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

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.