@article{ref1,
title="Improved insomnia is one pathway underlying the anti-suicidal properties of clozapine",
journal="Suicide and life-threatening behavior",
year="2024",
author="Vayalapalli, Ankita and McCall, William V. and McEvoy, Joseph P. and Miller, Brian J.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND: Insomnia is common in schizophrenia and associated with suicide. Clozapine has anti-suicidal properties and beneficial effects on sleep. Whether effects on insomnia mediate the anti-suicidal properties of clozapine remains unclear. <br><br>METHODS: In n = 76 patients from the Clinical Antipsychotic Trials of intervention effectiveness schizophrenia trial using a within-subjects design, we investigated whether improvement in terminal insomnia was associated with improvement in suicidal ideation (SI) after treatment with non-clozapine antipsychotics, and then after treatment with clozapine, using binary logistic regression. Terminal insomnia and SI over the past 2 weeks were assessed before and after both non-clozapine antipsychotic and clozapine treatment with the Calgary Depression Scale for Schizophrenia. <br><br>RESULTS: There was no association between improved terminal insomnia and resolution of SI after treatment with non-clozapine antipsychotics (OR = 0.2, 95% CI 0.0-9.0, p = 0.41). In the same patients, improved terminal insomnia was associated with resolution of SI after clozapine treatment (OR = 14.6, 95% CI 1.7-129.2, p = 0.02). <br><br>CONCLUSIONS: Improved terminal insomnia is associated with improved SI following clozapine treatment. <br><br>FINDINGS warrant replication in a larger sample with standard instruments in the assessment of insomnia and suicide, but suggest beneficial effects on sleep as a mediator of the anti-suicidal properties of clozapine. Future mechanistic studies are also needed.<p /> <p>Language: en</p>",
language="en",
issn="0363-0234",
doi="10.1111/sltb.13099",
url="http://dx.doi.org/10.1111/sltb.13099"
}