Reeve Sarah, Sheaves Bryony, Freeman Daniel
Department of Clinical, Educational, and Health Psychology, University College London, London, United Kingdom.
Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom.
PLoS One. 2021 Jan 15;16(1):e0245301. doi: 10.1371/journal.pone.0245301. eCollection 2021.
Clinical experience indicates that excessive sleepiness and hypersomnia may be a common issue for patients with psychosis. Excessive sleepiness is typically ascribed to the sedating effects of antipsychotic medications but there may be other potential contributors such as sleep disorders and depression. Furthermore, the impact of excessive sleepiness itself on patients' symptoms and general wellbeing is yet to be examined. The current study reports an exploratory cross-sectional between-groups comparison of patients with early psychosis fulfilling criteria assessed in a diagnostic interview for problematic excessive sleepiness (n = 14), compared with those not reporting excessive sleepiness (n = 46). There were no differences between the groups in diagnosis, medication type, or antipsychotic medication dosage. There were no significant group differences in sleep duration. Significantly lower activity levels were found in the excessive sleepiness group. Insomnia and nightmares were common in those reporting excessive sleepiness. No significant differences were found in psychiatric symptoms, although data did indicate more severe cognitive disorganisation and grandiosity, but less severe paranoia and hallucinations, in the excessive sleepiness group. Wide confidence intervals and small sample size mean that care should be taken interpreting these results. Overall, this study indicates that excessive sleepiness may not be solely related to medication but also to low levels of activity and other sleep disorders. This is a novel finding that, if replicated, could indicate routes of intervention for this clinical issue. Future research should aim to disentangle directions of effect amongst sleepiness, mood, activity, and psychotic symptoms and investigate possible interventions for excessive sleepiness in psychosis.
临床经验表明，过度嗜睡和失眠可能是精神病患者的常见问题。过度嗜睡通常归因于抗精神病药物的镇静作用，但可能还有其他潜在因素，如睡眠障碍和抑郁症。此外，过度嗜睡本身对患者症状和总体健康的影响尚待研究。本研究报告了一项探索性横断面组间比较，对符合问题性过度嗜睡诊断访谈标准的早期精神病患者（n = 14）与未报告过度嗜睡的患者（n = 46）进行比较。两组在诊断、药物类型或抗精神病药物剂量方面没有差异。睡眠时间在两组之间没有显著差异。过度嗜睡组的活动水平显著较低。失眠和噩梦在报告过度嗜睡的患者中很常见。在精神症状方面没有发现显著差异，尽管数据确实表明过度嗜睡组的认知紊乱和夸大症状更严重，但偏执和幻觉症状较轻。较宽的置信区间和较小的样本量意味着在解释这些结果时应谨慎。总体而言，本研究表明过度嗜睡可能不仅与药物有关，还与低活动水平和其他睡眠障碍有关。这是一个新发现，如果得到重复验证，可能为这一临床问题指明干预途径。未来的研究应旨在理清嗜睡、情绪、活动和精神病症状之间的影响方向，并研究针对精神病患者过度嗜睡的可能干预措施。
