Substance Use and Sleep Problems in Patients With Psychotic Disorders

sgac073Substance use and sleep problems are common in patients with psychotic disorders, but their associations in these patients have not been evaluated. We aimed to investigate associations between substance use and sleep problems in a large nationwide cohort of patients with a psychotic disorder.This study is part of the Finnish SUPER study, which belongs to the Stanley Global Neuropsychiatric Genomics Initiative. In this cross-sectional, multicenter study, participants (N = 8616) were recruited from primary and specialized healthcare. Patients with schizophrenia, schizoaffective disorder, bipolar disorder, and psychotic depression were included. Information on current alcohol (Alcohol Use Disorders Identification Test-Concise) and cigarette use as well as on lifetime illicit drug use, including cannabis, benzodiazepines, amphetamines, and opioids, was collected using questionnaires. The sleep outcomes in our logistic regression analysis were short (≤6 h) and long sleep (≥10 h) duration, difficulties initiating asleep, early morning awakenings, fatigue, and poor sleep quality (SQ).Self-reported substance use was associated with a higher prevalence of sleep problems. After adjustments with age, gender, diagnostic group, and living status, hazardous alcohol use (eg, poor SQ odds ratio [OR] = 1.80, 95\ 1.49 to 2.16, P \lt; .001), current smoking (short sleep duration OR = 1.28, 95\ 1.08 to 1.52, P = .005), and lifetime benzodiazepine misuse (difficulties initiating sleep OR = 2.00, 95\ 1.55 to 2.48, P \lt; .001) were associated with sleep problems.Substance use was associated with sleep problems. Our findings underline the potential benefits of screening substance use when treating sleep problems in patients with psychotic disorders.Peer reviewe

Sleep in psychotic disorders: Results from nationwide SUPER Finland study

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Reaction Time and Visual Memory in Connection with Alcohol Use in Schizophrenia and Schizoaffective Disorder

The purpose of this study was to explore the association between cognition and hazardous drinking and alcohol use disorder in schizophrenia and schizoaffective disorder. Cognition is more or less compromised in schizophrenia, and schizoaffective disorder and alcohol use might aggravate this phenomenon. The study population included 3362 individuals from Finland with diagnoses of schizophrenia or schizoaffective disorder. Hazardous drinking was screened with the AUDIT-C (Alcohol Use Disorders Identification Test for Consumption) screening tool. Alcohol use disorder (AUD) diagnoses were obtained from national registrar data. Participants performed two computerized tasks from the Cambridge Automated Neuropsychological Test Battery (CANTAB) on a tablet computer: The Five-Choice Serial Reaction Time Task (5-CSRTT) or the reaction time (RT) test and the Paired Associative Learning (PAL) test. The association between alcohol use and the RT and PAL tests was analyzed with log-linear regression and logistic regression, respectively. After adjustment for age, education, housing status, and the age at which the respondents had their first psychotic episodes, hazardous drinking was associated with a lower median RT in females and less variable RT in males, while AUD was associated with a poorer PAL test performance in terms of the total errors adjusted scores (TEASs) in females. Our findings of positive associations between alcohol and cognition in schizophrenia and schizoaffective disorder are unique.Peer reviewe

Reaction Time and Visual Memory in Connection with Alcohol Use in Schizophrenia and Schizoaffective Disorder

The purpose of this study was to explore the association between cognition and hazardous drinking and alcohol use disorder in schizophrenia and schizoaffective disorder. Cognition is more or less compromised in schizophrenia, and schizoaffective disorder and alcohol use might aggravate this phenomenon. The study population included 3362 individuals from Finland with diagnoses of schizophrenia or schizoaffective disorder. Hazardous drinking was screened with the AUDIT-C (Alcohol Use Disorders Identification Test for Consumption) screening tool. Alcohol use disorder (AUD) diagnoses were obtained from national registrar data. Participants performed two computerized tasks from the Cambridge Automated Neuropsychological Test Battery (CANTAB) on a tablet computer: The Five-Choice Serial Reaction Time Task (5-CSRTT) or the reaction time (RT) test and the Paired Associative Learning (PAL) test. The association between alcohol use and the RT and PAL tests was analyzed with log-linear regression and logistic regression, respectively. After adjustment for age, education, housing status, and the age at which the respondents had their first psychotic episodes, hazardous drinking was associated with a lower median RT in females and less variable RT in males, while AUD was associated with a poorer PAL test performance in terms of the total errors adjusted scores (TEASs) in females. Our findings of positive associations between alcohol and cognition in schizophrenia and schizoaffective disorder are unique

