Natural language processing of multi-hospital electronic health records for public health surveillance of suicidality.

There is an urgent need to monitor the mental health of large populations, especially during crises such as the COVID-19 pandemic, to timely identify the most at-risk subgroups and to design targeted prevention campaigns. We therefore developed and validated surveillance indicators related to suicidality: the monthly number of hospitalisations caused by suicide attempts and the prevalence among them of five known risks factors. They were automatically computed analysing the electronic health records of fifteen university hospitals of the Paris area, France, using natural language processing algorithms based on artificial intelligence. We evaluated the relevance of these indicators conducting a retrospective cohort study. Considering 2,911,920 records contained in a common data warehouse, we tested for changes after the pandemic outbreak in the slope of the monthly number of suicide attempts by conducting an interrupted time-series analysis. We segmented the assessment time in two sub-periods: before (August 1, 2017, to February 29, 2020) and during (March 1, 2020, to June 31, 2022) the COVID-19 pandemic. We detected 14,023 hospitalisations caused by suicide attempts. Their monthly number accelerated after the COVID-19 outbreak with an estimated trend variation reaching 3.7 (95%CI 2.1-5.3), mainly driven by an increase among girls aged 8-17 (trend variation 1.8, 95%CI 1.2-2.5). After the pandemic outbreak, acts of domestic, physical and sexual violence were more often reported (prevalence ratios: 1.3, 95%CI 1.16-1.48; 1.3, 95%CI 1.10-1.64 and 1.7, 95%CI 1.48-1.98), fewer patients died (p = 0.007) and stays were shorter (p < 0.001). Our study demonstrates that textual clinical data collected in multiple hospitals can be jointly analysed to compute timely indicators describing mental health conditions of populations. Our findings also highlight the need to better take into account the violence imposed on women, especially at early ages and in the aftermath of the COVID-19 pandemic.

[Pathophysiological hypothesis and diagnosis of insomnia disorder]. / Hypothèses physiopathologiques et diagnostic du trouble insomnie.

PATHOPHYSIOLOGICAL HYPOTHESES AND DIAGNOSIS OF INSOMNIA DISORDER. All pathophysiological models place hyperarousal as a central process in the mechanisms of insomnia. These models differ, however, in terms of the importance and role of the variables explaining this hyperarousal. Behavioral and cognitive models describe self-maintenance behaviors and dysfunctional thoughts, such as worries and concerns about sleep and the consequences of insomnia. Alterations in cognitive functions related to hyperarousal in perceptual and memory processes can explain these behaviors and thoughts. Neurobiological models show instability in the sleepwake balance, with orexin possibly involved, but this remains to be confirmed. The diagnosis of insomnia must consider the semiology related to the mechanisms of insomnia, as well as co-morbidities.

HYPOTHÈSES PHYSIOPATHOLOGIQUES ET DIAGNOSTIC DU TROUBLE INSOMNIE. L'ensemble des modèles physiopathologiques place l'hyperéveil comme processus central dans les mécanismes de l'insomnie. Les modèles se différencient cependant au regard de l'importance et du rôle des variables expliquant cet hyperéveil. Les modèles comportementaux et cognitifs décrivent les comportements d'autoentretien et les pensées dysfonctionnelles, de types soucis et inquiétudes concernant le sommeil et les conséquences de l'insomnie. Des altérations des processus cognitifs en lien avec l'hyperéveil dans les domaines perceptuels et mnésiques peuvent expliquer ces comportements et pensées. Les modèles neurobiologiques retrouvent une instabilité de la balance éveil/sommeil avec une possible implication de l'orexine, qui reste à confirmer. Le diagnostic de l'insomnie doit tenir compte de la sémiologie en lien avec ses mécanismes, tout en tenant compte des comorbidités.

CARECOS study: Medical students' empathy as assessed with the CARE measure by examiners versus standardized patients during a formative Objective and Structured Clinical Examination (OSCE) station.

