Prevalence of Circadian Rhythm Sleep-Wake Disorder in Outpatients with Schizophrenia and Its Association with Psychopathological Characteristics and Psychosocial Functioning.

Kentaro Matsui,Rie Akaho,Katsuji Nishimura,Ken Inada,Takuya Yoshiike,Hidehiro Oshibuchi,Kenichi Kuriyama,Kentaro Nagao

doi:10.3390/jcm10071513

Abstract

The prevalence of circadian rhythm sleep-wake disorder (CRSWD) among patients with schizophrenia is not clear. The effect of comorbid CRSWD on such patients has also not been fully evaluated yet. Outpatients with schizophrenia in the maintenance phase who visited Tokyo Women’s Medical University Hospital between April 2018 and March 2019 participated in this study. The Brief Psychiatric Rating Scale (BPRS), the Clinical Global Impressions–Severity Illness Scale (CGI-S), Global Assessment of Functioning (GAF), World Health Organization Disability Assessment Schedule II, Insomnia Severity Index (ISI), and Morningness–Eveningness Questionnaire (MEQ) were administered, and the patient responses with and without CRSWD were compared. Of the 105 patients with schizophrenia, 19 (18.1%) had CRSWD. There were trends toward higher BPRS and lower GAF scores in the CRSWD group than in the non-CRSWD group, although these did not reach statistical significance following a false discovery rate correction. Among the BPRS subitems, the anxiety scores were significantly higher in the CRSWD group than in the non-CRSWD group (p < 0.01). CRSWD was highly prevalent among patients with schizophrenia in the maintenance phase. Comorbidities of CRSWD may affect psychopathological characteristics and psychosocial functioning.

Highlights

Schizophrenia is a chronic mental disorder with a lifetime prevalence of 0.72% [1]
Antipsychotics that are usually used in the treatment of schizophrenia can attenuate the diurnal variation in sleep-wake behavior through a sedative effect that can persist during the day [9]
Few studies on sleep and circadian rhythms in patients with schizophrenia have focused on circadian rhythm sleep-wake disorder (CRSWD) in the International Classification of Sleep Disorders—Third Edition (ICSD-3) [14,15,16,17]

Summary

Introduction

Schizophrenia is a chronic mental disorder with a lifetime prevalence of 0.72% [1]. Positive symptoms, such as auditory hallucinations and paranoia, and negative symptoms, such as lack of motivation and interest, flat affect, and social withdrawal, as well as cognitive impairment, are major burdens on patients’ lives [2]. Negative symptoms can persist after the improvement of acute-phase symptoms, resulting in social dysfunction [7,8], which may further affect circadian rhythms as a result of reduced daytime activity. The impact of the psychopathological characteristics and sedative properties of antipsychotics are not clear, the disruption of sleep-wake rhythms has been reported in some patients with schizophrenia [10,11,12,13]. Few studies on sleep and circadian rhythms in patients with schizophrenia have focused on circadian rhythm sleep-wake disorder (CRSWD) in the International Classification of Sleep Disorders—Third Edition (ICSD-3) [14,15,16,17]

Methods

Results

Discussion

Conclusion