Sleep and circadian rhythm alterations and suicidal ideation in depressed patients: results from a prospective cohort study.
Pr Llorca is Professor of Psychiatry at the University Clermont Auvergne (UCA) in Clermont-Ferrand, France. He is at the head of the Psychiatric Department in the University Medical Center in Clermont-Ferrand. He is the Past President of the Ethics Committee of Auvergne. He is member of the French Society for Biological Psychiatry and Neuropsychopharmacology, of the European Psychiatric Association and of the World Federation for Biological Psychiatry. He is a member of the executive committee of the French Foundation for Mental Health “FondaMental”, and the national coordinator of the 4 French Networks of the “FondaMental” Expert Centers (Schizophrenia, Bipolar, Asperger and Treatment Resistant Depression).
His research interests include pharmacodynamic and pharmacokinetic approaches of psychotropics - and more specifically antipsychotics and antidepressants -, determinants of adherence to treatment (e.g., attitudes and beliefs related to treatment).
He is the Principal Investigator of the PsyCoh Schizophrenia Project (French cohort of schizophrenia patients), and leader of the Work Package 1 (French Minds Cohort) of the ProPSY project,both funded by the PIA (Programme Investissement d’Avenir). He is co-director of the theme “Image and Connectomics in Clinical Neurosciences” (ICCN) in Research Unit UMR CNRS UCA 6602 - Institut Pascal.
He is the coordinator of the Research Axis for Neuroscience of Clermont University Hospital. He coordinates with Prof Jardri (Lille) F-PsyNET, a national research network for Psychotic Disorders labelled by INSERM in 2022.
He published more than 440 articles in peer-review journals.
Bipolar Disorder (BD) patients experience disturbances of sleep and circadian rhythms during acute episodes, but also during remission phases, marked by abnormalities in sleep quality and quantity, and greater variability in sleep/wake rhythms. These patients frequently suffer from comorbid sleep disorders, including obstructive sleep apnea-hypopnea syndrome (OSAHS), restless legs syndrome, delayed sleep phase, chronic insomnia, excessive daytime sleepiness, with a frequency from 5 to 50% regarding the disorder.
We conducted 2 observational studies (longitudinal and cross-sectional), in two samples of euthymic BD patients.
In the first study (FACE-BD), patients (n=4422) were deeply phenotyped. We prospectively collected clinical, cognitive, and biological variables, relying on a network of Bipolar expert centers throughout France. In these patients, sleep disorders are correlated with emotional reactivity and have significant impact on functioning in a longitudinal perspective.
Poor sleep quality is also associated with suicide attempts and suicidal ideation.
The second one (Ophtymum), is a cross sectional study (n=525) evaluating residual mood symptoms and cognitive symptoms, sleep quality, chronotype and functioning. Residual sleep disturbances primarily affect the perceived cognitive performance of euthymic BD patients. Sleep disturbances are indirectly associated with functional impairment via the residual depressive symptoms and perceived cognitive performance. Regarding treatment, euthymic BD I patients taking Li have better sleep efficiency and longer sleep duration than patients not receiving Li.
These results from observational studies, highlight the importance of sleep quality evaluation, and the development of specific treatment strategies, according to the correlation with emotional reactivity and functioning. Intervention studies are needed to explore physiopathology and causality.