Supervisors info:
Ιωάννης Μιχόπουλος, Αναπληρωτής Καθηγητής, Τμήμα Ιατρικής, ΕΚΠΑ, Επιβλέπων
Αθανάσιος Δουζένης, Καθηγητής, Τμήμα Ιατρικής, ΕΚΠΑ
Θωμάς Παπαρρηγόπουλος, Καθηγητής, Τμήμα Ιατρικής, ΕΚΠΑ
Summary:
Introduction: Insomnia is a frequent disorder with a significant impact on patients’ quality of life and is associated with a multitude of psychiatric diseases. In addition, insomnia interacts with personality traits that forensic patients often present, such as aggression and impulsivity, with which it appears to share some pathophysiological routes. One example among them is the reduced function of the frontal cortex. The international literature concerning the sleep of forensic patients as well as the factors responsible for the sleep disorder is currently limited.
Purpose: This study aims to highlight factors that influence insomnia in a human forensic patient group while focusing on the impact of aggression and impulsivity. To illustrate this relationship, as well as other factors that might affect insomnia of forensic patients, a comparison is made with a group of hospitalised psychiatric patients as well as with a group of patients with diagnosed insomnia.
Method: A total of 91 adults participated in the study. The reference group was composed of thirty persons followed by the Forensic Psychiatry Unit at Attikon University General Hospital (Athens, Greece). The second group was made of thirty patients of the Second University Psychiatric Clinic of Attikon Hospital. The third group was composed of thirty one outpatients with insomnia followed by the Insomnia Unit in the Aiginiteio Hospital (Athens). All patients were asked to respond in writing to a self-completion questionnaire on their socio-demographic data and their medical history. They then were asked to complete four questionnaires to detect insomnia, depression and anxiety, impulsivity and aggression (AIS, HADS, BIS-11, AQ).
Results: A strong positive correlation was found between insomnia and aggression and impulsivity in forensic patients, a positive correlation in psychiatric patients and no correlation in patients with a diagnosed insomnia. The average change of insomnia square root value appeared to be affected by both impulsivity and aggression; it did not appear to be affected, though, by aggression when other statistically relevant factors were present. The other factors involved in the average change of insomnia score are the intake of medication disrupting sleep, the presence of stress and the group. Each one of them was checked in the presence of the other statistically relevant factors. Impulsivity appeared also to have a greater impact on the insomnia score in the group of forensic patients compared to the other two groups.
Conclusions: The findings of this study confirm the strong impact of aggression and, most importantly, impulsivity on the insomnia of forensic patients, thus differentiating them for the two other groups being studied, that is to say, psychiatric patients and patients with diagnosed insomnia. It has to be stressed that there is a significant variation in the causal association of insomnia depending on the population as well as a need for an individualised approach taking into account the specific traits of forensic patients. Consequently, additional studies are necessary to further investigate this matter.
Keywords:
Insomnia, Forensic patients, Aggression, Impulsivity