PURPOSE: To assess the Consultation And Relational Empathy (CARE) measure as a tool for examiners to assess medical students' empathy during Objective and Structured Clinical Examinations (OSCEs), as the best tool for assessing empathy during OSCEs remains unknown. METHODS: We first assessed the psychometric properties of the CARE measure, completed simultaneously by examiners and standardized patients (SP, either teachers - SPteacher - or civil society members - SPcivil society), for each student, at the end of an OSCE station. We then assessed the qualitative/quantitative agreement between examiners and SP. RESULTS: We included 129 students, distributed in eight groups, four groups for each SP type. The CARE measure showed satisfactory psychometric properties in the context of the study but moderate, and even poor inter-rater reliability for some items. Considering paired observations, examiners scored lower than SPs (p < 0.001) regardless of the SP type. However, the difference in score was greater when the SP was a SPteacher rather than a SPcivil society (p < 0.01). CONCLUSION: Despite acceptable psychometric properties, inter-rater reliability of the CARE measure between examiners and SP was unsatisfactory. The choice of examiner as well as the type of SP seems critical to ensure a fair measure of empathy during OSCEs.

Exploring seasonality in catatonia diagnosis: Evidence from a large-scale population study.

Catatonia is a severe psychomotor syndrome mainly associated with psychiatric disorders, such as mood disorders and schizophrenia. Seasonal patterns have been described for these psychiatric disorders, and a previous study conducted in South London showed for the first time a seasonal pattern in the onset of catatonia. In this study, we aim to extend those findings to a larger national sample of patients admitted to French metropolitan hospitals, between 2015 and 2022, and to perform subgroup analyses by the main associated psychiatric disorder. A total of 6225 patients diagnosed with catatonia were included. A seasonal pattern for catatonia diagnosis was described, using cosinor models. Two peaks of diagnoses for catatonic cases were described in March and around September-October. Depending on the associated psychiatric disorder, the seasonality of catatonia diagnosis differed. In patients suffering with mood disorders, peaks of catatonia diagnosis were found in March and July. For patients suffering with schizophrenia, no seasonal pattern was found.

Clinical usefulness of dual orexin receptor antagonism beyond insomnia: Neurological and psychiatric comorbidities.

Orexin is a neurotransmitter produced by a small group of hypothalamic neurons. Besides its well-known role in the regulation of the sleep-wake cycle, the orexin system was shown to be relevant in several physiological functions including cognition, mood and emotion modulation, and energy homeostasis. Indeed, the implication of orexin neurotransmission in neurological and psychiatric diseases has been hypothesized via a direct effect exerted by the projections of orexin neurons to several brain areas, and via an indirect effect through orexin-mediated modulation of sleep and wake. Along with the growing evidence concerning the use of dual orexin receptor antagonists (DORAs) in the treatment of insomnia, studies assessing their efficacy in insomnia comorbid with psychiatric and neurological diseases have been set in order to investigate the potential impact of DORAs on both sleep-related symptoms and disease-specific manifestations. This narrative review aimed at summarizing the current evidence on the use of DORAs in neurological and psychiatric conditions comorbid with insomnia, also discussing the possible implication of modulating the orexin system for improving the burden of symptoms and the pathological mechanisms of these disorders. Target searches were performed on PubMed/MEDLINE and Scopus databases and ongoing studies registered on Clinicaltrials.gov were reviewed. Despite some contradictory findings, preclinical studies seemingly support the possible beneficial role of orexin antagonism in the management of the most common neurological and psychiatric diseases with sleep-related comorbidities. However, clinical research is still limited and further studies are needed for corroborating these promising preliminary results.

Content analysis of insomnia questionnaires: A step to better evaluate the complex and multifaceted construct of insomnia disorder.

Insomnia disorder is a mental disorder that includes various types of symptoms (e.g., insomnia initiating, worries, mood disturbances) and impairments (e.g., distress related to sleep alterations). Self-report questionnaires are the most common method for assessing insomnia but no systematic quantified analysis of their content and overlap has been carried out. We used content analysis and a visualization method to better identify the different types of clinical manifestations that are investigated by nine commonly used insomnia questionnaires for adults and the Jaccard index to quantify the degree to which they overlap. Content analysis found and visualized 16 different clinical manifestations classified into five dimensions ("Insomnia symptoms", "Insomnia-related symptoms", "Daytime symptoms", "Insomnia-related impairments", "Sleep behaviors"). The average Jaccard Index was 0.409 (moderate overlap in content). There is a lack of distinction between symptoms and impairments, and the assessment of sleep duration and hyperarousal symptoms remains overlooked. This preliminary analysis makes it possible to visualize the content of each of the nine questionnaires and to select the most appropriate questionnaire based on the issue to be addressed. Suggestions are made regarding the development of future questionnaires to better distinguish symptoms and impairments, and the different phenotypes of insomnia disorder.

