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      Nightmare in schizophrenic and depressed patients

      research-article
      The European Journal of Psychiatry
      Universidad de Zaragoza
      Nightmare, Psychiatric disorders, Psychopathology, Sleep disorders

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          Abstract

          Background and Objectives: Nightmare is a common sleep disorder. While a sleep disorder such as insomnia can readily be associated with psychiatric disorders, the same cannot be said of nightmare. The objective of this study was to determine the prevalence rate of nightmare in a sample of psychiatric patients, and to compare this rate with the rate obtained in age- and sex- matched healthy control subjects in order to determine if there is a significant difference in the rates of nightmare in the different groups. Methods: Ninety - four randomly selected psychiatric patients made up of 54 schizophrenic patients and 40 depressed patients were recruited into the study. One hundred and twenty - three age- and sex- matched randomly selected control subjects were also recruited into the study. A questionnaire determining the one year prevalence of nightmare was administered to all the subjects. Each of them was required to indicate whether he or she had experienced nightmare in the previous one year and if so to indicate the number of episodes experienced during the said period. Results: The results showed prevalent rates of nightmare of 4.9%, 16.7% and 17.5% respectively for the healthy control subjects, schizophrenic patients and depressed patients. There was an overall prevalence rate of 17% among the psychiatric patients (schizophrenic patients and depressed patients) as against 4.9% in the healthy control subjects. Among those who experienced nightmare, the mean values for the number of episodes within the previous one year were, respectively 18 (sd = 6.6) for healthy control subjects (n = 6), 42.7 (sd = 6.3) for schizophrenic patients (n = 9) and 44.6 (sd = 5.9) for depressed patients (n = 7). Conclusions: The findings in this study provide support for a significant association between nightmare and schizophrenia as well as nightmare and depressive illness. In effect, there is a significant association between nightmare and psychopathology.

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          Most cited references20

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          Disturbed dreaming, posttraumatic stress disorder, and affect distress: a review and neurocognitive model.

          Nightmares are common, occurring weekly in 4%-10% of the population, and are associated with female gender, younger age, increased stress, psychopathology, and dispositional traits. Nightmare pathogenesis remains unexplained, as do differences between nontraumatic and posttraumatic nightmares (for those with or without posttraumatic stress disorder) and relations with waking functioning. No models adequately explain nightmares nor have they been reconciled with recent developments in cognitive neuroscience, fear acquisition, and emotional memory. The authors review the recent literature and propose a conceptual framework for understanding a spectrum of dysphoric dreaming. Central to this is the notion that variations in nightmare prevalence, frequency, severity, and psychopathological comorbidity reflect the influence of both affect load, a consequence of daily variations in emotional pressure, and affect distress, a disposition to experience events with distressing, highly reactive emotions. In a cross-state, multilevel model of dream function and nightmare production, the authors integrate findings on emotional memory structures and the brain correlates of emotion. (c) 2007 APA, all rights reserved
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            Sleep disturbance as the hallmark of posttraumatic stress disorder.

            The reexperiencing of a traumatic event in the form of repetitive dreams, memories, or flashbacks is one of the cardinal manifestations of posttraumatic stress disorder (PTSD). The dream disturbance associated with PTSD may be relatively specific for this disorder, and dysfunctional REM sleep mechanisms may be involved in the pathogenesis of the posttraumatic anxiety dream. Furthermore, the results of neurophysiological studies in animals suggest that CNS processes generating REM sleep may participate in the control of the classical startle response, which may be akin to the startle behavior commonly described in PTSD patients. Speculating that PTSD may be fundamentally a disorder of REM sleep mechanisms, the authors suggest several strategies for future research.
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              Conflict between current knowledge about posttraumatic stress disorder and its original conceptual basis.

              The author's goal was to explore the historical, political, and social forces that have played a major role in the acceptance of the idea of trauma as a cause of the specific symptoms of posttraumatic stress disorder (PTSD) and to discuss the impact that current research findings have had on some of the initial conceptualizations of the disorder. The conceptual origins of PTSD are described, and the literature on the prevalence, longitudinal course, phenomenology, and neurobiology of PTSD is reviewed. Paradoxically, there are a series of findings that support the idea that PTSD is a distinct diagnostic entity, but these are different from those originally developed from psychosocial theory and stress research. PTSD has been a controversial diagnosis and is again at a vulnerable point. It is imperative that the field address how current findings challenge the original conceptualizations of this disorder so that the next generation of conceptual issues can be formulated.
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                Author and article information

                Contributors
                Role: ND
                Journal
                ejpen
                The European Journal of Psychiatry
                Eur. J. Psychiat.
                Universidad de Zaragoza (Zaragoza, Zaragoza, Spain )
                0213-6163
                September 2009
                : 23
                : 3
                : 177-183
                Affiliations
                [01] Ile - Ife Osun orgnameObafemi Awolowo University orgdiv1Faculty of Clinical Sciences orgdiv2Department of Mental Health Nigeria
                Article
                S0213-61632009000300006
                10.4321/s0213-61632009000300006
                fa945332-0f64-45f6-a096-6bbdee006594

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

                History
                : 09 June 2009
                : 19 March 2009
                : 30 May 2009
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 14, Pages: 7
                Product

                SciELO Spain


                Nightmare,Psychiatric disorders,Psychopathology,Sleep disorders

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