Nightmares in Patients with Psychosis: The Relation with Sleep,Psychotic,Affective,and Cognitive Symptoms

Abstract

German

Objective:

To examine the prevalence of nightmares in people with psychosis and to describe the link between nightmares and sleep quality, psychotic, affective, and cognitive symptoms.

Methods:

Forty participants with psychotic symptoms completed an assessment of nightmares, sleep quality, positive symptoms of psychosis, affect, posttraumatic stress, social functioning, and working memory.

Results:

Among the patients, 55% reported weekly distressing nightmares. Experience of more frequent nightmares was related to poorer sleep quality and sleep efficiency. More distressing nightmares were positively associated with greater delusional severity, depression, anxiety, stress, and difficulties with working memory.

Conclusions:

Nightmares might be common in those with psychosis and are associated with increased day- and nighttime impairment. Future research should investigate treatments for nightmares, for people presenting with psychotic symptoms.

Keywords

nightmares psychoses psychotic symptoms sleep schizophrenia affect working memory

References

Wilson

Argyropoulos

Sleep in schizophrenia: Time for closer attention. Br J Psychiatry. 2012;200(4):273–274.

Wulff

Dijk

D-J

Middleton

, Sleep and circadian rhythm disruption in schizophrenia. Br J Psychiatry. 2012;200(4):308–316.

Freeman

Pugh

Vorontsova

, Insomnia and paranoia. Schizophr Res. 2009;108(1–3):280–284.

Bromundt

Köster

Georgiev-Kill

, Sleep–wake cycles and cognitive functioning in schizophrenia. Br J Psychiatry. 2011;198(4):269–276.

Ruhrmann

Schultz-Lutter

Salokangas

, Prediction of psychosis in adolescents and young adults at high risk. Arch Gen Psychiatry. 2010;67(3):241–251.

Freeman

Stahl

McManus

, Insomnia, worry, anxiety and depression as predictors of the occurrence and persistence of paranoid thinking. Soc Psychiatry Psychiatr Epidemiol. 2012;47(8):1195–1203.

Hofstetter

Lysaker

Mayeda

. Quality of sleep in patients with schizophrenia is associated with quality of life and coping. BMC Psychiatry. 2005;5:13.

Ritsner

Kurs

Ponizovsky

, Perceived quality of life in schizophrenia: Relationships to sleep quality. Qual Life Res. 2004;13(4):783–791.

Afonso

Figueira

Paiva

Sleep–wake patterns in schizophrenia patients compared to healthy controls. World J Biol Psychiatry. 2013;(53):1–8.

10.

Winkelman

. Schizophrenia, obesity, and obstructive sleep apnea. J Clin Psychiatry. 2001;62(1):8–11.

11.

Nielsen

Levin

Nightmares: A new neurocognitive model. Sleep Med Rev. 2007;11(4):295–310.

12.

Zhang

, Prevalence and correlates of frequent nightmares: A community-based 2-phase study. Sleep. 2010;33(6):774–780.

13.

Janson

Gislason

De Backer

, Prevalence of sleep disturbances among young adults in three European countries. Sleep. 1995;18(7):589–597.

14.

Leskin

Woodward

Young

, Effects of comorbid diagnoses on sleep disturbance in PTSD. J Psychiatr Res. 2002;36(6):449–452.

15.

Neylan

Marmar

Metzler

, Sleep disturbances in the Vietnam generation: Findings from a nationally representative sample of male Vietnam veterans. Am J Psychiatry. 1998;155(7):929–933.

16.

Semiz

Basoglu

Ebrinc

, Nightmare disorder, dream anxiety, and subjective sleep quality in patients with borderline personality disorder. Psychiatry Clin Neurosci. 2008;62(1):48–55.

17.

van Liempt

Sleep disturbance and PTSD: A perceptual circle. Eur J Psychotraumatol. 2012;3:19142.

18.

Krakow

Nightmare complaints in treatment-seeking patients in clinical sleep medicine settings: Diagnostic and treatment implications. Sleep. 2006;29(10):1313–1319.

19.

Pigeon

Pinquart

Conner

Meta-analysis of sleep disturbance and suicidal thoughts and behaviors. J Clin Psychiatry. 2012;73(9):e1160–e1167.

20.

Spoormaker

. A cognitive model of recurrent nightmares. Int J Dream Res. 2008;1(1):15–22.

21.

Aurora

Zak

Auerbach

, Best practice guide for the treatment of nightmare disorder in adults. J Clin Sleep Med. 2010;6(4):389–401.

22.

Koffel

Watson

Unusual sleep experiences, dissociation, and schizotypy: Evidence for a common domain. Clin Psychol Rev. 2009;29(6):548–559.

23.