Sleep Deprivation and Insomnia in Adolescence: Implications for Mental Health.

Sleep changes significantly throughout the human lifespan. Physiological modifications in sleep regulation, in common with many mammals (especially in the circadian rhythms), predispose adolescents to sleep loss until early adulthood. Adolescents are one-sixth of all human beings and are at high risk for mental diseases (particularly mood disorders) and self-injury. This has been attributed to the incredible number of changes occurring in a limited time window that encompasses rapid biological and psychosocial modifications, which predispose teens to at-risk behaviors. Adolescents' sleep patterns have been investigated as a biunivocal cause for potential damaging conditions, in which insufficient sleep may be both a cause and a consequence of mental health problems. The recent COVID-19 pandemic in particular has made a detrimental contribution to many adolescents' mental health and sleep quality. In this review, we aim to summarize the knowledge in the field and to explore implications for adolescents' (and future adults') mental and physical health, as well as to outline potential strategies of prevention.

Emotional Exhaustion, a Proxy for Burnout, Is Associated with Sleep Health in French Healthcare Workers without Anxiety or Depressive Symptoms: A Cross-Sectional Study.

Burnout is frequent among healthcare workers, and sleep problems are suspected risk factors. The sleep health framework provides a new approach to the promotion of sleep as a health benefit. The aim of this study was to assess good sleep health in a large sample of healthcare workers and to investigate its relationship with the absence of burnout among healthcare workers while considering anxiety and depressive symptoms. A cross-sectional Internet-based survey of French healthcare workers was conducted in summer 2020, at the end of the first COVID-19 lockdown in France (March to May 2020). Sleep health was assessed using the RU-SATED v2.0 scale (RegUlarity, Satisfaction, Alertness, Timing, Efficiency, Duration). Emotional exhaustion was used as a proxy for overall burnout. Of 1069 participating French healthcare workers, 474 (44.3%) reported good sleep health (RU-SATED > 8) and 143 (13.4%) reported emotional exhaustion. Males and nurses had a lower likelihood of emotional exhaustion than females and physicians, respectively. Good sleep health was associated with a 2.5-fold lower likelihood of emotional exhaustion and associations persisted among healthcare workers without significant anxiety and depressive symptoms. Longitudinal studies are needed to explore the preventive role of sleep health promotion in terms of the reduction in burnout risk.

Systematic Item Content and Overlap Analysis of Self-Reported Multiple Sleep Disorder Screening Questionnaires in Adults.

Sleep disorders are defined on the basis of diagnostic criteria presented in medical classifications. However, no consensus has emerged on the exact list of operational symptoms that should be systematically investigated in the field of sleep medicine. We propose a systematic analysis of sleep symptoms that figure in a set of self-reported multiple sleep disorder screening questionnaires for adult populations, to identify the content overlap of symptoms that probe the presence of central sleep symptoms, and to highlight the potential level of heterogeneity among sleep disorder questionnaires. The method comprises three steps: (i) the selection of self-reported multiple sleep disorder screening questionnaires; (ii) item extraction and selection; (iii) the extraction of symptoms from items. Frequency of sleep symptoms and content overlap (Jaccard Index) are analyzed. We extracted 469 items that provide 60 different symptoms from 12 questionnaires. Insomnia, somnolence, and sleep-related breathing symptoms were found in all the questionnaires. The mean overlap among all questionnaires evaluated with the Jaccard Index is 0.44, i.e., moderate similarity. Despite limitations related to the selection of questionnaires and the symptom extraction and harmonization, this study underlines the need to standardize sleep symptom contents for sleep medicine in order to enhance the practicability, reliability, and validity of sleep disorder diagnoses.

