Schizophrenia and sleep disorders: links, risks, and management challenges

Rachel E Kaskie,1 Bianca Graziano,2 Fabio Ferrarelli1 1Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; 2Department of Health Sciences, Università degli Studi di Milano, Milan, Italy Abstract: Schizophrenia is a major psychiatric disorder that has a massive, long-lasting negative impact on the patients as well as society. While positive symptoms (i.e., delusions and hallucinations), negative symptoms (i.e., anhedonia, social withdrawal), and cognitive impairments are traditionally considered the most prominent features of this disorder, the role of sleep and sleep disturbances has gained increasing prominence in clinical practice. Indeed, the vast majority of patients with schizophrenia report sleep abnormalities, which tend to precede illness onset and can predict an acute exacerbation of psychotic symptoms. Furthermore, schizophrenia patients often have a comorbid sleep disorder, including insomnia, obstructive sleep apnea, restless leg syndrome, or periodic limb movement disorder. Despite accumulating data, the links between sleep disorders and schizophrenia have not been thoroughly examined, in part because they are difficult to disentangle, as numerous factors contribute to their comorbidity, including medication status. Additionally, sleep disorders are often not the primary focus of clinicians treating this population, despite studies suggesting that comorbid sleep disorders carry their own unique risks, including worsening of psychotic symptoms and poorer quality of life. There is also limited information about effective management strategies for schizophrenia patients affected by significant sleep disturbances and/or sleep disorders. To begin addressing these issues, the present review will systematically examine the literature on sleep disorders and schizophrenia, focusing on studies related to 1) links between distinct sleep disorders and schizophrenia; 2) risks unique to patients with a comorbid sleep disorder; and 3) and management challenges and strategies. Keywords: psychosis, sleep disturbances, insomnia, obstructive sleep apnea&nbsp

Cortical Excitability, Plasticity and Oscillations in Major Psychiatric Disorders: A Neuronavigated TMS-EEG Based Approach

Developing biomarkers for psychiatric disorders represents a major challenge. Indeed, the identification of dependable brain-based measures, such as those derived from electrophysiological techniques, would represent a key step toward better profiling of patients with major psychiatric disorders. A principled neurophysiological approach would also deepen our understanding of the physiopathology and inform therapeutic decisions. The present chapter focuses on a neurophysiological technique, based on the combination of neuronavigated Transcranial Magnetic Stimulation and Electroencephalography (TMS-EEG), which allows probing directly and non-invasively cortical excitability, plasticity as well as the fundamental oscillatory properties of thalamocortical circuits. Since these parameters are often altered in psychiatric disorders, neuronavigated TMS-EEG may be in a suitable position to provide neurophysiological objective measures to support the diagnosis of psychiatric disorders, to highlight their physiopathological underpinnings, and to objectively assess the efficacy of treatment options