Risperidone Provides Better Improvement of Sleep Disturbances Than Haloperidol Therapy in Schizophrenia Patients With Cannabis-Positive Urinalysis.

Peta-Gaye L Thomas-Brown,Jacqueline S Martin,Wendel D Abel,Clayton A Sewell,Maxine D Gossell-Williams

doi:10.3389/fphar.2018.00769

Peta-Gaye L Thomas-Brown, Jacqueline S Martin + Show 3 more

Open Access

https://doi.org/10.3389/fphar.2018.00769

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Abstract

A high percentage of persons with Schizophrenia also uses Cannabis and this may potentially alter the therapeutic benefits of the antipsychotic medications prescribed. The aim of this study was to assess the impact of Cannabis usage on antipsychotic therapy of sleep disturbances in schizophrenia subjects. Male subjects, ≥18 years, admitted to the University Hospital of the West Indies psychiatric ward between October 2015 and October 2016, and diagnosed with schizophrenia were recruited for the study. Following written informed consent to the study, subjects were prescribed either risperidone monotherapy or haloperidol monotherapy orally for 14 days and classified as Cannabis users (CU) or non-users (non-CU), with presence/absence of Cannabis metabolite in urine samples. After 1 week of admission, subjects wore the Actiwatch-2 device, to record sleep data for 7 consecutive nights. Inferential statistical analysis involved non-parametric tests, expressed as median and inter-quartile ranges (IQR), with p<0.05 considered statistically significant. Fifty subjects were assessed, with a median (IQR) age of 28 (14) years. Majority (30; 60%) were CU, displaying longer sleep latency (SL) than non-CU when receiving haloperidol; but equivalent SL when receiving risperidone. In comparison to non-CU, the CU also displayed longer time in bed, but shorter durations asleep, awoke more frequently during the nights and for longer durations, whether receiving haloperidol or risperidone. This resulted in lower sleep efficiency for the CU (<85%) compared to the non-CU (≥85%). Over the study period, sleep efficiency was significantly improved for non-CU receiving either risperidone (p = 0.032) or haloperidol (p = 0.010); but was only significantly improved with risperidone for the CU (p = 0.045). It is apparent that the presence of Cannabis may be impacting the therapeutic benefits of antipsychotic drugs on sleep. In schizophrenia subjects with concomitant Cannabis use, risperidone is more beneficial than haloperidol in improving sleep efficiency.

Highlights

The prognosis of schizophrenia is often worsened with Cannabis use (Foti et al, 2010; Manrique-Garcia et al, 2014), mainly through potentiation of the well-established dopamine dysregulations in schizophrenia (Bossong et al, 2009, 2015)
The sample population consisted of 30 subjects (60%) presenting with first-time psychotic episodes
Based on self-declaration, initiation of Cannabis use was from a median (IQR) age of 14 (2) years

Summary

Introduction

The prognosis of schizophrenia is often worsened with Cannabis use (Foti et al, 2010; Manrique-Garcia et al, 2014), mainly through potentiation of the well-established dopamine dysregulations in schizophrenia (Bossong et al, 2009, 2015). Typical antipsychotic drugs, such as haloperidol (Clarenbach et al, 1978; Taylor et al, 1991; Maixner et al, 1998; Dursun et al, 1999), demonstrate sleep-promoting effects and improve sleep maintenance/continuity, mainly through the reduction of sleep latency (SL) and frequency of awakening, prolongation of sleep time and an increase in sleep efficiency in healthy subjects and schizophrenia patients (Taylor et al, 1991; Benson, 2006; Cohrs, 2008; Anderson and Bradley, 2013). Schizophrenia patients treated with risperidone display better sleep quantity, sleep quality, and general functioning compared to patients treated with typical antipsychotic drugs (Dursun et al, 1999; Yamashita et al, 2002; Giménez et al, 2007; Apiquian et al, 2008; Wichniak et al, 2011)

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