Terminal insomnia meaning8/24/2023 ![]() Study limitations included the cross-sectional study design and the nonstandardized antipsychotic (and other) medications in the study sample. Study strengths included the large cumulative sample size. They also found sex differences in correlations between insomnia and cognition in these patients. The authors concluded that females with schizophrenia had an increased prevalence of insomnia and greater cognitive impairment than males. By contrast, ISI scores were significantly negatively correlated with RBANS total scores (ρ=-0.18) and immediate memory (ρ=-0.19) scores in females. As a continuous measure, ISI scores were significantly, negatively correlated with RBANS total scores, language, attention, and delayed memory scores in males (ρ=-0.14 -0.12 for each). However, females with insomnia had lower RBANS total and subscale scores. By contrast, there was no difference in RBANS scores in males with versus without insomnia. In both males and females with schizophrenia, patients with (categorical) insomnia had higher PANSS scores than those without insomnia. Males with schizophrenia had higher (better) RBANS total, visuospatial/constructional, and language scores than females. Females with schizophrenia also had significantly higher PANSS total and subscale scores. There was a significantly increased prevalence of (categorical) insomnia in females versus males with schizophrenia (25.6% versus 18.3%, OR=1.54). The authors used 2 x 2 ANOVA (insomnia x sex) and Spearman correlation coefficients to investigate sex differences in clinical variables in patients with and without insomnia. Cognition was evaluated with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Symptoms were rated using the Positive and Negative Syndrome Scale (PANSS). Insomnia was assessed as both a categorical (yes/no) and a continuous measure with the Insomnia Severity Index (ISI). Patients were excluded if they had a history of neurological disease, severe medical comorbidity, head injury, pregnancy or lactation, or history of drug or alcohol abuse. Inclusion criteria for patients were age 17 to 70, Chinese Han ethnicity, DSM-IV diagnosis of schizophrenia, and stable antipsychotic dose for > 6 months. 5 They recruited 718 patients (480 males and 238 females) with chronic schizophrenia from 2 psychiatric hospitals and 397 healthy controls (169 males and 228 females) without a personal or family history of psychiatric or neurological disease. Zhu and colleagues investigated sex differences in insomnia and cognition in a large sample of Chinese patients with chronic schizophrenia. A trial of adjunctive electroconvulsive therapy for residual positive symptoms of psychosis was discontinued due to exacerbation of cognitive impairment. She has completed different forms of the Digit Symbol Coding test at multiple outpatient psychiatric clinic visits over the years, with a mean (SD) score of 31±4. ![]() She graduated with a 2-year technical degree after high school. She also has chronic cognitive impairment, thought to be in part due to not only her chronic psychotic illness, but also a sequela of the past cerebellar infarct. She has chronic auditory hallucinations, thought insertion, and persecutory beliefs. She chronically sleeps 3 to 5 hours per night, with both initial and terminal insomnia. She has been on a stable dose of antipsychotic medication for the past 10 years, prior to which a clozapine trial was discontinued due to tolerability and adverse effects. “Ms Smith” is a 50-year-old Caucasian female with a 20+ year history of schizoaffective disorder, bipolar type, and a remote history of a cerebellar hemorrhagic stroke. 4 In the general population, insomnia is associated with greater cognitive impairment, but its association (and potential sexual dimorphic effect) in schizophrenia is less clear. 2 Insomnia is also common in the clinical course of schizophrenia. 3 By contrast, findings regarding sex differences in cognition in schizophrenia are inconsistent. 1,2 Such sex differences may be mediated, in part, due to neuroprotective effects of estrogen. For example, compared to males, females have a slightly lower incidence of the disorder, a later age of onset, and more depressive symptoms. There is increased recognition of sex differences in the epidemiology and phenomenology of schizophrenia.
0 Comments
Leave a Reply.AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |