CBT insomnia treatment provides insights into psychosis causes and prevention in adolescents

Sleep disturbance has been recognised as a key clinical feature of schizophrenia since the disorder's earliest conceptualisations at the start of the 1900s. 1 Kraepelin E Barclay RM Robertson GM Dementia praecox and paraphrenia. E & S Livingstone, Edinburgh1919 Google Scholar In the intervening century, an extensive literature has confirmed the high prevalence of sleep complaints among individuals with psychosis and their exacerbating effect on clinical and functional impairments. 2 Ferrarelli F Sleep abnormalities in schizophrenia: state of the art and next steps. Am J Psychiatry. 2021; 178: 903-913 Crossref PubMed Scopus (27) Google Scholar However, only in the past decade has research focused on investigating sleep disturbances before psychosis onset (ie, among adolescents at clinical high risk of psychosis). By examining sleep during the prodromal period, researchers have hoped to answer two primary questions. The first question, regarding the aetiology of psychosis, is whether sleep has a role in driving psychosis onset during adolescence, 3 Lunsford-Avery JR Mittal VA Sleep dysfunction prior to the onset of schizophrenia: a review and neurodevelopmental diathesis-stress conceptualization. Clin Psychol Sci Pract. 2013; 20: 291-320 Crossref Scopus (44) Google Scholar and indeed, accumulating evidence supports the pervasiveness of sleep complaints in clinical high-risk populations and longitudinal associations with worsened clinical outcomes. 4 Clarke L Chisholm K Cappuccio FP et al. Sleep disturbances and the at risk mental state: a systematic review and meta-analysis. Schizophr Res. 2021; 227: 81-91 Crossref PubMed Scopus (15) Google Scholar Equally important is a second question regarding prevention: what if identifying and treating sleep disturbances could alter prognostic trajectories for adolescents at clinical high risk of psychosis, reducing psychosis and affective symptoms, improving cognition, and enhancing quality of life in the long term? 3 Lunsford-Avery JR Mittal VA Sleep dysfunction prior to the onset of schizophrenia: a review and neurodevelopmental diathesis-stress conceptualization. Clin Psychol Sci Pract. 2013; 20: 291-320 Crossref Scopus (44) Google Scholar It would be—in a word—game-changing. A targeted psychological treatment for sleep problems in young people at ultra-high risk of psychosis in England (SleepWell): a parallel group, single-blind, randomised controlled feasibility trialA randomised controlled trial of a targeted psychological sleep therapy for young people at ultra-high risk of psychosis is feasible. Patients can be retained in the trial and assessments done by masked assessors. Uptake of the sleep therapy was high, and we found preliminary evidence of sustained reductions in sleep problems. A definitive multicentre trial is now needed. Full-Text PDF Open Access