title: Insomnia as a predictor for symptom worsening following antipsychotic withdrawal in schizophrenia.
abstract: Sleep disturbances have been associated with schizophrenia, and are an especially prominent feature during the prodrome preceding psychotic relapse. In this study, we examined the changes in sleep quality following withdrawal of antipsychotic treatment, as well as the predictive value of sleep disturbances on symptom exacerbation. One hundred twenty-two patients with schizophrenia, schizophreniform disorder, or schizoaffective disorder underwent a 3-week medication wash-out prior to neuroimaging studies. Sleep quality was rated using items on the Hamilton Rating Scale for Depression (HAM-D), while symptom severity was measured using the Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS). Sleep quality deteriorated progressively following antipsychotic discontinuation. Total insomnia score prior to antipsychotic withdrawal had a significant effect on the severity of psychotic symptoms at the last weekly assessment, while baseline terminal insomnia had a significant effect on disorganized symptoms at the end of the medication-free period. These findings were independent of baseline symptom severity. Our findings suggest that schizophrenia patients with sleep disturbances are at a greater risk for worsening of positive symptoms after antipsychotic discontinuation. The implications of these findings in research and clinical settings are discussed.
authors.affiliation: Mental Health Clinical Research Center, Department of Psychiatry, The University of Iowa College of Medicine, Iowa City, IA 52242, USA.
authors.forename: Eran
authors.initials: E
authors.lastname: Chemerinski
authors.forename: Beng-Choon
authors.initials: BC
authors.lastname: Ho
authors.forename: Michael
authors.initials: M
authors.lastname: Flaum
authors.forename: Stephan
authors.initials: S
authors.lastname: Arndt
authors.forename: Frank
authors.initials: F
authors.lastname: Fleming
authors.forename: Nancy C
authors.initials: NC
authors.lastname: Andreasen
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000150:complications* / Q000188:drug therapy; D012720:Severity of Illness Index; D012890:Sleep / Q000187:drug effects; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology*; D013375:Substance Withdrawal Syndrome / Q000503:physiopathology* / Q000523:psychology
chemical_list: D014150:Antipsychotic Agents