Sleep across the psychosis continuum and its relationship to paranoid thinking

Background: The present thesis sought to explore the relationship between sleep and paranoia, and investigate what factors mediate this relationship. The research was conducted at different levels, and in different groups including healthy members of the general population, people with a diagnosis of psychosis and clinicians. Method: in chapter 3, a cross-sectional study was conducted online to examine the relationships between sleep and paranoia in a non-clinical sample. Following this, chapter 4 outlines a systematic review that aimed to further understand how sleep has been investigated in clinical samples of people with psychosis. Next, chapter 5 examined the relationship between sleep disturbance and paranoia in a clinical sample using novel experience sampling methodologies. Finally, chapter 6 explored clinician perceptions of sleep problems in people with psychosis. Results: chapter 3 found evidence for a mediation model whereby sleep predicted paranoia, and this relationship was mediated by negative emotions, alexithymia and perceptual anomalies. Chapter 4 revealed that there is a range of methodologies used to assess and measure sleep and identified areas of bias. Chapter 5 found no relationship between sleep and paranoia in a clinical sample of people with psychosis. Finally, chapter 6 found that clinicians are fully aware of the range and types of sleep problems in people with psychosis but lack the training and skills to treat sleep problems. Discussion: Overall, the relationship between sleep and paranoia is inconsistent. Sleep disturbances are common and should be treated in people with psychosis. More work is required to develop effective intervention strategies to address the range and type of sleep disturbances found in people with psychosis

Sleep quality and paranoia: the role of alexithymia, negative emotions and perceptual anomalies

Recent evidence suggests that sleep problems are associated with psychotic like experiences including paranoia. However, the mechanisms underpinning this association are not well understood and thus studies modelling hypothesised mediating factors are required. Alexithymia, the inability to recognise and describe emotions within the self may be an important candidate. In two separate studies we sought to investigate factors mediating the relationship between sleep quality and paranoia using a cross-sectional design. Healthy volunteers without a mental health diagnosis were recruited (study 1, N= 401, study 2, N= 402). Participants completed a series of measures assessing paranoia, negative emotions, alexithymia and perceptual anomalies in an online survey. In study 1, regression and mediation analyses showed that the relationship between sleep quality and paranoia was partially mediated by alexithymia, perceptual anomalies and negative affect. In contrast, study 2 found that the relationship between sleep quality and paranoia was fully mediated by negative affect, alexithymia and perceptual anomalies. The link between sleep quality and paranoia is unclear and reasons for discrepant results are discussed. Novel findings in this study include the link between alexithymia and paranoia

Clinician perceptions of sleep problems, and their treatment, in patients with non-affective psychosis

Aims and method: To assess clinicians’ views about their understanding and treatment of sleep problems in people with non-affective psychosis. An online survey was emailed to adult mental health teams in two NHS trusts. Results: One hundred and eleven clinicians completed the survey. All clinicians reported disrupted sleep in their patients, and endorsed the view that sleep and psychotic experiences each exacerbate the other. However, most clinicians (n = 92, 82%) assessed sleep problems informally, rather than using standard assessment measures. There was infrequent use of the recommended cognitive-behavioural treatments for sleep problems such as persistent insomnia, with the approaches typically used being sleep hygiene and medications instead. Clinical implications: Clinicians recognise the importance of sleep in psychosis, but the use of formal assessments and recommended treatments is limited. Barriers to treatment implementation identified by the clinicians related to services (e.g. lack of time), patients (e.g. their lifestyle) and environmental features of inpatient settings

Sleep reactivity predicts insomnia in patients diagnosed with breast cancer

This is a study looking at the role of the Ford Insomnia Response to Stress Test and its relationship to insomnia in a sample of women with breast cancer