Better characterizing sleep beliefs for personalized sleep health promotion: the French sleep beliefs scale validation study.

Background: The Sleep Beliefs Scale (SBS) is a well-known tool to design and monitor personalized sleep health promotion at an individual and population level. The lack of an established French version limits the development of effective interventions targeting these populations. Thus, the aim of this study was to validate the French version of the SBS in a representative sample of the general population. Methods: Quota sampling was used to recruit 1,004 participants (18-65 years, mean age: 43 years, 54% of female) who underwent an online survey to complete the SBS, and to assess sleep schedules, sleep quality and disorders, and mental health. Cronbach's α coefficient, confirmatory factor analysis, item-internal consistency (IIC), and item discriminant validity (IDV) of the SBS were computed to assess internal validity while bivariate associations with sleep schedules, sleep quality and disorders, and mental health were used to assess external convergent and discriminant validity. Results: The mean score on the SBS was 12.3 ± 4.9. Item 19 ("Quiet & Dark") showed the highest rate of correct answers (n = 801, 79.8%), while item 20 ("Recovering sleep") showed the lowest rate of correct answers (n = 246, 24.5%). Overall, the SBS showed satisfactory internal consistency (α = 0.87) and confirmed the three-factor structure proposed by the original study. All items were found consistent (IIC > 0.4) and discriminant (IIC > IDV) except for item 20 ("recovering lost sleep by sleeping for a long time"). Females, older participants, and subjects with short time-in-bed, poor sleep quality, insomnia, and circadian rhythm disorder had higher SBS scores while participants with depressive symptoms had lower SBS scores. Conclusion: We successfully translated and validated the French version of the SBS in a representative sample, making it a reliable instrument for researchers and clinicians to assess and target sleep beliefs. Correct answers vary from 25 to 80% which underlines the importance of continuing sleep health promotion campaigns by targeting poorly understood behaviors. Our findings also shed light on the fickleness of beliefs that are prone to vary within individuals across time, in step with societal changes. Several associated factors were identified, thus contributing to our understanding of sleep beliefs and offering insights for personalized approaches to enhance sleep health and overall well-being.

Gender-related associations between psychiatric disorders and alcohol use disorder: Findings from the french "Mental health in the general population" survey.

Women with alcohol use disorder (AUD) might be particularly vulnerable to psychiatric comorbidities. However, population surveys have yielded disparate findings. We used data from the French Mental Health in the General Population survey to investigate gender-related risks of psychiatric comorbidities associated with AUD. A cross-sectional survey based on face-to-face interviews, including the Mini International Neuropsychiatric Interview, was conducted among 38,717 subjects. Logistic regression models were used to assess risks of psychiatric comorbidities associated with AUD. After adjustment for socio-demographics and other psychiatric disorders, both women and men with AUD were at higher risk of comorbid depressive disorder (odds ratio [OR] = 2.6, 95% confidence interval [CI]: 2.0-3.4 in women, and OR = 2.0, 95% CI: 1.7-2.4 in men), bipolar I disorder (2.5; 1.4-4.4 in women vs. 2.6; 1.9-3.4 in men), and psychotic disorder (1.6; 1.01-2.5 in women vs. 1.8; 1.4-2.3 in men). Women with AUD exhibited an increased risk of comorbid panic disorder (OR = 1.6, 95% CI: 1.1-2.2) while the increased risk of post-traumatic stress disorder (PTSD) was significant in men only (OR = 2.6, 95% CI: 1.6-4.2). The increased risk of comorbid substance use disorder (SUD) was more elevated in women, compared to men (12.9; 8.1-18.1 vs. 4.8; 4.0-5.8 in men). Most of psychiatric conditions were over-represented in both women and men with AUD, relative to controls. Gender-specific findings were that women with AUD had an increased risk of comorbid SUD or panic disorder, while men had a significantly higher risk of comorbid PTSD.

A Systematic Review of Sleep-Wake Disorder Diagnostic Criteria Reliability Studies.

