Insomnia, worry, anxiety and depression as predictors of the occurrence and persistence of paranoid thinking

ArticleinSocial Psychiatry 47(8):1195-203 · September 2011with74 Reads
DOI: 10.1007/s00127-011-0433-1 · Source: PubMed
Our theoretical model proposes that insomnia, worry, and negative affect are important determinants of paranoid thinking. Anxiety produces anticipation of threat, depression increases the sense of vulnerability, worry leads to implausible ideas, and insomnia exacerbates negative affect and creates an altered perceptual state. The study objective was to examine for the first time these factors as predictors of the onset of new paranoid thinking and of the persistence of existing paranoid thinking. A total of 2,382 participants in the 2000 British National Psychiatric Morbidity Survey were followed-up 18 months after their first assessment. Baseline assessments were used to predict the development and persistence of paranoid thinking at follow-up. Data were weighted to be representative of the general household population. Insomnia, worry, anxiety, depression and depressive ideas were each substantial predictors both of new inceptions of paranoia and of the persistence of existing paranoid thinking. Worry and insomnia were the strongest predictors. For example, insomnia at the first assessment led to a more than threefold increase in later inceptions of paranoid thinking. The study indicates that insomnia, worry, anxiety and depression are potential risk factors for new inceptions of paranoid thinking. The results also corroborate an emerging literature indicating that anxiety, worry and depression may encourage the persistence of paranoid thinking. The study provides the first longitudinal evidence linking insomnia and paranoia. The important clinical implication is that the use of interventions for common mental health difficulties in people with psychosis may have the additional benefit of reducing paranoia.
    • "These results add weight to the view that insomnia might have a contributory causal role in the onset of psychotic experiences (Freeman et al., 2012). A next step in testing this hypothesis is to treat insomnia and assess the impact on psychotic experiences (an approach termed an interventionist model of causality (Kendler and Campbell, 2009)). "
    [Show abstract] [Hide abstract] ABSTRACT: Insomnia is common in people experiencing psychosis. It has been identified as a contributory cause of paranoia, but any causal relationship with hallucinations has yet to be established. We tested the hypotheses that insomnia i) has a cross-sectional association with hallucinations ii) predicts new inceptions of hallucinations and iii) that these associations remain after controlling for depression, anxiety, and paranoia. Data from the second (2000, N=8580) and third (2007, N=7403) British Psychiatric Morbidity Surveys were used to assess cross-sectional associations between insomnia and hallucinations. The 2000 dataset included an 18 month follow up of a subsample (N=2406) used to test whether insomnia predicted new inceptions of hallucinations. Insomnia was associated with hallucinations in both cross-sectional datasets. Mild sleep problems were associated with 2-3 times greater odds of reporting hallucinations, whilst chronic insomnia was associated with four times greater odds. Insomnia was also associated with increased odds of hallucinations occurring de novo over the next 18 months. These associations remained significant, although with smaller odds ratios, after controlling for depression, anxiety and paranoia. This is the first longitudinal evidence that insomnia is associated with the development of hallucinatory experiences. Effective treatment of insomnia may lessen the occurrence of hallucinations.
    Full-text · Article · Apr 2016
    • "The authors found that sleep dysfunction at three different levels of severity (sleep difficulties, moderately severe insomnia, and chronic insomnia) were all associated with increased risk for paranoia , with the more persistent and severe sleep disturbances having larger effects. A subsample of participants were assessed 18 months later, and a longitudinal analysis showed that insomnia predicted the persistence and new inception of paranoia after adjusting for sociodemographic variables (Freeman et al., 2012). Freeman et al. (2011) found similar effect sizes in another survey of households in England (Adult Psychiatric Morbidity Survey), which also used the CIS-R, but only used one definition of insomnia (problems getting or trying to stay asleep in the past week, where it took at least a quarter of an hour to get to sleep, and the problem occurred for at least 6 months). "
    [Show abstract] [Hide abstract] ABSTRACT: Sleep disturbances have been linked to psychotic experiences in the general adult populations of multiple countries, but this association has yet to be confirmed in the United States using robust diagnostic measures. We analyzed a subsample (n = 2304) of the National Comorbidity Survey Replication, and found that when compared with those who did not report any sleep problems, individuals with sleep disturbances lasting two weeks or longer over the past 12 months were significantly more likely to report at least one psychotic experience during that same time frame. Specifically, difficulty falling asleep, waking up during the night, early morning awakenings, and feeling sleepy during the day were each associated with greater odds of reporting psychotic experiences over the past year after controlling for socio-demographic variables. However, only difficulty falling asleep and early morning awakenings were still significant after adjusting for DSM comorbid disorders. Reporting three or four types of sleep disturbances was especially predictive of psychotic experiences. Our findings underscore the importance of detecting and reducing sleep problems among individuals who report PE.
    Full-text · Article · Jan 2016
    • "No data on mood changes were collected. Given the robust link between insomnia and paranoia discussed previously (Freeman, Brugha, et al., 2010; Freeman et al., 2009 Freeman et al., , 2011 Freeman et al., , 2012 ), it is intriguing that no effects of sleep deprivation on paranoia were reported in this study. One potential rationale could be that the 8 item PSI subscale for paranoia includes several items which are less specific to persecutory ideation (e.g. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Sleep dysfunction is extremely common in patients with schizophrenia. Recent research indicates that sleep dysfunction may contribute to psychotic experiences such as delusions and hallucinations. Objectives: The review aims to evaluate the evidence for a relationship between sleep dysfunction and individual psychotic experiences, make links between the theoretical understanding of each, and highlight areas for future research. Method: A systematic search was conducted to identify studies investigating sleep and psychotic experiences across clinical and non-clinical populations. Results: 66 papers were identified. This literature robustly supports the co-occurrence of sleep dysfunction and psychotic experiences, particularly insomnia with paranoia. Sleep dysfunction predicting subsequent psychotic experiences receives support from epidemiological surveys, research on the transition to psychosis, and relapse studies. There is also evidence that reducing sleep elicits psychotic experiences in non-clinical individuals, and that improving sleep in individuals with psychosis may lessen psychotic experiences. Anxiety and depression consistently arise as (partial) mediators of the sleep and psychosis relationship. Conclusion: Studies are needed that: determine the types of sleep dysfunction linked to individual psychotic experiences; establish a causal connection between sleep and psychotic experiences; and assess treatments for sleep dysfunction in patients with non-affective psychotic disorders such as schizophrenia.
    Full-text · Article · Sep 2015
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