Sömn hos patienter med psykotiska sjukdomar : resultat från landsomfattande SUPER Finland-studien

IMPORTANCE: We lack information regarding the prevalence of sleep problems among patients with psychotic disorders and, furthermore, their clinical significance and relation to subjective health. DESIGN, SETTING, AND PARTICIPANTS: The study is based on the SUPER study sample. 10 473 Finnish patients with a psychotic disorder were asked in a questionnaire about their sleep, and these results were compared to a nationally representative sample of the Finnish population from the Health 2000 survey (N=8018). MAIN OUTCOMES AND MEASURES: The main measures were total sleep duration (TSD), difficulties initiating sleep (DIS), early morning awakenings (EMA), and fatigue (FAT). Long sleep duration (Long SD) was defined as ≥10 hours, and short sleep duration (short SD) as ≤6 hours. RESULTS: Generally, the patients with psychotic disorders had more sleep problems (DIS in 30.2% of patients, 7.1% of controls). Long SD was the most deviating property of the sleep characteristics, especially among young patients with schizophrenia (p<.001, OR=27.9, CI=22.1-35.2, 47.4% in patients, 3.3% in controls). All sleep problems were associated with worse subjective health. We also conducted a latent class analysis, resulting in a relatively sleep problem-free cluster (58% of patients), an insomnia symptom cluster (26%), and a hypersomnia symptom (15%) cluster. CONCLUSIONS AND RELEVANCE: Patients with psychotic disorders have an increased prevalence of sleep problems compared to the general population but the prevalence varies in diagnostic, gender and age groups. The association between sleep problems and worse subjective health underscores the importance of an assessment of various sleep symptoms and their treatment in these patients.I denna studie undersöktes prevalensen för olika sömnproblem hos patienter med psykotiska sjukdomar och sömnproblemens förhållande till ett dåligt subjektivt hälsotillstånd. Studien är en del av SUPER-forskningsprojektet, som består 10 473 finländska patienter med psykotiska sjukdomar. Denna studie innefattar patienter med schizofreni, schizoaffektivt syndrom, bipolärt syndrom eller psykotisk depression. Patienterna svarade på frågor om deras sömn i ett frågeformulär, och dessa resultat jämfördes med ett finländskt nationellt representativt sampel från Hälsa 2000-studien (N=8018). De sömnvariabler som primärt undersöktes var total sömnduration, insomningssvårigheter, tidiga uppvakningar och trötthet. Kort sömnduration var definierat som ≤6 timmar och lång sömnduration som ≥10 timmar. Generellt hade patienterna klart mera sömnproblem än befolkningen i genomsnitt (t.ex. insomningssvårigheter hos 30,2% av patienterna och 7,2% i befolkningen). Den mest avvikande egenskapen i patienternas sömn var lång sömnduration, speciellt hos unga patienter med schizofreni (p<.001, OR=27,9, CI=22,1-35,2, 47,4% av patienterna och 3,3% i befolkningen). I en latent klassanalys indelades patienterna i en relativt symptomfri grupp (58%), en grupp med insomnisymptom (26%) och en grupp med hypersomnisymptom (15%). Alla sömnproblem hade en signifikant koppling till ett subjektivt dåligt hälsotillstånd. Studien visar att patienter med psykotiska sjukdomar har avsevärt mera sömnproblem än befolkningen i genomsnitt, att sömnproblemen har en koppling till dålig subjektiv hälsa, och att man kan dela upp patienterna på basis av deras sömnprofil. Fortsatta studier borde bland annat fokusera på att reda ut orsaker till sömnproblemen

Uniongelmat psykoosisairauksissa

Unen ja vuorokausirytmin ongelmat psykoosisairauksissa ovat yleisiä ja keskeinen osa potilaiden oirekuvaa. Uniongelmat ovat laadultaan monimuotoisia ja kattavat sekä unettomuuden että liikaunisuuden. Myös unen ja vuorokausirytmin ongelmien syyt ovat lukuisia ja ulottuvat genetiikasta ja komorbideista unihäiriöistä elintapoihin. Huono unenlaatu liittyy huonompaan elämänlaatuun ja psykoosisairauden ennusteeseen sekä suurentuneeseen itsemurhariskiin.Peer reviewe

Adolescent self-harm with and without suicidality : cross-sectional and longitudinal analyses of a Swedish regional register

Background: Self-harm is common and there is a need for studies that investigate the relevance of this behavior in clinical samples to inform risk assessment and treatment. The objectives in the current studies were to compare clinical and psychosocial correlates and subsequent adverse outcomes in youth who present to child and adolescent mental health services (CAMHS) with self-harm only (SH), self-harm with suicidality (SH+SU), with those without any indication of SH or SH+SU. Methods: We conducted a case-control study and a longitudinal cohort study using data from a regional clinical care register, and Swedish national registers. The case-control study included all patients (5-17 years) between 2011 and 2015 (N = 25,161). SH and SH+SU cases were compared with controls (patients without SH) regarding a range of correlates. The longitudinal study included former CAMHS patients (N = 6,120) who were followed for a median time of 2.8 years after termination of CAMHS contact regarding outcomes such as clinical care consumption, social welfare recipiency, and crime conviction. Results: In the case-control study, both the SH and SH+SU groups received more clinical care, had lower global functioning, and higher odds of having mental disorders compared to controls. In most comparisons, the SH+SU group had more problems than the SH group. In the longitudinal study, the same pattern emerged for most outcomes; for example, the adjusted hazard ratio for recurrent care due to self-harm was 23.1 (95% confidence interval [CI], 17.0-31.4) in the SH+SU group compared to 3.9 (95% CI, 2.3-6.7) in the SH group. Conclusions: Adolescent patients presenting with self-harm have higher risks for adverse outcomes than patients without self-harm. Suicidality in addition to self-harm is associated with more severe outcomes, importantly recurrent episodes of care for self-harm

Reaction Time and Visual Memory in Connection to Alcohol Use in Persons with Bipolar Disorder

The purpose of this study was to explore the association of cognition with hazardous drinking and alcohol-related disorder in persons with bipolar disorder (BD). The study population included 1268 persons from Finland with bipolar disorder. Alcohol use was assessed through hazardous drinking and alcohol-related disorder including alcohol use disorder (AUD). Hazardous drinking was screened with the Alcohol Use Disorders Identification Test for Consumption (AUDIT-C) screening tool. Alcohol-related disorder diagnoses were obtained from the national registrar data. Participants performed two computerized tasks from the Cambridge Automated Neuropsychological Test Battery (CANTAB) on A tablet computer: the 5-choice serial reaction time task, or reaction time (RT) test and the Paired Associative Learning (PAL) test. Depressive symptoms were assessed with the Mental Health Inventory with five items (MHI-5). However, no assessment of current manic symptoms was available. Association between RT-test and alcohol use was analyzed with log-linear regression, and e beta with 95% confidence intervals (CI) are reported. PAL first trial memory score was analyzed with linear regression, and beta with 95% CI are reported. PAL total errors adjusted was analyzed with logistic regression and odds ratios (OR) with 95% CI are reported. After adjustment of age, education, housing status and depression, hazardous drinking was associated with lower median and less variable RT in females while AUD was associated with a poorer PAL test performance in terms of the total errors adjusted scores in females. Our findings of positive associations between alcohol use and cognition in persons with bipolar disorder are difficult to explain because of the methodological flaw of not being able to separately assess only participants in euthymic phase.Peer reviewe