Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa, Azienda Ospedaliera Universitaria Pisana (AOUP), Pisa, Italy.
Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa, Azienda Ospedaliera Universitaria Pisana (AOUP), Pisa, Italy.
Compr Psychiatry. 2019 Feb;89:46-51. doi: 10.1016/j.comppsych.2018.12.009. Epub 2018 Dec 19.
Insomnia symptoms are very common in Bipolar Disorder. Our aim was to assess the potential association between insomnia, emotion dysregulation and suicidality in subjects with Bipolar Disorder.
Seventy-seven subjects with Bipolar Disorder type II with a depressive episode with mixed features were recruited. Patients were assessed with SCID-DSM-5, the Insomnia Severity Index (ISI), the Difficulties in Emotion Regulation Scale (DERS), the Scale for Suicide Ideation (SSI) while evaluating manic and depressive symptoms.
Subjects with insomnia symptoms compared to those without showed higher scores in the DERS scale and subscales, including impulsivity, and in the SSI scale. Insomnia symptoms significantly predicted the severity of depressive symptoms, emotion dysregulation, and suicidality in subjects with bipolar disorder. In particular, insomnia was related to difficulties in some areas of emotion regulation including impulsivity. Emotion dysregulation significantly mediated the association between insomnia and depressive symptoms (Z = 2.9, p = 0.004). Furthermore, emotional impulsivity mediated the association between insomnia symptoms and suicidality (Z = 2.2, p = 0.03).
In our study, subjects with bipolar disorder suffering from insomnia experienced a greater severity of depressive symptoms and suicidality compared to subjects without insomnia. Insomnia was associated with emotion dysregulation, impulsivity and suicidality. Further research is necessary to investigate if these latter features may benefit from early insomnia treatment in subjects with bipolar disorder.
双相情感障碍患者常伴有失眠症状。本研究旨在评估双相情感障碍患者的失眠、情绪调节障碍与自杀意念之间的潜在关联。
本研究共纳入 77 例双相情感障碍 II 型伴混合特征抑郁发作的患者。采用 SCID-DSM-5、失眠严重程度指数（ISI）、情绪调节困难量表（DERS）、自杀意念量表（SSI）对患者进行评估，同时评估躁狂和抑郁症状。
与无失眠症状的患者相比，有失眠症状的患者在 DERS 量表及冲动性等各分量表、SSI 量表上的评分更高。失眠症状可显著预测双相情感障碍患者抑郁症状、情绪调节障碍和自杀意念的严重程度。具体而言，失眠与情绪调节困难的某些方面（包括冲动性）有关。情绪调节障碍显著中介了失眠与抑郁症状之间的关联（Z=2.9，p=0.004）。此外，情绪冲动性中介了失眠症状与自杀意念之间的关联（Z=2.2，p=0.03）。
在本研究中，与无失眠的患者相比，患有失眠的双相情感障碍患者经历了更严重的抑郁症状和自杀意念。失眠与情绪调节障碍、冲动性和自杀意念有关。需要进一步研究以探讨这些特征是否可以从双相情感障碍患者的早期失眠治疗中获益。
