Vol 7 No.4 - Sleep Disorders, Neuropsychiatry, and Psychotropics
Past issues Contributors How to publish Contributions and comments Home
 
ental illness exacts a heavy toll on individuals, families, and society. In 1998, an estimated 44.3 million people in the USA suffered from a diagnosable mental disorder.Twenty-nine thousand three hundred and fifty people died from suicide in 2000, and suicide was the third leading cause of death in the 15- to 24-year age- group.1 Using the Disability Adjusted Life Years mea- sure, the Global Burden of Disease Study reported that psychiatric disorders constitute 15.4% of the total dis- ease burden in established market economies.2 Psychiatric disorders are frequently associated with dis- turbances of sleep and circadian rhythms. The relation- ship between psychiatric disorders and sleep complaints is bidirectional. In a community survey of 7954 people in different major US cities from 1981 to 1985, Ford and Kamerow reported that more subjects met the criteria for mental illness among those with complaints of insom- nia (40%) or hypersomnia (46.5%), compared with sub- jects without any sleep complaints (16.4%).3 In a study of 14 915 subjects from the UK, Germany, Italy, and Portugal,  aged  15  to  100  years,  Ohayon  and  Roth reported that 28% of subjects with insomnia had a cur- rent diagnosis of mental disorders, and 25.6% had a prior psychiatric history. In most cases of mood disorders, insomnia appeared prior to (~40%) or simultaneously with (~22%) mood disorder symptoms.4 However, when anxiety disorders were involved, insomnia appeared at the same time (~38%) or after (~34%) the onset of the anxiety disorder.4 In another study, 21% of insomniacs had  symptoms  of  major  depression,  while  13%  had symptoms of generalized anxiety.5 Persistent childhood sleep problems can herald adult anxiety disorders. In a prospective  longitudinal  study  of  943  children  (52% male), Gregory et al6 found that persistent sleep prob- lems in childhood predicted the development of anxiety disorders (odds ratio [OR] =1.60, 95% confidence inter- S t a t e   o f   t h e   a r t 2 9 1 Sleep and psychiatry Vivien C. Abad, MD, MBA; Christian Guilleminault, MD, BiolD M Copyright © 2005 LLS SAS.  All rights reserved www.dialogues-cns.org Psychiatric disorders constitute 15.4% of the disease bur- den in established market economies. Many psychiatric disorders are associated with sleep disturbances, and the relationship is often bidirectional. This paper reviews the prevalence of various psychiatric disorders, their clinical presentation, and their association with sleep disorders. Among the psychiatric disorders reviewed are affective disorders, psychosis, anxiety disorders (including post- traumatic stress disorder), substance abuse disorders, eat- ing disorders, and attention deficit/hyperactivity disorders. The spectrum of associated sleep disorders includes insom- nia, hypersomnia, nocturnal panic, sleep paralysis, hypn- agogic hallucinations, restless legs/periodic limb move- ments of sleep, obstructive sleep apnea, and parasomnias. The effects on sleep of various psychotropic medications utilized to treat the above psychiatric disorders are sum- marized.    © 2005, LLS SAS Dialogues Clin Neurosci. 2005;7:291-303. Keywords: sleep disorder; psychiatric disorder; depression; psychosis;
anxiety; sleep Author affiliations:  Stanford University Sleep Disorders Clinic and Sleep Research Center, Stanford, Calif; Clinical Monitoring Sleep Disorders Center; Camino  Medical Group, Palo Alto Medical Foundation, Cupertino, usa Calif, Address  for  correspondence: Christian Guilleminault, MD, BiolD, Stanford

Sleep Disorders Center, 401 Quarry Road, Suite 3301, Stanford, CA 94305,
USA

 (e-mail: cguil@stanford.edu)