Sleep problems and worrying precede psychotic symptoms during an online intervention for psychosis

Sleep and paranoia: A systematic review and meta-analysis

BACKGROUND

Sleep dysfunction commonly co-occurs with paranoia and is hypothesised to be a contributory causal mechanism in its development and maintenance.

OBJECTIVES

To systematically review and quantitatively evaluate the evidence for the relationship between sleep dysfunction and paranoia across the spectrum of severity.

METHOD

A systematic search was conducted to identify studies investigating the relationship between aspects of sleep and paranoia across clinical and non-clinical groups. A random effects model using a Fisher r-to-z transformed correlation coefficient was used for meta-analysis.

RESULTS

45 studies were included in the review and 14 in the meta-analysis. The literature supports a small-to-moderate association (r = 0.30, 95 % CI: 0.16-0.40 for the seven studies using the most robust measures) with significant heterogeneity among studies but no evidence of publication bias. There is evidence that the relationship is to some extent causal, with sleep disruption leading to increased paranoia, though there is also some evidence of a bi-directional relationship. Negative affect is frequently seen as a mediator of this relationship.

CONCLUSION

This review for the first time examines the significant relationship between sleep and paranoia individually. Studies are needed that further assess the potential for early intervention of sleep dysfunction in those experiencing paranoia.

Cognitive Flexibility as a Mediator in the Relationship Between Generalized Anxiety and Paranoid Ideation: The Role of Perceived Control

The clinical literature encourages further exploration of the relationship between anxiety and paranoid ideation with the overall objective of identifying processes that mitigate such relationship, thus establishing targets for cognitive intervention. Empirical studies demonstrate that increased levels of anxiety precede the emergence of paranoid cognitions. Yet, possible mediators are still to be investigated. In all, 273 adults completed a battery of standardized questionnaires, and collated data were analyzed statistically. Generalized anxiety was positively associated with paranoid ideation, for both ideas of reference and persecutory beliefs. Although the relationship was not mediated by cognitive flexibility in its entirety, perceived control over internal experiences and external events, an essential constituent of cognitive flexibility, acted as a significant mediator. The results highlight the importance of increasing adaptive perceptions of control among individuals experiencing generalized anxiety, which would likely reduce the co-occurrence of paranoid ideation and lower the risk of transitioning into clinical levels of paranoia.

Perspective of patients with first-episode psychosis, their relatives, and mental health professionals on the design and usability of an app in clinical practice

AIM

Therapeutic non-compliance remains the main difficulty for people with psychotic disorders, standing around 50% in people with schizophrenia. Lack of treatment adherence, either partial or total, to medication has economic and clinical consequences. E-health technologies may be a promising therapeutic tool to improve adherence, with the subsequent reduction in clinical and economic burden. Our aims were to know the preferences on how technologies in mental health treatment should be for use in clinical practice, and to learn about the opinion and preferences on the use of technologies in mental health treatment from the perspectives of patients with FEP, their relatives, and mental health professionals.

METHODS

Forty-one patients with a diagnosis of first-episode psychosis (FEP), 18 relatives and 49 mental health professionals were included in the study. They completed an online survey related to the use, availability and user-skill of online platforms and apps created by a group of experts in psychosis and in the use of technologies. Data were summarized in frequencies, percentages, and means, and Chi-square tests were used to calculate differences between-groups.

RESULTS

An app directed to people with psychosis would be well received by users if it contains psychoeducational material, offers reminders for scheduled visits and treatment and allows online consultations.

CONCLUSIONS

Co-creating an app with users, their families and mental health professionals allows incorporating their preferences to increase its use, improve outpatient care and creating an app that is viable in clinical practice.

Systematic review of early warning signs of relapse and behavioural antecedents of symptom worsening in people living with schizophrenia spectrum disorders

BACKGROUND

Identification of the early warning signs (EWS) of relapse is key to relapse prevention in schizophrenia spectrum disorders, however, limitations to their precision have been reported. Substantial methodological innovations have recently been applied to the prediction of psychotic relapse and to individual psychotic symptoms. However, there has been no systematic review that has integrated findings across these two related outcomes and no systematic review of EWS of relapse for a decade.

METHOD

We conducted a systematic review of EWS of psychotic relapse and the behavioural antecedents of worsening psychotic symptoms. Traditional EWS and ecological momentary assessment/intervention studies were included. We completed meta-analyses of the pooled sensitivity and specificity of EWS in predicting relapse, and for the prediction of relapse from individual symptoms.

RESULTS

Seventy two studies were identified including 6903 participants. Sleep, mood, and suspiciousness, emerged as predictors of worsening symptoms. Pooled sensitivity and specificity of EWS in predicting psychotic relapse was 71% and 64% (AUC value = 0.72). There was a large pooled-effect size for the model predicting relapse from individual symptom which did not reach statistical significance (d = 0.81, 95%CIs = -0.01, 1.63).

