Improved insomnia is one pathway underlying the anti-suicidal properties of clozapine.

IF 2.7 3区医学 Q2 PSYCHIATRY

Suicide and Life-Threatening Behavior Pub Date : 2024-06-07 DOI:10.1111/sltb.13099

Ankita Vayalapalli, William V McCall, Joseph P McEvoy, Brian J Miller

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Abstract

Background: Insomnia is common in schizophrenia and associated with suicide. Clozapine has anti-suicidal properties and beneficial effects on sleep. Whether effects on insomnia mediate the anti-suicidal properties of clozapine remains unclear.

Methods: In n = 76 patients from the Clinical Antipsychotic Trials of intervention effectiveness schizophrenia trial using a within-subjects design, we investigated whether improvement in terminal insomnia was associated with improvement in suicidal ideation (SI) after treatment with non-clozapine antipsychotics, and then after treatment with clozapine, using binary logistic regression. Terminal insomnia and SI over the past 2 weeks were assessed before and after both non-clozapine antipsychotic and clozapine treatment with the Calgary Depression Scale for Schizophrenia.

Results: There was no association between improved terminal insomnia and resolution of SI after treatment with non-clozapine antipsychotics (OR = 0.2, 95% CI 0.0-9.0, p = 0.41). In the same patients, improved terminal insomnia was associated with resolution of SI after clozapine treatment (OR = 14.6, 95% CI 1.7-129.2, p = 0.02).

Conclusions: Improved terminal insomnia is associated with improved SI following clozapine treatment. Findings warrant replication in a larger sample with standard instruments in the assessment of insomnia and suicide, but suggest beneficial effects on sleep as a mediator of the anti-suicidal properties of clozapine. Future mechanistic studies are also needed.

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改善失眠是氯氮平具有抗自杀特性的一个途径。

背景：失眠是精神分裂症的常见症状，与自杀有关。氯氮平具有抗自杀作用，对睡眠也有益处。对失眠的影响是否介导了氯氮平的抗自杀特性仍不清楚：在n = 76名来自临床抗精神病药物干预有效性精神分裂症试验的患者中，我们采用受试者内设计，使用二元逻辑回归法研究了在使用非氯氮平类抗精神病药物治疗后，以及在使用氯氮平治疗后，终末失眠的改善是否与自杀意念（SI）的改善相关。在使用非氯氮平类抗精神病药物和氯氮平治疗前后，均使用卡尔加里精神分裂症抑郁量表对过去两周的终末失眠和自杀意念进行了评估：结果：使用非氯氮平类抗精神病药物治疗后，终末期失眠症的改善与 SI 的缓解之间没有关联（OR = 0.2，95% CI 0.0-9.0，p = 0.41）。在同一患者中，末期失眠的改善与氯氮平治疗后SI的缓解相关（OR = 14.6，95% CI 1.7-129.2，p = 0.02）：结论：末期失眠的改善与氯氮平治疗后SI的改善有关。研究结果需要在使用失眠和自杀评估标准工具的更大样本中进行验证，但结果表明，睡眠是氯氮平抗抑自杀作用的介质，对睡眠产生有益影响。未来还需要进行机理研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Suicide and Life-Threatening Behavior Medicine-Public Health, Environmental and Occupational Health

CiteScore

5.40

自引率

3.10%

发文量

期刊介绍： An excellent resource for researchers as well as students, Social Cognition features reports on empirical research, self-perception, self-concept, social neuroscience, person-memory integration, social schemata, the development of social cognition, and the role of affect in memory and perception. Three broad concerns define the scope of the journal: - The processes underlying the perception, memory, and judgment of social stimuli - The effects of social, cultural, and affective factors on the processing of information - The behavioral and interpersonal consequences of cognitive processes.

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