EU_Psychiatry_Mignot_Capasso_quark6.qxp 24/6/08 04:24 Page 50
Insomnia
one to three weeks. Aggressiveness when awake, hyperphagia and and anxiety. Similarly, in adults, some patients may wake up partially and
hypersexuality often occur during the episodes. Most importantly, go to eat during the night. A variation of consciousness is often present
patients are completely normal between episodes, which re-occur with in these disorders, where the patients is half asleep and half awake. In
no pattern for several years to several decades (median 12 years), and some cases, these conditions can be difficult to distinguish from
finally decrease in intensity and frequency until they stop altogether. nocturnal seizures, although in these cases movements and behaviour
Unfortunately, there is no treatment for KLS. The most important are usually more consistent. Behavioural and pharmacotherapy can be
recommendation is to leave the patient in a familiar environment (at helpful in parasomnias.
home) if not in danger during episodes. Stimulants are typically
unhelpful if the episodes are intense, as confusion and aggressiveness Conclusion
may result instead of excess sleep. When episodes are frequent, A thorough evaluation of sleep disturbances in neuropsychiatric
thymoregulators such as lithium or carbamazepine have been patients is needed. Once identified, problems such as sleep apnea,
suggested to reduce episode frequency.
57
hypersomnia or insomnia should be aggressively treated, as they may
well be causal or participatory to the clinical picture and its impact.
Sleepwalking, Night Terrors and Parasomnias Unfortunately, however, expertise in sleep medicine is often not easily
Many patients complain of abnormal activity during sleep. REM available and waiting lists for access to sleep centres are long. Co-
behaviour disorder affects older males. The patient acts out during ordinated action by a psychiatrist and a sleep medicine specialist is
dreaming, often hurting himself or the person he shares a bed with. It is often needed in these cases, or, even better, psychiatrists should be
typically a precursor of Parkinson’s disease or Lewy body dementia.
58
encouraged to learn the required skills to take advantage of this new
Sleepwalking and night terrors occur during slow-wave sleep, which is discipline and make their patients better. We hope this review will
usually one hour after sleep onset, and are often associated with stress encourage clinicians to enter this new area. ■
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50 EUROPEAN PSYCHIATRIC REVIEW
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