Sleep Problems and Positive Prodromal Symptoms Restricted; Files Only

Goines, Katrina (Fall 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/tq57nr98z?locale=en
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Abstract

Sleep dysfunction has long been associated with psychotic disorders. Recent findings on sleep’s effect on physical and mental health have spurred interest in whether sleep problems might contribute to psychotic illness. Previous research in the area of sleep and psychotic symptoms was conducted largely on samples with schizophrenia, or in healthy populations. Neither approach is well-suited for testing whether sleep problems contribute to the emergence of psychotic disorders. In addition, previous longitudinal studies of sleep problems and psychotic symptoms have only tested the association across two time points, and in one direction (i.e., tested whether sleep problems predict later psychotic symptoms). No previous studies have attempted to test the reverse relationship (i.e., whether psychotic symptoms predict later sleep problems), or a bidirectional relationship. This dissertation investigated both the cross-sectional and longitudinal relations between sleep problems and positive prodromal symptoms in a large sample of youth at Clinical High Risk (CHR) for psychosis. Study 1 assessed the cross-sectional association of sleep problems and positive prodromal symptoms in an attempt to replicate previous findings and assess whether findings from general population samples and psychotic samples extend to this CHR sample. Results from Study 1 were largely consistent with previous findings and found that sleep problems were significantly associated with positive psychotic symptom severity at baseline. Sleep problems were also found to be associated with only certain specific prodromal symptoms (e.g., suspiciousness, perceptual abnormalities, and disorganized speech).Further, cross-sectional analyses of direct and indirect effects provided some support for depression as a mediator in the association between sleep problems and psychotic symptoms. Study 2 utilized longitudinal data from three time points in an autoregressive panel design. The aims were to characterize the longitudinal relations of sleep problems and positive prodromal symptoms, as well as to test the possibility of a bidirectional association. Results revealed that although sleep problems had no significant effect on later prodromal symptoms, prodromal symptoms significantly predicted sleep problems at later time points. These results run counter to common assumptions of the sleep and psychosis association, and they highlight the benefits of longitudinal designs in understanding the directionality of associations.

Table of Contents

Dissertation General Introduction…………………………………………..………………….… 1

Study 1: Cross-Sectional Associations Between Sleep Problems and Prodromal Symptoms in a Clinical High Risk Sample ............................................................................................................. 18

            Introduction……………………………………………………………………………19      

            Method…………………………………………………………………………………..23

            Results……………………………………………………………………………...……27

            Discussion…………………………………………………………………………...….30

            References……………………………………………………………………………….34

Appendix A….………..…………………………………………………………………36

 

Study 2: Longitudinal Associations Between Sleep Problems and Prodromal Symptoms in a Clinical High Risk Sample………...………............................................................................................45

Introduction……………………………………………………………………………...46

            Method………………………………………………………………………………….....48

            Results……………………………………………………………………………...…...…55

            Discussion…………………………………………………………………………...…....69

            References………………………………………………………………………………....72

            Appendix B …..………..……………………………………………………………….....74 

       

Dissertation General Conclusion..…………………………………………..…………….…......79

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