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睡眠干预在精神分裂症和双相情感障碍治疗中的应用

Sleep Interventions in the Treatment of Schizophrenia and Bipolar Disorder.

作者信息

Gica Şakir, Selvı Yavuz

机构信息

Necmettin Erbakan University, Meram Medical Faculty, Department of Psychiatry, Konya, Turkey.

Selçuk University, Selçuklu Medical Faculty, Department of Psychiatry, Konya, Turkey.

出版信息

Noro Psikiyatr Ars. 2021 Sep 20;58(Suppl 1):S53-S60. doi: 10.29399/npa.27467. eCollection 2021.

Abstract

Due to the effects of sleep on the central nervous system, it is thought that sleep disorders have a special importance in the onset, course and treatment of psychiatric diseases. Although the negative effects of sleep problems on the occurrence, recurrence and clinical course of psychiatric disorders are well known, it is reported that clinicians do not spend enough time for sleep problems in practice. This may be related to the fact that patients underreport their complaints for various reasons, insufficient examination time, and clinicians' lack of knowledge about the importance of the subject. Pharmacotherapy, psychological and behavioral interventions are options among the therapeutic approaches to sleep problems. But, it seems that clinicians tend to prefer pharmacological approaches for the treatment of sleep problems. However, it is important to choose the appropriate treatment option with considering the method preferred by the patients, who already use many and high doses of pharmacological agents, the nature of the psychiatric disorder and the sleep problem. In this context, chronotherapeutic approaches such as bright light, sleep deprivation, interpersonal relations and social rhythm therapy, and cognitive behavioral therapy techniques adapted for patients with bipolar disorder can be used in the treatment of suitable patients. In this article, the current literature about sleep-related problems observed in patients with schizophrenia and bipolar disorder is reviewed comprehensively with presenting clinical phenotypes and treatment approaches.

摘要

由于睡眠对中枢神经系统的影响,人们认为睡眠障碍在精神疾病的发病、病程及治疗中具有特殊重要性。尽管睡眠问题对精神障碍的发生、复发及临床病程的负面影响已广为人知,但据报道临床医生在实际工作中并未花足够时间关注睡眠问题。这可能与患者因各种原因少报自身症状、检查时间不足以及临床医生对该问题重要性缺乏认识有关。药物治疗、心理和行为干预是治疗睡眠问题的方法选择。但是,临床医生似乎倾向于选择药物治疗方法来处理睡眠问题。然而,考虑到患者已使用多种高剂量药物、精神障碍的性质以及睡眠问题,选择适合患者偏好的治疗方法很重要。在此背景下,对于合适的患者,可采用诸如强光疗法、睡眠剥夺、人际关系和社会节律疗法等时间治疗方法,以及针对双相情感障碍患者调整的认知行为治疗技术。在本文中,全面回顾了关于精神分裂症和双相情感障碍患者中观察到的与睡眠相关问题的现有文献,并介绍了临床表型和治疗方法。

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