Pedro Afonso

Schizophrenia patients with predominantly positive symptoms have more disturbed sleep-wake cycles measured by actigraphy

Sleep disturbances are widespread in schizophrenia, and one important concern is to determine the impact of this disruption on self-reported sleep quality and quality of life (QoL). Our aim was to evaluate the sleep-wake cycle in a sample of patients with schizophrenia (SZ), and whether sleep patterns differ between patients with predominantly negative versus predominantly positive symptoms, as well as its impact on sleep quality and QoL. Twenty-three SZ outpatients were studied with 24 h continuous wrist-actigraphy during 7 days. The quality of sleep was assessed with the Pittsburgh Sleep Quality Index (PSQI), and the self-reported QoL was evaluated with the World Health Organization Quality of Life - Abbreviated version (WHOQOL-Bref). About half of the studied population presented an irregular sleep-wake cycle. We found a trend for more disrupted sleep-wake patterns in patients with predominantly positive symptoms, who also had a trend self-reported worse quality of sleep and worse QoL in all domains. Overall, patients with worse self-reported QoL demonstrated worse sleep quality. Our findings suggest that SZ patients are frequently affected with sleep and circadian rhythm disruptions; these may have a negative impact on rehabilitation strategies. Moreover, poor sleep may play a role in sustaining poor quality of life in SZ patients.

Sleep-wake patterns in schizophrenia patients compared to healthy controls.

Abstract Objectives. The aim of this study was to examine the differences between a sample of patients with schizophrenia and a sample of healthy controls in terms of sleep patterns and self-reported sleep quality and quality of life (QoL). Methods. Thirty-four schizophrenia outpatients (SP), 12 women and 22 men and 34 healthy subjects (HS), 15 women and 19 men, participated in this study. Wrist-actigraphy recordings and a sleep diary were used for sleep–wake cycle assessment. The quality of sleep was measured using the Pittsburgh Sleep Quality Index (PSQI), the QoL was evaluated using the World Health Organization Quality of Life – Abbreviated version (WHOQOL-Bref). The Positive and Negative Syndrome Scale (PANSS) was used for psychopathology assessment. Results. Patients sleep more at night, but have poorer sleep efficiency, than HS. Sleep latency and nighttime awakenings were significantly higher in SP. Self-reported QoL scores were significantly higher, in all four domains, in HS. Scores on PSQI were significantly higher in SP, indicating a worse quality of sleep. Two disturbed patterns of sleep–wake phase were found in SP: advance sleep-phase syndrome (ASPS) (N = 3) and irregular sleep–wake rhythm (N = 3). Conclusion. Schizophrenia patients have more disturbed sleep–wake patterns and poor sleep quality and quality of life compared with healthy controls.

Sleep-promoting action of the endogenous melatonin in schizophrenia compared to healthy controls

Abstract Objective. The aim of this study was to compare the endogenous melatonin sleep-promoting effect in schizophrenic patients to a sample of healthy controls. Methods. Thirty-four schizophrenia outpatients (SP) and 34 healthy subjects (HS) participated in this study. Wrist-actigraphy recordings and a sleep diary were used for sleep–wake cycle assessment. The quality and patterns of sleep were measured with the Pittsburgh Sleep Quality Index (PSQI) and the Positive and Negative Syndrome Scale (PANSS) was used for psychopathology assessment. To quantify and assess nocturnal melatonin profiles, saliva samples were collected for one night under dim light conditions (<50 lux) hourly from 20:00 h to 23:00 h. Results. Scores on PSQI were significantly higher in SP as compared to HS, indicating a worse quality of sleep. Patients sleep more at night, but have poorer sleep efficiency, than HS. Sleep latency and nighttime awakenings were significant higher in SP. Melatonin levels were negatively correlated with sleep latency, total sleep time and positively correlated with sleep efficiency in HS but not in SP. Conclusion. The results of the present study indicate that endogenous melatonin sleep-promoting action seems to be compromised in schizophrenia.