The aim of this article is to provide a systematic review of reliability studies of the sleep-wake disorder diagnostic criteria of the international classifications used in sleep medicine. Electronic databases (ubMed (1946-2021) and Web of Science (-2021)) were searched up to December 2021 for studies computing the Cohen's kappa coefficient of diagnostic criteria for the main sleep-wake disorder categories described in the principal classifications. Cohen's kappa coefficients were extracted for each main sleep-wake disorder category, for each classification subtype, and for the different types of methods used to test the degree of agreement about a diagnosis. The database search identified 383 studies. Fifteen studies were analyzed in this systematic review. Insomnia disorder (10/15) and parasomnia disorder (7/15) diagnostic criteria were the most studied. The reliability of all sleep-wake disorders presented a Cohen's kappa with substantial agreement (Cohen's kappa mean = 0.66). The two main reliability methods identified were "test-retest reliability" (11/15), principally used for International Classification of Sleep Disorders (ICSD), and "joint interrater reliability" (4/15), principally used for Diagnostic and Statistical Manual of Mental Disorders (DSM) subtype diagnostic criteria, in particularl, the DSM-5. The implications in terms of the design of the methods used to test the degree of agreement about a diagnosis in sleep medicine are discussed.

Insomnia evaluation and treatment during peripartum: a joint position paper from the European Insomnia Network task force "Sleep and Women," the Italian Marcè Society and international experts task force for perinatal mental health.

Insomnia symptoms are frequent during peripartum and are considered risk factors for peripartum psychopathology. Assessing and treating insomnia and related conditions of sleep loss during peripartum should be a priority in the clinical practice. The aim of this paper was to conduct a systematic review on insomnia evaluation and treatment during peripartum which may be useful for clinicians. The literature review was carried out between January 2000 and May 2021 on the evaluation and treatment of insomnia during the peripartum period. The PubMed, PsycINFO, and Embase electronic databases were searched for literature published according to the PRISMA guidance with several combinations of search terms "insomnia" and "perinatal period" or "pregnancy" or "post partum" or "lactation" or "breastfeeding" and "evaluation" and "treatment." Based on this search, 136 articles about insomnia evaluation and 335 articles on insomnia treatment were found and we conducted at the end a narrative review. According to the inclusion/exclusion criteria, 41 articles were selected for the evaluation part and 22 on the treatment part, including the most recent meta-analyses and systematic reviews. Evaluation of insomnia during peripartum, as for insomnia patients, may be conducted at least throughout a clinical interview, but specific rating scales are available and may be useful for assessment. Cognitive behavioral therapy for insomnia (CBT-I), as for insomnia patients, should be the preferred treatment choice during peripartum, and it may be useful to also improve mood, anxiety symptoms, and fatigue. Pharmacological treatment may be considered when women who present with severe forms of insomnia symptoms do not respond to nonpharmacologic therapy.

Efficacy and safety of topiramate for reducing impulsivity: A transdiagnostic systematic review and meta-analysis of a common clinical use.

Impulsivity is an important transdiagnostic feature of many psychiatric disorders, as well as a marker of poorer outcome. Topiramate is broadly used for reducing impulsivity in various neuropsychiatric disorders, but no systematic review or meta-analysis has ever explored whether evidence supports this clinical use. We conducted a systematic review and meta-analysis of the literature, using PubMed, PsycInfo and Cochrane databases. We included all studies assessing the efficacy of topiramate in adults with high levels of impulsivity, based on either psychometric or neuropsychological measures. Seven articles were included, involving 578 participants. Important heterogeneity in designs and quality features was observed. Topiramate lowered impulsivity levels in two of the studies that used the Barratt Impulsiveness Scale (BIS) (401 participants) and in one of the studies that used neuropsychological measures (63 participants). Four other studies found no effect of topiramate on impulsivity. A larger reduction in the BIS-11 overall score, with a mean difference of 2.57 (95% confidence interval -4.12 to -1.02), was found in the topiramate group than the placebo group using a random effects model. However, one study accounted for the major part (85.5%) of it, and most included studies presented a high risk of bias. The use of a self-assessment scale induced an additional risk of self-report bias. No clear-cut evidence was found for a transdiagnostic effectiveness of topiramate in reducing impulsivity levels. However, encouraging results were found in some specific disorders.

