Clinical Trial Explores Relationships Between Psychopathology, Suicidal Ideation, and Sleep Problems in First-Episode Psychosis

CASE VIGNETTE " Mr Deuce" is a 22-year-old male with no psychiatric history who presents to the emergency department with his family. He is a senior in college who has not been sleeping well. He complains of initial insomnia and says he has been taking NyQuil to help him sleep. According to his sister, the patient has exhibited delusional thinking, saying he is a superhero and that his college roommates are talking about him. He has had paranoid ideation that his room had been wiretapped. At admission, he told the interviewer that he was going to meet the president the next day. The patient also has periods in which speech is mostly incoherent. His laboratory study results, including a urine drug screening, were unremarkable. He received a diagnosis of a first episode of psychosis and was stabilized on risperidone 3 mg daily during an inpatient psychiatric hospitalization. Insomnia is not part of the diagnostic criteria for psychotic disorders, but it is common in the clinical course of schizophrenia, affecting one-quarter to half of patients.¹ Insomnia is strongly associated with suicidal ideation and behavior in psychiatric disorders, including schizophrenia.² This association is relevant because there is a lifetime prevalence of 27% for suicide attempt³ and 5% for suicide death in the disorder.⁴ Several study results have also found associations between insomnia and greater symptom severity, including total, positive, and general psychopathology.²