Sleep and circadian difficulties in schizophrenia: presentations, understanding, and treatment.

IF 5.9 2区 医学 Q1 PSYCHIATRY
Daniel Freeman, Felicity Waite
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Abstract

It is common in mental health care to ask about people's days but comparatively rare to ask about their nights. Most patients diagnosed with schizophrenia struggle at nighttime. The next-day effects can include a worsening of psychotic experiences, affective disturbances, and inactivity, which in turn affect the next night's sleep. Objective and subjective cognitive abilities may be affected too. Patients commonly experience a mix of sleep difficulties in a night and across a week. These difficulties include trouble falling asleep, staying asleep, or sleeping at all; nightmares and other awakenings; poor-quality sleep; oversleeping; tiredness; sleeping at the wrong times; and problems establishing a regular sleep pattern. The patient group is also more vulnerable to obstructive sleep apnea and restless legs syndrome. We describe in this article how the complex presentation of non-respiratory sleep difficulties arises from variation across five factors: timing, mental state, need for sleep, self-care, and environment. We set out 10 illustrative patterns of such difficulties experienced by patients with non-affective psychosis. These sleep problems are eminently treatable with intensive psychological therapy delivered over approximately eight sessions. We describe key techniques and their typical order of implementation by presentation. Sleep problems are an important issue for patients. Giving them the therapeutic attention patients often desire brings both real clinical benefits and improves views of services. Treatment is also very likely to lessen psychotic experiences and mood disturbances while improving daytime functioning and quality of life. Tackling sleep difficulties can be a route toward the successful treatment of psychosis.

精神分裂症的睡眠和生理困难:表现、理解和治疗。
在心理健康护理中,询问人们白天的情况很常见,但询问他们晚上的情况相对较少。大多数被诊断为精神分裂症的患者在夜间挣扎。第二天的影响可能包括精神病症状的恶化、情感障碍和不活动,这些都会影响第二天晚上的睡眠。客观和主观认知能力也可能受到影响。患者通常会在一个晚上和一个星期内经历多种睡眠困难。这些困难包括难以入睡、保持睡眠状态或根本无法入睡;噩梦和其他觉醒;低质量的睡眠;睡懒觉;疲劳;在错误的时间睡觉;以及建立规律睡眠模式的问题。患者群体也更容易受到阻塞性睡眠呼吸暂停和不宁腿综合症的影响。我们在这篇文章中描述了非呼吸性睡眠困难的复杂表现是如何由五个因素引起的:时间、精神状态、睡眠需求、自我保健和环境。我们列出了非情感性精神病患者所经历的这种困难的10种说明性模式。这些睡眠问题可以通过大约八个疗程的强化心理治疗来显著治疗。我们通过演示描述了关键技术及其典型的实现顺序。睡眠问题对病人来说是一个重要的问题。给予他们患者经常渴望的治疗关注,既能带来真正的临床效益,又能改善对服务的看法。治疗也很可能减少精神病的经历和情绪障碍,同时改善白天的功能和生活质量。解决睡眠困难可能是成功治疗精神病的一条途径。
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来源期刊
Psychological Medicine
Psychological Medicine 医学-精神病学
CiteScore
11.30
自引率
4.30%
发文量
711
审稿时长
3-6 weeks
期刊介绍: Now in its fifth decade of publication, Psychological Medicine is a leading international journal in the fields of psychiatry, related aspects of psychology and basic sciences. From 2014, there are 16 issues a year, each featuring original articles reporting key research being undertaken worldwide, together with shorter editorials by distinguished scholars and an important book review section. The journal''s success is clearly demonstrated by a consistently high impact factor.
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