Sleep Markers in Psychiatry: Do Insomnia and Disturbed Sleep Play as Markers of Disrupted Neuroplasticity in Mood Disorders? A Proposed Model.

INTRODUCTION: Since insomnia and disturbed sleep may affect neuroplasticity, we aimed at reviewing their potential role as markers of disrupted neuroplasticity involved in mood disorders. METHODS: We performed a systematic review, according to PRIMA, on PubMed, PsycINFO and Embase electronic databases for literature regarding mood disorders, insomnia, sleep loss/deprivation in relation to different pathways involved in the impairment of neuroplasticity in mood disorders such as (1) alterations in neurodevelopment (2) activation of the stress system (3) neuroinflammation (4) neurodegeneration/neuroprogression, (5) deficit in neuroprotection. RESULTS: Sixty-five articles were analyzed and a narrative/ theoretical review was conducted. Studies showed that insomnia, sleep loss and sleep deprivation might impair brain plasticity of those areas involved in mood regulation throughout different pathways. Insomnia and disrupted sleep may act as neurobiological stressors by over-activating the stress and inflammatory systems, which may affect neural plasticity causing neuronal damage. In addition, disturbed sleep may favor a deficit in neuroprotection hence contributing to impaired neuroplasticity. CONCLUSION: Insomnia and disturbed sleep may play a role as markers of alteration in brain plasticity in mood disorders. Assessing and targeting insomnia in the clinical practice may potentially play a neuroprotective role, contributing to "repairing" alterations in neuroplasticity or to the functional recovery of those areas involved in mood and emotion regulation.

Why do sleep disorders belong to mental disorder classifications? A network analysis of the "Sleep-Wake Disorders" section of the DSM-5.

This article proposes to investigate how Sleep disorders have been conceptualized within the DSM-5 through symptom network analysis of the diagnostic criteria of the "Sleep-Wake Disorders" section in the DSM-5. We hypothesize that the analysis of the most central symptoms will allow us to better analyze the position of Sleep disorders in Mental disorders. We thus i) extracted the symptoms of the DSM-5 diagnostic criteria of Sleep-Wake disorders, ii) built the Sleep-Wake disorder DSM-5 network representation, and iii) quantified its structure at local and global levels using classical symptom network analysis. Thirty-four different symptoms were identified among the 53 DSM-5 diagnostic criteria of the 9 main disorders of the "Sleep-Wake Disorders" section. The symptom network structure of this section showed that the most central sleep symptoms are "Daytime Sleepiness", the Insomnia symptoms group ("Insomnia initiating", "Insomnia maintaining" and "Non-restorative sleep"), and Behavioral sleep symptoms (such as "Altered oniric activity", "Ambulation", "Abnormal responsiveness"). This network analysis shown that the belonging of Sleep-Wake disorders in the DSM-5 have been associated with central sleep symptoms considered as "Mental", given their phenomenality (qualitative nature of the experience) and subjectivity (in personal mental lives). Such a symptom network analysis can serve as an organizing framework to better understand the complexity of Sleep-Wake disorders by promoting research to connect the architecture of the symptom network to relevant biological, psychological and sociocultural factors.

Early Life Stress and Chronobiological Rhythms Desynchronization: Possible Impact on Mood Symptoms and Suicidal Ideation in Bipolar Disorder.

ABSTRACT: The study aimed at investigating the potential impact of early stressful events on the clinical manifestations of bipolar disorder (BD). A sample of 162 adult individuals with BD was assessed using the Structural Clinical Interview for DSM-5, the Beck Depression Inventory-II, the Young Mania Rating Scale, the Early Trauma Inventory Self Report-Short Form, the Biological Rhythms Interview of Assessment in Neuropsychiatry, the Insomnia Severity Index, and the Scale for Suicide Ideation. A significant path coefficient indicated a direct effect of early life stressors on biological rhythms (coeff. = 0.26; p < 0.001) and of biological rhythms on depressive symptoms (coeff. = 0.5; p < 0.001), suicidal risk (coeff. = 0.3; p < 0.001), and insomnia (coeff. = 0.34; p < 0.001). Data suggested that the desynchronization of chronobiological rhythms might be one mediator of the association between early life stress and the severity of mood symptoms/suicidal ideation in BD. Addressing circadian rhythm alterations in subjects exposed to early stressors would help in preventing consequences of those stressors on BD.

