financial investment over recent years to provide this. OBJECTIVES To assess the effectiveness of physical health monitoring as a means of reducing morbidity, mortality and reduction in quality of life in people with serious mental illness. SEARCH STRATEGY We searched the Cochrane Schizophrenia Group Trials Register (October 2009) which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO. SELECTION CRITERIA All randomised or quasi-randomised clinical trials focusing on physical health monitoring versus standard care or comparing i) self monitoring vs monitoring by health care professional; ii) simple vs complex monitoring; iii) specific vs non-specific checks iv) once only vs regular checks or v) comparison of different guidance. DATA COLLECTION AND ANALYSIS The authors (GT, AC, SM) independently screened search results and identified three studies as possibly fulfilling the review's criteria. On examination, however, all three were subsequently excluded. MAIN RESULTS We did not identify any randomised trials which assessed the effectiveness of physical health monitoring in people with serious mental illness. AUTHORS' CONCLUSIONS There is no evidence from randomised trials to support current guidance and practice. Guidance and practice are based on expert consensus, clinical experience and good intentions rather than high quality evidence.
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Affiliation(s)
- Graeme Tosh
- East Midlands Workforce Deanery, Nottingham, UK
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