Adolescents at clinical-high risk for psychosis: Circadian rhythm disturbances predict worsened prognosis at 1-year follow-up.
Individuals with psychotic disorders experience disruptions to both the sleep and circadian components of the sleep/wake cycle. Recent evidence has supported a role of sleep disturbances in emerging psychosis. However, less is known about how circadian rhythm disruptions may relate to psychosis symptoms and prognosis for adolescents with clinical high-risk (CHR) syndromes. The present study examines circadian rest/activity rhythms in CHR and healthy control (HC) youth to clarify the relationships among circadian rhythm disturbance, psychosis symptoms, psychosocial functioning, and the longitudinal course of illness.



Thirty-four CHR and 32 HC participants were administered a baseline evaluation, which included clinical interviews, 5days of actigraphy, and a sleep/activity diary. CHR (n=29) participants were re-administered clinical interviews at a 1-year follow-up assessment.



Relative to HC, CHR youth exhibited more fragmented circadian rhythms and later onset of nocturnal rest. Circadian disturbances (fragmented rhythms, low daily activity) were associated with increased psychotic symptom severity among CHR participants at baseline. Circadian disruptions (lower daily activity, rhythms that were more fragmented and/or desynchronized with the light/dark cycle) also predicted severity of psychosis symptoms and psychosocial impairment at 1-year follow-up among CHR youth.



Circadian rhythm disturbances may represent a potential vulnerability marker for emergence of psychosis, and thus, rest/activity rhythm stabilization has promise to inform early-identification and prevention/intervention strategies for CHR youth. Future studies with longer study designs are necessary to further examine circadian rhythms in the prodromal period and rates of conversion to psychosis among CHR teens.
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA. Electronic address: jessica.r.avery@duke.edu.
Jessica R
JR
Lunsford-Avery
Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.
Bruno da Silva Brandão
BDSB
Gonçalves
Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.
Elisa
E
Brietzke
Program for Recognition and Intervention in Individuals in At-Risk Mental States (PRISMA), Interdisciplinary Laboratory of Clinical Neuroscience (LINC), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.
Rodrigo A
RA
Bressan
Program for Recognition and Intervention in Individuals in At-Risk Mental States (PRISMA), Interdisciplinary Laboratory of Clinical Neuroscience (LINC), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.
Ary
A
Gadelha
Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA.
Randy P
RP
Auerbach
Departments of Psychology, Psychiatry, and Medical Social Sciences and the Institute for Policy Research, Northwestern University, Evanston, IL, USA.
Vijay A
VA
Mittal
D056044:Actigraphy; D000293:Adolescent; D002648:Child; D002940:Circadian Rhythm / Q000502:physiology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D062706:Prodromal Symptoms; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000503:physiopathology* / Q000523:psychology; D012890:Sleep / Q000502:physiology; D055815:Young Adult
Actigraphy; Circadian rhythm; Clinical high-risk; Prodromal; Psychosis; Schizophrenia