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العنوان
Sleep profile in patients with schizophrenia :
المؤلف
Ghanem, Marwa Mohamed.
هيئة الاعداد
باحث / مروه محمد غانم
مشرف / طارق أسعد عبده
مشرف / ياسر عبدالرازق محمد
مشرف / مروة عبدالرحمن سلطان
مشرف / داليا عبدالمنعم محمود
تاريخ النشر
2018.
عدد الصفحات
152 p. :
اللغة
الإنجليزية
الدرجة
الدكتوراه
التخصص
الطب النفسي والصحة العقلية
تاريخ الإجازة
1/1/2018
مكان الإجازة
جامعة عين شمس - كلية الطب - طب المخ والأعصاب والطب النفسى
الفهرس
Only 14 pages are availabe for public view

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from 152

Abstract

In many ways, the normal dream experience is similar to psychosis. Hallucinations, perceptual distortions, bizarre thinking, and temporary delusions can intermingle with more normal thought and perceptual processes. Consequently, the discovery of rapid eye movement (REM) sleep and its associ-ated dream reports not only ushered in the modern era of sleep research but also stimulated many of the studies of the sleep of schizophrenics. Studies explored the hypothesis that the pathogenesis of schizophrenia might rest with REM sleep abnormalities or, more directly, with the intrusion of the dream state into waking. In subsequent years, a large body of research revealed other abnormalities more frequently present in the sleep patterns in schizophrenia.
Bad sleep quality is a common feature of psychiatric illnesses. A change in sleep pattern can be the first sign of psychosis, i.e.: sleep disorders can be a warning sign of psychiatric illness.
Subjective reports of sleep disorders often precede psychotic relapse, as reported by the patients or relatives. And the same applies to acutely ill and chronic patients.
Although the clinical efficacy of FGAs and SGAs has been amply documented, objective evidence that these agents coun¬teract the insomnia and other sleep abnormalities associated with schizophrenia is particularly sketchy.
Commonly the mental health practitioner must balance clinical efficacy of an AP agent against a range of potential adverse effects and thus will prescribe a main¬tenance dose that is the lowest clinically effective dose. As a result, some degree of untreated hyperarousal and associated insomnia may be present in schizophrenics on maintenance doses of APs.
In addition to current neuroleptic treatment, patients with schizophrenia are occasionally given melatonin to improve their sleep further. Modafinil might also improve daytime sleepiness in an off-label condition such as AP-associated somnolence.
Both mental health and sleep medicine specialists should be cognizant of the fact that most patients with schizophrenia can benefit from sleep hygiene counseling.
In order to maintain healthy sleep habits, the factors that interfere with sleep must be controlled. Sleep interference can result from both behavioral and environmental factors.
The main aim of the current study was to highlight the pattern of sleep among schizophrenic patients & to study the correlation between sleep patterns and symptom profile in schizophrenia.
The objective was accomplished through hospital based case control study. The study was conducted on 30 patients presented to Institute of psychiatry, Faculty of Medicine, Ain Shams University hospitals, from both the inpatient units and the outpatient clinics, diagnosed with schizophrenia (according to the DSM-IV-R). Psychometric sleep Assessment Instruments in sleep evaluation: Arabic version, Polysomnography test and PANSS scale for positive and negative symptoms were performed for them.
The matched control group was chosen to have no previously diagnosed medical, neurological or psychiatric disorder. Psychometric sleep Assessment Instruments in sleep evaluation: Arabic version was done. A Polysomnography test was also done for them.
Regarding Demographic data the age of the patients in the study population ranged from 24 to 41 years with a mean age of 32.6 years, of which 16 were males and 14 were females, 18 of them were single, 9 were married and 3 were divorced. As for the control group, age ranged from 24 to 41 years with a mean age of 32.5 years, of which 18 were males and 11 were females, 14 of them were single, 15 were married and none of them was divorced.
Regarding Sleep Efficiency the study results showed a lower mean of sleep efficiency among patients 76.8% compared to 89.7% among controls and the difference is highly significant statistically.
Regarding Sleep latency the study results also showed a higher mean of sleep latency among patients 30.9 compared to 15.8 among controls and the difference is highly significant statistically.
Regarding NREM stages the study showed a higher mean stage N1 % among patients compared to controls and the difference is highly significant statistically. There was no significant statistical difference between patients and controls as regards the mean stage N2%. There was a lower mean stage N3% among patients compared to controls and the difference is highly significant statistically.
Regarding REM sleep there was no significant statistical difference between patients and controls as regards REM percentage. Although this study shows that there is a lower mean REM latency among patients compared to control and the difference is highly significant statistically. The study showed that there is no significant statistical difference between cases and controls as regards the mean REMD.
Regarding Arousal index the study showed a higher mean arousal index among patients compared to controls and the difference is highly significant statistically.
Regarding Respiratory index the study showed a higher mean RDI among patients compared to controls and the difference is statistically significant. Yet, the study showed no statistically significant difference between cases and controls as regards desaturation index.
Regarding Periodic leg movement index the results of the current study showed a higher mean PLMI among patients compared to controls and the difference is highly significant statistically.
Regarding Sleep questionnaire the current study showed a higher percentage of initial insomnia among schizophrenic patients 60% compared to 10.3% among controls and the difference is highly significant statistically. It also showed a higher percentage of middle insomnia among patients 26.7% compared to 0% among control and the difference is highly significant statistically. Higher percentage of late insomnia among patients 16.7% compared to 0% among controls and the difference is statistically significant was also shown.
The study showed a higher percentage of hypersomnia among patients 36.7% compared to 0% among control and the difference is highly significant statistically.
Regarding nightmares the current study showed a higher percentage of nightmares among controls compared to patients but the difference is not statistically significant.
Regarding Correlation with PANSS the current study showed a highly significant negative correlation between PANSS positive scale score and the sleep efficiency percentage. It also showed a significant correlation between sleep latency and PANSS positive scale, and a significant correlation between stage N1 of sleep and PANSS positive scale in schizophrenic patients. It shows a highly significant negative correlation between PANSS positive scale and REM and REMD. In addition, a highly significant Positive correlation between PANSS positive scale and the arousal index among schizophrenic patients was shown.
The findings of the present study showed no significant correlation between negative scale of PANSS and the studied parameters of polysomnogram.
The current study showed a significant negative correlation between general scale and sleep efficiency. It also showed a significant positive correlation between general scale and sleep latency, Stage N1%. It also showed a significant negative correlation between general scale and REMD. In addition it showed a significant positive correlation between general scale and arousal index.
In conclusion, an acknowledgement of the potential role of sleep in the occurrence of psychotic experiences is beginning to be shown. It is now clear from the research that these two phenomena are connected. The direction of effect is yet to be shown and the mechanisms by which sleep and psychotic experiences are linked remain to be established, although there are many plausible different routes for further investigation.
Study findings suggest future directions for causal connections between sleep and psychosis. We would argue that the high prevalence of sleep problems in patients with psychosis should still become a target in clinical services, since it is an important problem in its own right, for which effective treatments exist