Chronotype and sleep quality in forensic psychiatric patients with schizophrenia: exploring their interplay with aggressive and impulsive traits

Objective: This study aimed to investigate the relationships between chronotype, sleep quality, and aggressive and impulsive traits in forensic psychiatric inpatients with schizophrenia. Method:A cross-sectional, observational study was conducted with 71 male forensic psychiatric inpatients diagnosed with schizophrenia.Participants completed self-report scales for chronotype using the Morningness-Eveningness Questionnaire, sleep quality using the Pittsburgh Sleep Quality Index (PSQI), aggression using the Buss-Warren Aggression Questionnaire, and impulsivity using the Barratt Impulsiveness Scale. Results:The results indicated that 37% of participants had an evening chronotype, and 55% were classified as poor sleepers (PSQI>5).Eveningness was associated with poorer sleep quality, increased indirect aggression, and higher levels of attentional impulsivity.Poor sleep quality was linked to most aggressive and impulsive traits.Mediation analysis demonstrated that indirect aggression mediated the relationship between chronotype and attentional impulsivity, with greater eveningness associated with higher levels of indirect aggression, which, in turn, increased attentional impulsivity. Conclusion:The findings underscore the significance of chronotype and sleep quality in shaping aggressive and impulsive traits in forensic psychiatric inpatients with schizophrenia.Indirect aggression partially mediated the relationship between chronotype and attentional impulsivity, highlighting the intricate interplay between circadian rhythms, emotion regulation, and cognition.Strategies aimed at correcting circadian misalignment and enhancing sleep quality may aid in managing aggressive and impulsive behaviors in this vulnerable population.