精神科急性住院病人主客觀睡眠品質、精神症狀與暴力風險之相關性：前驅研究

A Pilot Study of Associations between Subjective and Objective Sleep Quality, Psychiatric Symptoms, and Violent Risk among Acute Psychiatric Patients

10.6847/TJPMHN.201906_14(1).01

高綺吟(Chi-Yin KAO)；陳幸琪(Shin-Chi CHEN)；陳嬿今(Yen-Chin CHEN)；柯乃熒(Nai-Ying KO)；林靜蘭(Esther Ching-Lan LIN)

睡眠品質 ； 生理手環 ； 精神症狀 ； 暴力風險 ； 精神科急性住院病人 ； sleep quality ； actigraphy ； psychiatric symptoms ； violence risk ； acute psychiatric patients

精神衛生護理雜誌

14卷1期（2019 / 06 / 01）

5 - 14

繁體中文

目的：瞭解精神科急性住院病人的主客觀睡眠品質、精神症狀、暴力風險及其相關性。方法：採相關性研究設計，研究對象為某醫學中心精神科急性病房雙相情緒障礙及思覺失調症病人。以護理人員的睡眠記錄與生理手環收集連續7天客觀睡眠品質；請病人於首日及第7天填寫中文版匹茲堡睡眠品質量表，評估過去7天主觀睡眠品質；由專業人員以楊氏躁症評估量表、漢氏憂鬱量表、簡明精神病量表及Brøset暴力風險評估表於首日及第7天評量臨床症狀。結果：收案後一週睡眠平均總時數部分，病人主觀評估與生理測量手環所測得的時數相近。護理人員的睡眠記錄則與生理測量手環與病人主觀評估有落差。收案第7天之精神症狀分數皆較收案首日的分數低。思覺失調症病人首日客觀睡醒時間與精神症狀、第7天客觀入睡時間與暴力風險，均有顯著負相關。雙相情緒障礙病人首日躁症症狀與暴力風險有顯著正相關，與睡眠潛伏期有顯著負相關；憂鬱症狀與主觀睡眠潛伏期有顯著正相關，與主觀睡眠品質及睡眠品質有顯著負相關。第7天躁症症狀與暴力風險有顯著正相關，與主觀睡眠總時數有顯著負相關。結論／實務應用：前驅研究結果顯示主客觀睡眠評量與精神病人臨床症狀具有密切關係，建議未來臨床照護宜加入主客觀睡眠測量互為參照，以利於增進病人睡眠及照護品質。

Aim: The study aimed to examine the associations between patients' sleep quality, psychiatric symptoms, and violent risk in an acute psychiatric unit. Method: Correlational research design was used; patients who had suffered from bipolar disorders or schizophrenia were recruited at an acute psychiatric unit in a medical center in Taiwan. Nursing observation and actigraphy were used to collect objective sleep quality for 7 days. Participants were required to complete the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) on Day 1 and Day 7 in order able to collect subjective sleep quality for the past 7 days. Psychiatric symptoms on Day 1 and Day 7 were assessed with the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Brief psychiatric rating scale (BPRS), and the Brøset Violence Checklist (BVC) by health professionals. Result: Total sleep time of CPSQI and actigraphy for 7 days was similar, but not as similar as the nursing record. Psychiatric symptoms generally improved on Day 7 compared with Day 1. Among participants with schizophrenia, there were significant negative correlations between wake up time of actigraphy on Day 1 and the scores of BPRS, and sleep starting time on Day 7 of actigraphy and the scores of the BVC. Among participants with bipolar disorder, there was a significant positive correlation between the scores of HDRS on Day 1 and sleep latency and total scores of CPSQI, whereas there was a significant negative correlation between the scores of YMRS, go-to- bed and sleep latency. There was a significant negative correlation between the scores of YMRS and total sleep time of CPSQI, whereas there was a significant negative correlation between the BVC, sleep latency, wake-up time, and total sleep time of CPSQI, and nursing record. Conclusions and implications: Our pilot study results supported that psychiatric patients' clinical symptoms are correlated with their subjective and objective sleep quality. Objective sleep quality of patients having schizophrenia was correlated with their psychiatric symptoms and violent risk, whereas subjective sleep quality of patients having bipolar disorder was correlated with their mood symptoms and violent risk. Integrating subjective and objective sleep assessment into clinical practice is recommended for patients' sleep quality and care quality.

