Psychological Distress, Sleep, and Aggression in Psychosis.
Research type
Research Study
Full title
Exploring Sleep Experiences of Psychosis Patients in Relation to Psychological Distress and Aggression.
IRAS ID
341756
Contact name
Jane Ireland
Contact email
Sponsor organisation
University of Central Lancashire
Duration of Study in the UK
0 years, 8 months, 30 days
Research summary
Research summary:
Disruptions to sleep have been previously linked to externalised behaviours, such as aggression (Rijo-Ferreira & Takahashi, 2019). However, the mechanisms connecting the two remain poorly understood (Davies et al., 2017). This is particularly true for populations with severe mental illness, regardless of the high incidence of sleep disturbances among patients with schizophrenia (approximately 80%, Ngo et al., 2023). Literature suggests that additional work is therefore needed, particularly among high-risk populations (Greenwood et al., 2022).
Hence, the current research aims to address gaps in the literature, enhance knowledge, and provide a basis for future research. The intention is to understand patient perspectives on sleep experiences in relation to their psychosis journey. Preliminary interviews will be used, focusing on psychological distress and how this may impact both sleep experiences and aggression in secure forensic settings. Two groups of mental health inpatients will be interviewed: those with ‘active’ psychosis symptoms and those with ‘residual’ psychosis symptoms (Gaebel & Salveridou-Hof, 2023). We anticipate that patients will experience sleep problems, such as nightmares, and that these will be worse for those with current symptoms (Gellis and Gehrman, 2011).
The sample used will be adult males with a diagnosis of schizophrenia. It is anticipated that around 30 patients will participate; however, the number of patients in the ‘active’ sample will likely be smaller. Patients will be asked to reflect on their thoughts when they wake during the night and whether these relate to events from their past. They will also consider how their perceptions of sleep will impact their aggression. Since the existing theory is sparse, grounded theory will be used to analyse the data (Glaser & Strauss, 1967). This approach will assist us with enhancing our understanding of the field, from which we may develop the theory further (Makri & Neely, 2021).
Summary of results:
The study explored patient perspectives of sleep issues and experiences, using male psychiatric patients based at a high-secure mental health facility. Interviews were conducted with 30 individuals at Ashworth Hospital, with pre-determined questions centring around sleep quality and duration, nightmares and parasomnias, such as night terrors. Participants were also asked about externalising behaviours, such as aggression. Interviews were analysed, using thematic analysis, producing a variety of themes.
Themes indicated:
Disrupted eating habits and unhealthy behaviours among participants A preference for eveningness, suggesting evening chronotypes (night-owls) Night time is a period of vulnerability for psychosis symptoms and pre-sleep arousal Poor sleep as a ‘tipping point’ for psychosis symptoms Intense overlapping between nightmares and flashbacks, maintaining fear of sleep Negative cognitions and ruminations at night time drive sleep disturbances Trauma therapy has significantly improved sleep and reduced nightmaresParticipants appeared reluctant to discuss externalising behaviours, often denying feelings of aggression or frustration. Still, results highlighted the complex relationship between trauma, sleep and psychosis. Findings emphasising the importance of improving sleep experiences among high-secure populations. Results from this study have also uncovered areas for future research, such as chronotype, night time cognitions, fear of sleep, and pre-sleep arousal.
REC name
West of Scotland REC 5
REC reference
24/WS/0136
Date of REC Opinion
3 Oct 2024
REC opinion
Further Information Favourable Opinion