Nicolas Alain, Dorey Jean-Michel, Charles Eric, Clement Jean-Pierre
Service hospitalo-universitaire de psychiatrie, Unité d'exploration hypnologique, CH Le Vinatier, Bron.
Psychol Neuropsychiatr Vieil. 2010 Sep;8(3):171-8. doi: 10.1684/pnv.2010.0224.
Mood disorders and sleep disturbances are closely related. In elderly people, the prevalence of insomnia and depressive symptoms is increased. Moreover, somatic co-morbidities associated with aging are known to be risk factors for both insomnia and depression. Assessment of the origin of sleep complaints must consider primary and secondary insomnia, and the existence of associated depression. Causal treatment of insomnia is necessary keeping in consideration that depressive dimension can, afterward, evolve on its own. In presence of intense sleep complaints in inadequacy with somatic examination, and not documented by sleep recordings, depression must be evoked. In patients with a diagnosis of depression, treatment and monitoring of the evolution of insomnia is necessary, because persistent disturbances of sleep are associated with poor prognosis. Concerning the therapeutics, beyond antidepressant treatment and psychotherapy, chronotherapy is a promising, but still not yet evaluated, approach, which presents the advantage to limit the use of psychotropics drugs.
情绪障碍与睡眠障碍密切相关。在老年人中，失眠和抑郁症状的患病率有所增加。此外，与衰老相关的躯体合并症是失眠和抑郁的已知危险因素。对睡眠主诉来源的评估必须考虑原发性和继发性失眠，以及是否存在相关的抑郁症。考虑到抑郁维度随后可能自行演变，对失眠进行病因治疗是必要的。在存在与体格检查不符且未通过睡眠记录证实的强烈睡眠主诉时，必须考虑抑郁症。对于诊断为抑郁症的患者，有必要对失眠的演变进行治疗和监测，因为持续的睡眠障碍与预后不良有关。关于治疗方法，除了抗抑郁治疗和心理治疗外，时间疗法是一种有前景但尚未得到评估的方法，其优点是限制精神药物的使用。