1. Ancoli-Israel, S.,Cole, R.,Alessi, C.,Chambers, M.,Moorcroft, W.,Pollak, C. P.(2003).The role of actigraphy in the study of sleep and circadian rhythms.Sleep,26(3),342-392.
2. Andersen, J.,Larsen, J. K.,Kørner, A.,Nielsen, B. M.,Schultz, V.,Behnke, K.,Bjørum, N.(1986).The Brief Psychiatric Rating Scale: Schizophrenia, reliability and validity studies.Nordisk Psykiatrisk Tidsskrift,40(2),135-138.
3. Backman, H.,Laajasalo, T.,Saukkonen, S.,Salmi, V.,Kivivouori, J.,Aronen, E. T.(2015).Are qualitative and quantitative sleep problems associated with delinquency when controlling psychopathic features and parental supervision?.Journal of Sleep Research,24(5),543-548.
4. Boudebesse, C.,Geoffroy, P. A.,Bellivier, F.,Henry, C.,Folkard, S.,Leboyer, M.,Etain, B.(2014).Correlations between objective and subjective sleep and circadian markers in remitted patients with bipolar disorder.Chronobiology International,31(5),698-704.
5. Cudney, L. E.,Frey, B. N.,Streiner, D. L.,Minuzzi, L.,Sassi, R. B.(2016).Biological rhythms are independently associated with quality of life in bipolar disorder.International Journal of Bipolar Disorders,4(9)
6. Ehlers, C. L.,Frank, E.,Kupfer, D. J.(1988).Social zeitgebers and biological rhythms: A unified approach to understanding the etiology of depression.Archives of General Psychiatry,45(10),948-952.
7. Eidelman, P.,Talbot, L. S.,Gruber, J.,Hairston, I.,Harvey, A. G.(2010).Sleep architecture as correlate and predictor of symptoms and impairment in inter-episode bipolar disorder: Taking on the challenge of medication effects.Journal of Sleep Research,19(4),516-524.
8. Ettinger, U.,Kumari, V.(2015).Effects of sleep deprivation on inhibitory biomarkers of schizophrenia: Implications for drug development.Lancet Psychiatry,2(11),1028-1035.
9. Finan, P. H.,Quartana, P. J.,Remeniuk, B.,Garland, E. L.,Rhudy, J. L.,Hand, M.,Smith, M. T.(2017).Partial sleep deprivation attenuates the positive affective system: Effects across multiple measurement modalities.Sleep,40(1),1-9.
10. Frank, E.(2007).Interpersonal and social rhythm therapy: A means of improving depression and preventing relapse in bipolar disorder.Journal of Clinical Psychology,63(5),463-473.
11. Geoffroy, P. A.,Boudebesse, C.,Belliviere, F.,Lajnefa, M.,Henry, C.,Leboyer, M.,Etain, B.(2014).Sleep in remitted bipolar disorder: A naturalistic case-control study using actigraphy.Journal of Affective Disorders,158,1-7.
12. Geoffroy, P. A.,Scott, J.,Boudebesse, C.,Lajnef, M.,Henry, C.,Leboyer, M.,Etain, B.(2015).Sleep in patients with remitted bipolar disorders: a meta-analysis of actigraphy studies.Acta Psychiatrica Scandinavia,131(2),89-99.
13. Gonzalez, R.,Tamminga, C.,Tohen, M.,Suppes, T.(2013).Comparison of objective and subjective assessments of sleep time in subjects with bipolar disorder.Journal of Affective Disorders,149(1-3),363-366.
14. Grandin, L. D.,Alloy, L. B.,Abramson, L. Y.(2006).The social zeitgeber theory, circadian rhythms, and mood disorders: Review and evaluation.Clinical Psychology Review,26(6),679-694.
15. Hamilton, M.(1960).A rating scale for depression.Journal of Neurology, Neurosurgery, and Psychiatry,23,56-62.