Treatment adherence and quality of sleep in schizophrenia outpatients

Abstract Objective. Patients with schizophrenia (SZ) often present sleep complaints, and patients with sleep disturbances are at a greater risk for symptom worsening after antipsychotic discontinuation. Long-term adherence to antipsychotic treatment remains a challenge for clinicians, and the relationship between quality of sleep and treatment adherence in SZ outpatients has been poorly studied. Methods. In this cross-sectional, non-interventional study, 811 adult outpatients with a diagnosis of SZ were divided into two groups according to the presence (or absence) of sleep disturbances, and assessed using measures of symptom severity, quality and patterns of sleep, adherence/compliance to treatment, and family support degree. Results. Patients with sleep disturbances were significantly more symptomatic (p < 0.0001), and scored significantly higher on the Pittsburgh Sleep Quality Index (PSQI) as compared with patients without sleep disturbances (p < 0.0001). More compliant patients showed less sleep disturbances (p < 0.0001); moreover, patients with worse compliance to pharmacological treatment showed significantly higher scores on the PSQI (p < 0.0001). Regarding family support degree, patients with sleep disorders presented a lower family support (p = 0.0236), and patients with worse treatment adherence had worse family support (p < 0.0001). Conclusions. Our findings show that SZ outpatients reporting sleep disturbances show greater symptom severity, and worse adherence/compliance to treatment, as well as a lower family support.

Assessing the relation between career satisfaction in psychiatry with lifelong learning and scientific activity

Lifelong learning (LLL) is an essential feature for the doctor to keep clinically updated and has been described as an indicator of competence and professionalism. The aim of this study was to evaluate the association between career satisfaction in psychiatry, lifelong learning, and commitment in scientific activities, taking into account other personal and professional effects. The survey was sent to 453 national psychiatrists and 190 surveys (41.9%) were completed online and validated. The Jefferson Scale of Physician Lifelong Learning (JSPLL) was used to assess the level of LLL for each doctor. The results of the analysis of JSPLL showed that participants more satisfied with their career have greater motivation and invest more in the LLL. Furthermore, participants who were more satisfied with their career had a higher percentage of scientific activity in the last year. Multiple linear regression with these two effects in the model revealed a positive association between career satisfaction in psychiatry, LLL and the publication of scientific papers, leading to the main conclusion that satisfaction with a career in psychiatry has a significant correlation with LLL and with involvement in scientific activities.

Sleep disturbances in anorexia nervosa

ABSTRACT In clinical practice, insomnia is a common feature in anorexia nervosa (AN). Sleep self-reports in AN suggest that these patients report poor sleep quality and reduced total sleep time. Weight loss, starvation and malnutrition can all affect sleep. Patients with eating disorders who have sleep disturbances have more severe symptomatology. The authors intend to review sleep disturbances observed in AN, describe possible pathophysiological mechanisms and evaluate the clinical impact of sleep disturbances on the treatment and prognosis of the disease. In this study, a non-systematic search of published literature from January 1970 and August 2015 was carried out, through PubMed, using the following key words: ‘sleep’, ‘anorexia nervosa’ and ‘insomnia’. These patients subjectively report having poor sleep quality, with difficulty falling asleep, interrupted sleep, early morning waking or reduced total sleep time. Sleep disturbances found in AN using polysomnography are: reduction in total sleep time, decrease in slow wave sleep, slow wave activity and reduced sleep efficiency. Privation of adequate and restful sleep has a negative impact on the quality of life of patients, may contribute to the appearance of comorbidities, such as depression and anxiety, and to a poor prognosis for AN.

The Sleep Changes in Bipolar Disorder

Introduction The bipolar disorder, characterized by mania episodes, hypomania and depression is a serious recurring perturbation associated not only to severe sleep pattern disturbances but also to a significant circadian disruption. These fluctuations/changes have a great impact on quality of life and in the disease prognosis. Objectives Review the main sleep pattern alterations/fluctuations observed in the bipolar disorder, their clinical impact and the involved pathophysiological mechanisms. Results Complaints about sleep pattern changes may occur during any phase of the disease. These include frequent night-time awakenings, poor sleep quality, reduction of the total sleeping time (TST) and decreased latency and increased density of REM sleep. In the depressive phase, patients also reveal insomnia/hypersomnia, difficulty waking up and excessive daytime sleepiness. Discussion/Conclusion Sleep pattern fluctuations are frequent in bipolar disorders and have a great clinic implication as a symptom. The corrections of sleep disturbances observed in bipolar disorder should be considered a therapeutic priority, since they prevent symptoms recurrence and smooth the socio-professional integration, thus providing greater success in patient’s rehabilitation and quality of life.