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Sleep quality in patients with positive and negative symptoms of schizophrenia

Faezeh Tatari, Habbibolah Khazaie, Pardis Parsapour, Leeba Rezaie


Background: Schizophrenia is a debilitating psychiatric disorder that primarily manifests itself in two ways, showing either positive or negative symptoms. Sleep disorders are one of the main attributes of this disorder that affects the quality of patients with schizophrenia. The evaluation of the quality of sleep in patients showing both positive and negative symptoms can be useful in the planning program of the diagnosis and treatment of these patients. Therefore, this study aimed to compare the quality of sleep of schizophrenic patients showing positive symptoms with those who show negative symptoms.

Methods: This study was descriptive-analytic in nature. A total of 100 patients suffering from schizophrenia admitted to the Farabi Hospital in Kermanshah, Iran, during 2015-16, were considered for this study. We used convenience sampling to assign the participants into 2 groups of patients showing positive and negative symptoms of schizophrenia, respectively. The data were collected by conducting face-to-face interviews. Two questionnaires were used, namely, the Anderson Positive and Negative Symptoms Questionnaire and the Pittsburgh Sleep Quality Questionnaire. The data were analyzed with the SPSS-22 software.

Results: There was a significant difference between the overall score of sleep quality in patients with positive and negative symptoms for schizophrenia (P = 0.046) with the patients with positive symptoms reporting poorer sleep quality. In addition, patients with the positive symptoms showed a higher impairment of daily functions than those with negative symptoms (p = 0.024). However, there was no significant difference in the subjective quality of sleep, delayed sleep, sleep duration, sleep disorders and the use of sleep medications between the 2 groups (P >0.05).

Conclusion: According to the results of this study, the quality of sleep in patients with positive symptoms is poorer than those with negative symptoms, which is associated with a higher impairment in their daily functions. Therefore, attention to sleep quality is recommended during the person-centered treatment of these patients.


Clinical outcomes, Iran, negative symptoms, person-centered healthcare, person-centered mental health, positive symptoms, quality of life, schizophrenia, sleep quality, treatment adherence

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Whiteford, H.A., Degenhardt, L., Rehm, J., Baxter, A.J., Ferrari, A.J., Erskine, H.E., Charlson, F.J., Norman, R.E., Flaxman, A.D., Johns, N., Burstein, R., Murray, C.J. & Vos, T. (2013). Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet 382 (9904) 1575-1586.

Sadock, B.J. & Sadock, V.A. (2003). Kaplan & Sadock's synopsis of psychiatry: behavioral sciences/clinical psychiatry. pp. 1732-1735. 9th edn. Philadelphia: Lippincott Williams & Wilkins.

Van Os, J. & Kapur, S. (2009). Schizophrenia. Lancet 374, 635-645.

Monti, J. & Monti, D. (2005). Sleep disturbance in schizophrenia. International Review of Psychiatry 17, 247-253.

Manoach, D.S. & Stickgold, R. (2009). Does abnormal sleep impair memory consolidation in schizophrenia? Frontiers in Human Neuroscience 3, 1-8.

Afonso, P., Figueira, M.L. & Paiva, T. (2014). Sleep-wake patterns in schizophrenia patients compared to healthycontrols. World Journal of Biological Psychiatry 15 (7) 517-524.

Poulin, J., Chouinard, S., Pampoulova, T., Lecomte, Y., Stip, E. & Godbout, R. (2010). Sleep habits in middle-aged, non-hospitalized men and women with schizophrenia: A comparison with healthy controls. Psychiatry Research 179 (3) 274-278.

Benson, K. (2006) Sleep in schizophrenia: Impairments, correlates, and treatment. Psychiatric Clinics of North America 29, 1033-1045.

Rezaie, L., Khazaie, H. & Yazdani, F. (2016). Exploration of the experience of living with chronic insomnia: A qualitative study. Sleep Science 9 (3) 179-185.

Khazaie, H. & Rezaie, L. (2015). Determination of consequences of chronic insomnia: A qualitative study. Scientific Journal of Kurdistan Medical University of Sciences 20 (4) 112-124.

Hofstetter, J.R., Lysaker, P.H. & Mayeda, A.R. (2005). Quality of sleep in patients with schizophrenia is associated with quality of life and coping. BMC Psychiatry 5, 13.

Pompili, M., Lester, D., Grispini, A., Innamorati, M., Calandro, F., Iliceto, P., de Pisa, E., Tatarelli, R. & Girardi, P. (2009). Completed suicide in schizophrenia: evidence from a case- control study. Psychiatry Research 167 (3) 251-257.

Brissos, S., Afonso, P., Cañas, F., Bobes, J., Bernardo Fernandez, I. & Guzman, C. (2013). Satisfaction with Life of Schizophrenia Outpatients and Their Caregivers: Differences between Patients with and without Self-Reported Sleep Complaints. Schizophrenia Research and Treatment 2013:502172.

Afonso, P., Brissos, S., Cañas, F., Bobes, J. & Bernardo-Fernandez, I. (2014). Treatment adherence and quality of sleep in schizophrenia outpatients. International Journal of Psychiatry in Clinical Practice 18 (1) 70-76.

Chemerinski, E., Ho, B.C., Flaum, M., Arndt, S., Fleming, F. & Andreasen, N.C. (2002). Insomnia as a predictor for symptom worsening following antipsychotic withdrawal in schizophrenia. Comprehensive Psychiatry 43, 393-396.

Lunsford-Avery, J.R., Le Bourgeois, M.K., Gupta, T. & Mittal, V.A. (2015). Actigraphic-measured sleep disturbance predicts increased positive symptoms in adolescents at ultrahigh-risk for psychosis: A longitudinal study. Schizophrenia Research 164 (1-3) 15-20.

Afonso, P., Brissos, S., Figueira, M.L. & Paiva, T. (2011). Schizophrenia patients with predominantly positive symptoms have more disturbed sleep-wake cycles measured by actigraphy. Psychiatry Research 189 (1) 62-66.

Ahmad Zadeh, G.H. & Karim Zadeh, T. (2002). Positive and negative symptoms in Iranian Schizophrenic patients. Journal of Research in Medical Sciences 7 (1) 12-19. [In Persian].

Buysse, D.J., Reynolds, C.F., Monk, T.H., Berman, S.R. & Kupfer, D.J. (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research 28, 193-213.

Farrahi, J., Nakhaee, N., Sheibani, V., Garrusi, B. & Amirkafi, A. (2009). Psychometric properties of the Persian version of the Pittsburgh Sleep Quality Index addendum for PTSD (PSQI-A). Sleep and Breathing 13 (3) 259-262.

Bian, Y., Wang, Z.X., Han, X.L., Chen, L., Zhu, Y. & Wu, C.J. (2016). Sleep state misperception in schizophrenia: Are negative symptoms at work? Comprehensive Psychiatry 67, 33-38.

Trajanovic, N.N, Radivojevic, V., Kaushansky, Y. & Shapiro, C.M. (2007). Positive sleep state misperception - A new concept of sleep misperception. Sleep Medicine 8 (2) 111-118.

Orff, H.J., Drummond, S.P., Nowakowski, S. & Perlis, M.L. (2007). Discrepancy between subjective symptomatology and objective neuropsychological performance in insomnia. Sleep 30 (9) 1205.



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