Sleep reactivity predicts insomnia in patients diagnosed with breast cancer

Study Objectives: To examine the role of sleep reactivity as a predictor of insomnia in patients diagnosed with breast cancer. Methods: One hundred and seventy three women with breast cancer participated and were followed up over a period of 9 months. At baseline participants were assigned to a high (n=114) or low (n=59) sleep reactivity group, based on their responses to the Ford Insomnia Response to Stress Test (FIRST). We assessed whether these FIRST groupings (high/low sleep reactivity) predicted changes in insomnia over time using the Insomnia Severity Index (ISI). We also tested if these FIRST groupings predicted insomnia disorder (using ISI index cut-offs) at three different time points (T3, T6 and T9). Results: Individuals with high sleep reactivity were more likely to experience a worsening of insomnia. Using logistic regression we also found that FIRST grouping predicted insomnia disorder. Results remained significant after controlling for estimated pre-morbid sleep, age and whether someone had chemotherapy. Conclusions: Our study shows that sleep reactivity may be a robust predictor of insomnia within breast cancer populations. Sleep reactivity should be considered in routine clinical assessments as a reliable way to identify patients at risk of developing insomnia. This would facilitate early sleep intervention for those patients who are considered high risk

The role of sleep in predicting paranoia in non-affective psychosis: an experience sampling study

Introduction: Growing evidence suggests a relationship between sleep disturbance and paranoid thinking, in both clinical and non-clinical populations. Research also suggests that this relationship is mediated by negative affect. The aims of this study were to 1) examine whether sleep disturbance predicted paranoia and the dimensions of paranoia, including distress, preoccupation and conviction and 2) to test whether there was a time-lagged, relationship between sleepiness and paranoia, and whether this was mediated by negative affect. Method: Sleep was measured subjectively via questionnaires, sleep diary and this was used to test the first aim. Experience sampling methods were also used and these were used to test the second aim. Momentary assessments of sleepiness, mood, and paranoia were measured 8 times a day, for 8 days, at semi-random intervals. Multi-level modelling was then used to assess relationships between the variables. Results: Twenty- three patients with a diagnosis of non-affective psychosis took part in the study, and 20 completed the experience sampling procedure. There was no relationship between sleep diary variables and paranoia, or its dimensions. There was no time-lagged relationship between sleepiness and paranoia. A subset of individuals in the sample were identified who did not report any variation or fluctuations in their measurements. Discussion: There was no relationship between subjective sleep and paranoia. Lack of power may be why no relationship was found. However sleep disturbances were common in people with non-affective psychosis. Our findings support the treatment of sleep problems in this sample, but not in relation to paranoia

Comprehensive Meta-Analysis Mulligan's Mobilization with Movement in Knee Osteoarthritis Immediate and Short-term Efficacy on Pain, Function, and Emotional Well-being

Knee osteoarthritis (KOA) poses a significant global health challenge, impacting individuals' overall well-being through pain, compromised balance, and emotional distress. Mulligan's mobilization with movement (MWM) has emerged as a promising intervention, demonstrating immediate benefits in pain reduction and functional improvement. However, a comprehensive understanding of its sustained effects and potential synergies with other modalities remains limited. This meta-analysis aims to evaluate the immediate and short-term efficacy of Mulligan's MWM on pain reduction, physical function, and emotional well-being in KOA patients. Additionally, the study explores the sustained positive effects of MWM and its potential synergies with exercise programs and pharmacological interventions. A systematic literature review spanning 2017 to 2023 was conducted, selecting over 15 peer-reviewed studies from databases such as PubMed, Google Scholar, Cochrane Library, and Mendeley. The analysis focused on pain reduction using the Visual Analogue Scale, improvements in physical function through Time Up and Go Test and range of motion assessments, and emotional well-being evaluated via the Beck Depression Inventory. Longitudinal studies provided insights into sustained effects, and a comparative analysis explored synergies with other therapeutic modalities. Mulligan's MWM demonstrated consistent and substantial pain reduction, validated by Visual Analogue Scale scores. Improvements in physical function were evident through enhanced Time Up and Go Test results and increased range of motion. Emotional well-being saw a notable reduction in depression scores. Longitudinal studies indicated sustained positive effects, while a network meta-analysis suggested comparable efficacy with pharmacological interventions. This meta-analysis supports the immediate and short-term efficacy of Mulligan's MWM in addressing pain, improving physical function, and positively impacting emotional well-being in KOA patients. Sustained positive effects and potential synergies with other therapeutic modalities highlight the versatility of Mulligan's MWM, encouraging its integration into evidence-based guidelines for KOA management