Predictors of Suicidal Ideation and Preparatory Behaviors in Individuals With Bipolar Disorder: The Contribution of Chronobiological Dysrhythmicity and Its Association With Hopelessness.

OBJECTIVE: To examine the role of chronobiological dysrhythmicity in suicidal ideation and behaviors and its relation with hopelessness. METHODS: One hundred twenty-seven patients (77 females, mean age of 47.4 ± 12.5 years) with a major depressive episode and bipolar disorder (BD) type I or II (according to Structured Clinical Interview for DSM-5 assessment) were recruited in 2019 and assessed for depressive and manic symptoms (Beck Depression Inventory-II, Young Mania Rating Scale) and with the Biological Rhythms Interview of Assessment in Neuropsychiatry, Beck Hopelessness Scale, and Scale for Suicide Ideation. Univariate regression and mediation analyses were performed. RESULTS: Forty-one patients (32.3%) showed clinically significant suicidal ideation and were more frequently affected by BD type I (P = .029) with mixed features (P = .022). Compared to nonsuicidal individuals, they had significantly more depressive symptoms (P = .019), higher emotional component of hopelessness (P = .037), and higher dysrhythmicity of sleep (P = .009), activities (P = .048), and social life (P = .019). Passive and active suicidal ideation and suicidal plans were best predicted by dysrhythmicity of sleep and social life. Dysrhythmicity of sleep and social life mediated the direct effect of depressive symptoms on passive and active suicidal ideation and also of active ideation on suicidal plans. The emotional component of hopelessness was related to dysrhythmicity of social life and mediated its effect on suicidal plans (P = .010). CONCLUSIONS: Chronobiological alterations directly contributed to passive and active suicidal ideation and to suicidal preparation, with a key role of dysrhythmicity of sleep, activities, and social life. Chronobiological alterations also impacted the emotional component of hopelessness, hence indirectly contributing to suicidal ideations and plans. These findings call for the systematic screening of these dysrhythmicity dimensions when considering suicidal risk in individuals with BD.

Association between coffee, tobacco, and alcohol daily consumption and sleep/wake cycle: an actigraphy study in euthymic patients with bipolar disorders.

Individuals with bipolar disorder (BD) have higher than average rates of coffee, tobacco and alcohol use. These substances may have deleterious effects on sleep quality and quantity, which may destabilize sleep/wake cycles and negatively impact the clinical course and prognosis of BD. The use of these substances may also be perceived as a self-medication attempt, for example, to induce sleep or to increase vigilance during the day. The objective of the current study was to investigate associations between the self-reported daily use of coffee, tobacco, and alcohol, and objective measures of sleep and activity patterns in adult individuals with BD. A sample of 147 euthymic individuals with BD were assessed for daily coffee, tobacco and alcohol consumption and 21 days of actigraphy monitoring. Actigraphic measures of sleep quantity and daytime activity were compared between groups classified as coffee+/coffee-, tobacco+/tobacco- and alcohol+/alcohol-, defined according to their current daily use. Then, we examined potential correlations between sleep/wake cycle parameters and the amount of daily consumption of each substance. Multivariable analyses identified associations between the use of coffee, tobacco, and alcohol and several sleep and activity parameters, such as between coffee, alcohol, and the relative amplitude of activity (respectively, p = .003 and p = .005), between alcohol and M10 onset (onset time of the 10 most active hours during the 24-h cycle) (p = .003), and between coffee and sleep duration (p = .047). This study supports the hypothesis that there is a relationship, whose direction would be bidirectional, between the daily use of these substances and the sleep/wake cycle in euthymic individuals with BD. These preliminary results require replications in other retrospective and prospective samples. They may have a clinical impact on psycho-education strategies to be proposed to individuals with BD.