Important research on clinical perceptions of sedation in psychosis - please take part and circulate if you can! 🙏.

Exciting new paper out today in BJClinPsy reporting a qualitative analysis of excessive sleep in psychosis. Hugely interesting work by @UEA_ClinPsyD trainee Kate Robbins supervised by myself and @johodgekins - please read and share!

Epic work here from @CpsyhR & Better Sleep Programme team (which I am privileged to support). Paper out in BJClinPsy - - reporting on implementation of a sleep intervention within youth MH services across a whole region of the UK. Several steps ahead!.

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Congratulations (again!) to Aviva on a cracking paper and thank you to Sheri Oduola - also not on twitter - for her support in this project as well. and well done you, for making it through this thread!.

Given the bevvy of evidence supporting sleep interventions as feasible and effective in SMI groups this seems like something worth working on (!), which includes thinking about making sleep assessment/treatment more accesible and adapted for SMI settings, and widening training.

In summary, there continues to be a big implementation gap around sleep in SMI. Despite sleep being identified in lots of patients records as linked to their MH issues, it's not being properly addressed or treated - which is a missed opportunity for patients and clinicians.

There was also some interesting inpatient/outpatient differences- outpatients were less likely to receive treatment for their sleep issues, inpatients were more likely to have non-recommended treatments - this makes sense based on settings, but indicates some work needed!.

As a psychologist, I have to add that the 9% offered recommended treatment is mostly sleep hygiene , with only 3 patients being offered CBT for insomnia (out of 203!), despite lots of evidence supporting efficacy in SMI groups.

Only 43% of those 203 with a sleep issue were offered any treatment, and only 9% were offered a NICE-recommended treatment. Most of this gap was non-sleep medications (e.g. antipsychotics) being used for sleep, or sleep medications being used without CBT/sleep hygiene.

Of the 203 patients where a sleep issue was mentioned, for 84% of them detail was very limited -'sleeps poorly', 'bad sleep', 'problems sleeping' - not including hrs slept, specific sleep disorders, triggers, impacts or other relevant clinical information.

The data used is a 1yr snapshot (09/21-09/22) and captures all patient questionnaires, templates, and structured clinical forms (risk assessment, CPA, etc.) - sadly routine progress notes and letters etc. weren't included, but this still gave us a huge amount of data to look at.

(we also tested whether sleep problems being related to lower appointment attendance and more appointments needing to be scheduled, no sig associations were found. but also the appointment data was quite sparse due to clinical systems changing - a challenge of real-world data!).

So, based off of anonymised clinical records gathered in CPFT (via the CRATE system), Aviva identified all the SMI patient records mentioning sleep problems and assessed a) how sleep problems were described and b) what was used to treat them (vs NICE guidlines for sleep problems).

. but these conclusions are based on those who respond to a survey about sleep, so potentially not representative. We also know that specific sleep treatments for SMI patients are not routinely offered, but we don't know details of whats happening instead.