Dashevsky B A, Kramer M
Sleep Disorders Center, Bethesda Hospital, Cincinnati, OH 45206, USA.
J Clin Psychiatry. 1998 Dec;59(12):693-9; quiz 700-1. doi: 10.4088/jcp.v59n1210.
Psychiatric patients often have residual intractable insomnia as a serious problem.
Forty-eight psychiatrically ill patients (DSM-IV diagnoses) who had failed to respond to medicinal treatment for chronic insomnia were referred for and completed behavioral therapy as an adjunct to the pharmacologic treatment of their insomnia. The behavioral treatments included structured sleep hygiene, progressive muscle relaxation, stimulus control, and sleep restriction. The treatment program was accomplished in 6 sessions over 2 months. Follow-up evaluations were completed at 2, 6, and 12 months from the beginning of the treatment program. The outcome of the treatment program was evaluated in terms of the change in (1) self-reported specific sleep parameters, (2) self-ratings of sleep-related day-time state, (3) self-rating of quality of sleep, (4) the use of sleep medication, and (5) the therapist's global rating of improvement.
There was a statistically significant change from the baseline in all self-reported specific sleep parameters after 2 months that was sustained after 6 and 12 months. Sleep-related characteristics of daytime state showed statistically significant changes after 2 and 6 months that were maintained after 12 months. Sleep quality had a statistically significant change after 2 months, continued to improve statistically after 6 months, and was maximum after 12 months. Over half the patients (52.7%; 20 of 38) either reduced their sleep medication by half or stopped it completely. The therapist's global rating showed an improvement in 29.2% (N = 14) of patients after 2 months, 56.2% (N = 27) after 6 months, and 68.7% (N = 33) after 12 months.
The use of concomitant behavioral and pharmacologic treatment of chronic insomnia in psychiatrically ill patients results in improving sleep and sleep-related state and reduces the risk of return of insomnia for 10 months after finishing active treatment.
精神疾病患者常常存在顽固性残留失眠这一严重问题。
48名患有精神疾病（依据《精神疾病诊断与统计手册》第四版诊断）且对慢性失眠药物治疗无反应的患者被转介接受行为疗法，并将其作为失眠药物治疗的辅助手段。行为治疗包括结构化睡眠卫生、渐进性肌肉松弛、刺激控制和睡眠限制。治疗方案在2个月内分6次完成。从治疗方案开始起，在2个月、6个月和12个月时完成随访评估。治疗方案的结果依据以下方面的变化进行评估：（1）自我报告的特定睡眠参数；（2）与睡眠相关的日间状态自评；（3）睡眠质量自评；（4）助眠药物的使用情况；（5）治疗师对改善情况的整体评分。
2个月后，所有自我报告的特定睡眠参数与基线相比有统计学显著变化，且在6个月和12个月后持续存在。与睡眠相关的日间状态特征在2个月和6个月后有统计学显著变化，并在12个月后保持。睡眠质量在2个月后有统计学显著变化，6个月后继续有统计学改善，并在12个月时达到最佳。超过半数患者（52.7%；38名中的２０名）将助眠药物用量减半或完全停用。治疗师的整体评分显示２个月后29.2%（N = 14）的患者有改善，6个月后为56.2%（N = 27），12个月后为68.7%（N = 33）。
对患有精神疾病的患者采用行为疗法与药物疗法相结合治疗慢性失眠，可改善睡眠及与睡眠相关的状态，并降低积极治疗结束后10个月内失眠复发的风险。