CONCLUSIONS

Important methodological advancements in the prediction of psychotic relapse in schizophrenia spectrum disorders are evident with improvements in the precision of prediction. Further efforts are required to translate these advances into effective clinical innovations.

Predictors of paranoia in the daily lives of people with non-affective psychosis and non-clinical controls: A systematic review of intensive longitudinal studies

BACKGROUND AND OBJECTIVES

Worrying, self-esteem, sleep problems, anomalous internal experiences, reasoning biases, and interpersonal sensitivity are associated with paranoia. However, no review has examined whether these variables function as predictors of paranoia in everyday life. The present systematic review of intensive longitudinal studies (e.g., experience sampling) examined contemporaneous and time-lagged associations between paranoia and each candidate mechanism in individuals with non-affective psychosis and controls (pre-registration: https://osf.io/uwr9d).

METHODS

We searched electronic databases, PsyArXiv, and reference lists for studies published since 1994.

RESULTS

Of n = 5,918 results, n = 54 fulfilled inclusion criteria (n = 43 datasets). Most studies examined individuals with non-affective psychosis (n = 34). Strong evidence emerged for negative affect (subsumed under 'anomalous internal experiences') and sleep problems. For self-esteem, results suggest contemporaneous and lagged effects on paranoia but associations are likely driven by between-person variance. The low number of studies (n = 2 studies each) allowed no conclusions regarding worrying and reasoning biases. Findings on interpersonal sensitivity, which should be interpreted with caution because of the predictor's conceptual overlap with paranoia, indicate contemporaneous effects whereas time-lagged and within-person associations could not be judged due to insufficient data.

LIMITATIONS

The present review used a narrative data-synthetization and it did not cover outcomes such as hallucinations.

CONCLUSIONS

Despite convincing evidence for affect and sleep problems, it remains unclear whether affective states are precursors or also consequences of paranoia (vicious circle), and which of the actigraphy measures (sleep time, -efficiency, -fragmentation, etc.) best predicts paranoia.

Association between Sleep and Suicidal Ideation in Chinese Undergraduate Students

Suicide is an important global public health issue, which deserves more attention. This study aims to examine the relative independent relationship between suicide ideation and subjective sleep quality, sleep hygiene, and insomnia symptoms in undergraduate students in China. This population-based study included 2379 undergraduate students aged 18-26, randomly recruited from three public universities in Shanghai. The participants completed four questionnaires: the Pittsburgh Sleep Quality Index; Sleep Hygiene Practice Scale; Insomnia Severity Index; and the Symptom Checklist 90 (specifically the depression and anxiety dimensions and Q15-suicide ideation). The results of Spearman's correlation analysis indicate that poor sleep quality, short sleep duration, poor sleep hygiene, and insomnia symptoms were all associated with suicidal ideation in undergraduate students. However, according to the results of the hierarchical linear regression, no experience of sharing a bedroom at home, poor relationship with roommates, short sleep duration, sleep medicine use, and good daytime function were related to suicidal ideation, after controlling for the symptoms of depression and anxiety, which may be important in the identification of suicidal ideation. Sleep problems are highly discoverable and modifiable, and have a low sense of shame, therefore, sleep interventions for individuals with suicidal ideation and poor sleep quality may be an efficient and effective approach to suicide prevention.

Identifying Resilience Factors of Distress and Paranoia During the COVID-19 Outbreak in Five Countries

The ongoing COVID-19 pandemic outbreak has affected all countries with more than 100 million confirmed cases and over 2.1 million casualties by the end of January 2021 worldwide. A prolonged pandemic can harm global levels of optimism, regularity, and sense of meaning and belonging, yielding adverse effects on individuals' mental health as represented by worry, paranoia, and distress. Here we studied resilience, a successful adaptation despite risk and adversity, in five countries: Brazil, Colombia, Germany, Israel, and Norway. In April 2020, over 2,500 participants were recruited for an observational study measuring protective and obstructive factors for distress and paranoia. More than 800 of these participants also completed a follow-up study in July. We found that thriving, keeping a regular schedule, engaging in physical exercise and less procrastination served as factors protecting against distress and paranoia. Risk factors were financial worries and a negative mindset, e.g., feeling a lack of control. Longitudinally, we found no increase in distress or paranoia despite an increase in expectation of how long the outbreak and the restrictions will last, suggesting respondents engaged in healthy coping and adapting their lives to the new circumstances. Altogether, our data suggest that humans adapt even to prolonged stressful events. Our data further highlight several protective factors that policymakers should leverage when considering stress-reducing policies.