Nightmares and Psychiatric Illness

Nightmares can occur in patients with psychiatric illness. Depression is sometimes associated with themes of masochism and poor self-image in dreams. Patients with schizophrenia and dissociative disorders may have intense dreams during a relapse of the illness. Panic attacks can occur during REM sleep in patients who have panic disorders and depression, and in patients who have asthma and breathing disorders of sleep. The REM sleep rebound related to withdrawal from alcohol and sedative-hypnotics, which chronically suppress REM sleep, may present as disturbing nightmares.

A strong association exists between REM sleep and dreaming.

Most frightening dreams occur during REM sleep, and most REM-altering disorders and medications affect dreaming. A variety of REM-associated illnesses can alter dreaming. Symptoms of underlying illness can also occur during REM sleep. It often happens that persons awakening from REM sleep, a state that is electrophysiologically near waking, recall the mentation and physical symptoms associated with the state of REM sleep. Dreams are finally mind's excretions. The view that dreams have no evolutionary advantage and that they have no functions has been endorsed by many scientists, yet if we look deeper into the annals of psychology, the significance of dreams in explaining mental life cannot be overlooked.

REM – associated Disorders

REM - associated disorders most commonly affect middle-aged men. REM - associated disorders are characterized by vivid, action-filled, violent dreams that the dreamer acts out, sometimes resulting in injury to the dreamer or the sleeping partner. On polysomnography, these patients show elevated submental limb electromyographic tone, which may be phasic or tonic and that is associated with prominent jerking of the limb.

REM - associated disorders often occur without concomitant pathophysiology, but can be associated with neurodegenerative neurologic disorders. The most common of these disorders are Parkinson's disease, primary dementia and narcolepsy. Computed tomography or magnetic resonance imaging brain scans of affected patients may show diffuse hemispheric lesions, bilateral thalamic abnormalities or brain stem lesions.

Night Terrors

Night terrors are nocturnal episodes of extreme terror and panic that usually occur early in the sleep period. They are similar to other arousal disorders that occur during deep sleep, such as somnambulism (sleepwalking) and confusional arousals. Night terrors are associated with discharge, confusion and vocalizations, often a "blood-curdling" scream. Persons with night terrors are often difficult to arouse and have limited recall of their dream content. Night terrors can occur in association with the other arousal disorders that are associated with deep sleep. Night terrors are most common in children between four and twenty years of age and affect 1 to 4 percent of the population. Polysomnographic studies in these patients generally show increased arousals from deep sleep.

Adults who have night terrors are more likely than children to have psychopathology, mainly substance abuse and affective disorders. As with other parasomnias that affect adults, night terrors are more likely to occur in association with other sleep pathology, such as periodic limb movements and obstructive sleep apnea.

Often, nightmares and night terrors can be diagnosed on the basis of the patient's history. In persons who have a history of nocturnal injuries, polysomnography is required to diagnose REM – associated disorder or nocturnal seizures. In up to 25 percent of patients with epilepsy, the condition may present only as nocturnal seizures. A diagnosis of nocturnal seizure may be suggested by family history, stereotypic nocturnal behaviors and incontinence. Nocturnal seizures can be grand mal, petit mal, partial-complex, vegetative or paroxysmal nocturnal dystonias.

All parasomnias more commonly affect persons who have breathing disorders during sleep. Polysomnography is appropriate for any patient with symptoms or signs of obstructive sleep apnea, such as daytime hypersomnolence, nocturnal hypoxia, loud snoring and increased neck circumference. REM - associeted disorder often occurs concomitantly with degenerative neurologic illnesses that may require further evaluation. In adults, the onset of arousal disorders such as somnambulism and night terrors may reflect underlying neurologic disease. Thus, neurologic evaluation, including imaging of the central nervous system, may be helpful.

Date: 2015-12-11; view: 760