Izuhara Muneto, Matsuda Hiroyuki, Saito Ami, Hayashida Maiko, Miura Syoko, Oh-Nishi Arata, Azis Ilhamuddin Abdul, Abdullah Rostia Arianna, Tsuchie Keiko, Araki Tomoko, Ryousuke Arauchi, Kanayama Misako, Hashioka Sadayuki, Wake Rei, Miyaoka Tsuyoshi, Horiguchi Jun
Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan.
Front Psychiatry. 2018 Jun 12;9:260. doi: 10.3389/fpsyt.2018.00260. eCollection 2018.
The authors present the case of a 38-year-old man with schizophrenia and with severe insomnia, who attempted suicide twice during oral drug therapy with risperidone. The patient slept barely 2 or 3 h per night, and he frequently took half days off from work due to excessive daytime sleepiness. As a maladaptive behavior to insomnia, he progressively spent more time lying in bed without sleeping, and he repeatedly thought about his memories, which were reconstructed from his hallucinations. His relatives and friends frequently noticed that his memories were not correct. Consequently, the patient did not trust his memory, and he began to think that the hallucinations controlled his life. During his insomniac state, he did not take antipsychotic drugs regularly because of his irregular meal schedule due to his excessive daytime sleepiness. The authors started cognitive behavioral therapy for insomnia (CBT-i) with aripiprazole long acting injection (LAI). CBT-i is needed to be tailored to the patient's specific problems, as this case showed that the patient maladaptively use chlorpromazine as a painkiller, and he exercised in the middle of the night because he believed he can fall asleep soon after the exercise. During his CBT-i course, he learned how to evaluate and control his sleep. The patient, who originally wanted to be short sleeper, began to understand that adequate amounts of sleep would contribute to his quality of life. He finally stopped taking chlorpromazine and benzodiazepine as sleeping drugs while taking suvorexant 20 mg. Through CBT-i, he came to understand that poor sleep worsened his hallucinations, and consequently made his life miserable. He understood that good sleep eased his hallucinations, ameliorated his daytime sleepiness and improved his concentration during working hours. Thus, he was able to improve his self-esteem and self-efficacy by controlling his sleep. In this case report, the authors suggest that CBT-i can be an effective therapy for schizophrenia patients with insomnia to the same extent of other psychiatric and non-psychiatric patients.
作者介绍了一名38岁患有精神分裂症且严重失眠的男性病例，该患者在口服利培酮药物治疗期间曾两次试图自杀。患者每晚仅睡2至3小时，且由于白天过度嗜睡，他经常请半天假。作为对失眠的一种适应不良行为，他逐渐花更多时间躺在床上却无法入睡，并且反复回想由幻觉重构而来的记忆。他的亲戚和朋友经常注意到他的记忆不正确。因此，患者不信任自己的记忆，并开始认为幻觉控制了他的生活。在失眠状态下，由于白天过度嗜睡导致饮食不规律，他没有规律服用抗精神病药物。作者开始采用阿立哌唑长效注射剂（LAI）联合失眠认知行为疗法（CBT-i）对其进行治疗。CBT-i需要根据患者的具体问题进行调整，因为该病例显示患者将氯丙嗪不当用作止痛药，并且在半夜锻炼，因为他认为锻炼后很快就能入睡。在CBT-i治疗过程中，他学会了如何评估和控制自己的睡眠。这位原本希望成为短睡眠者的患者开始明白充足的睡眠有助于提高生活质量。他最终停止服用氯丙嗪和苯二氮䓬类安眠药，转而服用20毫克的苏沃雷生。通过CBT-i，他开始明白睡眠不佳会加重幻觉，进而使他的生活痛苦不堪。他认识到良好的睡眠可以减轻幻觉、改善白天的嗜睡状况并提高工作时的注意力。因此，他能够通过控制睡眠来提高自尊和自我效能感。在本病例报告中，作者认为CBT-i对于患有失眠的精神分裂症患者而言，与其他精神科和非精神科患者一样，可能是一种有效的治疗方法。