16. Harvey, A. G.(2008).Sleep and circadian Rhythms in bipolar disorder: Seeking synchrony, harmony and regulation.American Journal of Psychiatry,165(7),820-829.
17. Jayaram, G.,Sporney, H.,Perticone, P.(2010).The Utility and effectiveness of 15-minute checks in inpatient settings.Psychiatry,7(8),46-49.
18. Kamphuis, J.,Meerlo, P.,Koolhaas, J. M.,Lancel, M.(2012).Poor sleep as a potential causal factor in aggression and violence.Sleep Medicine,13(4),327-334.
19. Margraf, J.,Lavallee, K.,Zhang, X.,Schneider, S.(2016).Social rhythm and mental health: A cross-cultural comparison.Public Library of Science One,2016(11),e0150312.
20. Monti, J. M.,Monti, D.(2004).Sleep in schizophrenia patients and the effects of antipsychotic drugs.Sleep Medicine Reviews,8,133-148.
21. Müller, M. J.,Olschinski, C.,Kundermann, B.,Cabanel, N.(2016).Subjective sleep quality and sleep duration of patients in a psychiatric hospital.Sleep Science,9(3),202-206.
22. Overall, J. E.,Gorham, D. R.(1962).The brief psychiatric rating scale.Psychological Reports,10(3),799-812.
23. Pinho, M.,Sehmbi, M.,Cudney, L. E.,Kauer-Sant’anna, M.,Magalhaes, P. V.,Reinares, M.,Rosa, A. R.(2016).The association between biological rhythms, depression, and functioning in bipolar disorder: A large multi-center study.Acta Psychiatrica Scandinavica,133(2),102-108.
24. Robillard, R.,Hermens, D. F.,Lee, R. S. C.,Jones, A.,Carpenter, J. S.,White, D.,Hicki, I. B.(2016).Sleep–wake profiles predict longitudinal changes in manic symptoms and memory in young people with mood disorders.Journal of Sleep Research,25(5),549-555.
25. Rock, P.,Goodwin, G.,Harmer, C.,Wulff, K.(2014).Daily rest-activity patterns in the bipolar phenotype: A controlled actigraphy study.Chronobiology International,31(2),290-296.
26. Tsai, P. S.,Wang, S. Y.,Wang, M. Y.,Su, C. T.,Yang, T. T.,Huang, C. J.,Fang, S. C.(2005).Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects.Quality Life Research,14(8),1943-1952.
27. Vaughn, M. G.,Salas-Wright, C. P.,White, N. A.,Kremer, K. P.(2015).Poor sleep and reactive aggression: Results from a national sample of African American Adults.Journal of Psychiatric Research,66-67,54-59.
28. Yao, X.,Li, Z.,Arthur, D.,Hu, L.,An, F. R.,Cheng, G.(2014).Acceptability and psychometric properties of Brøset Violence Checklist in psychiatric care settings in China.Journal of Psychiatric and Mental Health Nursing,21(9),848-855.
29. Young, R. C.,Biggs, J. T.,Ziegler, V. E.,Meyer, D. A.(1978).A rating scale for mania: Reliability, validity and sensitivity.British Journal of Psychiatry,133(5),429-435.
30. Zheng, Y. P.,Zhao, J. P.,Phillips, M.,Liu, J. B.,Cai, M. F.,Sun, S. Q.,Huang, M. F.(1988).Validity and reliability of the Chinese Hamilton Depression Rating Scale.British Journal of Psychiatry,152,660-664.
31. Zschoche, M.,Schlarb, A. A.(2015).Is there an association between insomnia symptoms, aggressive behavior, and suicidality in adolescents?.Adolescent Health, Medicine and Therapeutics,6,29-36.
32. 胡海國(1999).精神醫學診斷手冊.臺北市:健康文化事業股份有限公司.

1. 潘安妮,陳幸琪,許倍甄,林靜蘭(2022)。雙相症病人主客觀睡眠品質與情緒症狀相關性之縱貫性研究。精神衛生護理雜誌，17(3)，26-36。