Fisher

Lereya

Thompson

, Childhood parasomnias and psychotic experiences at age 12 years in a United Kingdom birth cohort. Sleep. 2014;37(3):475–482.

24.

Levin

Fireman

Nightmare prevalence, nightmare distress, and self-reported psychological disturbance. Sleep. 2002;25(2):205–212.

25.

Lusignan

F-A

Zadra

Dubuc

M-J

, Dream content in chronically-treated persons with schizophrenia. Schizophr Res. 2009;112(1–3):164–173.

26.

Schaefer

Giangrande

Weinberger

, The global cognitive impairment in schizophrenia: Consistent over decades and around the world. Schizophr Res. 2013;150(1):42–50.

27.

Fatouros-Bergman

Cervenka

Flyckt

, Meta-analysis of cognitive performance in drug-naïve patients with schizophrenia. Schizophr Res. 2014;158(1–3):156–162.

28.

Buysse

Reynolds

3rd Monk

, The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193–213.

29.

Robert

Zadra

Measuring nightmare and bad dream frequency: Impact of retrospective and prospective instruments. J Sleep Res. 2008;17(2):132–139.

30.

Haddock

McCarron

Tarrier

, Scales to measure dimensions of hallucinations and delusions: The Psychotic Symptom Rating Scales (PSYRATS). Psychol Med. 1999;29(4):879–889.

31.

Drake

Haddock

Tarrier

, The Psychotic Symptom Rating Scales (PSYRATS): Their usefulness and properties in first episode psychosis. Schizophr Res. 2007;89(1–3):119–122.

32.

Lovibond

. Manual for the Depression Anxiety Stress Scales. Sydney (AU): Psychology Foundation; 1995.

33.

Huppert

Smith

Apfeldorf

. Use of self-report measures of anxiety and depression in outpatients with schizophrenia: Reliability and validity. J Psychopathol Behav Assess. 2002;24(4):275–283.

34.

Foa

Cashman

Jaycox

, The validation of a self-report measure of posttraumatic stress disorder: The Posttraumatic Diagnostic Scale. Psychol Assess. 1997;9(4):445–451.

35.

Spitzer

Williams

JBW

Gibbon

, Structured Clinican Interview for DSM-III-R Axis II Disorders (SCID-II). Washington DC: American Psychiatric Press; 1990.

36.

Steel

Haddock

Tarrier

, Auditory hallucinations and posttraumatic stress disorder within schizophrenia and substance abuse. J Nerv Ment Dis. 2011;199(9):709–711.

37.

Jolley

Garety

Ellett

, A validation of a new measure of activity in psychosis. Schizophr Res. 2006;85(1–3):288–295.

38.

Wechsler

Wechsler Memory Scale. 3rd ed. London (GB): The Psychological Corporation; 1998.

39.

SPSS Inc. PASW statistics for Windows, version 18.0. Chicago (IL): SPSS Inc; 2009.

40.

Graphpad Software Inc. Confidence interval of a proportion or count [Internet]. [cited 2013 Feb 15]. Available from: http://www.graphpad.com/quickcalcs/confInterval1.

41.

Reynolds

. Nonparametric partial correlation and causal analysis. Soc Methods Res. 1974;2(3):376–392.

42.

Department of Health. NHS choices: Track your drinking [Internet]. 2012 [cited 2013 Feb 10]. Available from: http://www.nhs.uk/Livewell/alcohol/Pages/Alcoholtracker.aspx.

43.

Woods

. Chlorpromazine equivalent doses for the newer atypical antipsychotics. J Clin Psychiatry. 2003;64:663–667.

44.

Atkins

Burgess

Bottomley

, Chlorpromazine equivalents: A consensus of opinion for both clinical and research applications. Psychiatr Bull. 1997;21(4):224–226.

45.

Nappi

Drummond

Thorp

, Effectiveness of imagery rehearsal therapy for the treatment of combat-related nightmares in veterans. Behav Ther. 2010;41(2):237–244.

46.

Johns

Cannon

Singleton

, Prevalence and correlates of self-reported psychotic symptoms in the British population. Br J Psychiatry. 2004;185:298–305.

47.

Freeman

Garety

Bebbington

, Psychological investigation of the structure of paranoia in a nonclinical population. Br J Psychiatry. 2005;186:427–435.

48.

Bentall

Claridge

Slade

. The multidimensional nature of schizotypal traits: A factor analytic study with normal subjects. Br J Clin Psychol. 1989;28(4):363–375.

49.

Peters

Day

McKenna

, Delusional ideation in religious and psychotic populations. Br J Clin Psychol. 1999;38(1):83–96.

50.

Van Os

Verdoux

Maurice-Tison

, Self-reported psychosis-like symptoms and the continuum of psychosis. Soc Psychiatry Psychiatr Epidemiol. 1999;34(9):459–463.

51.

Davies

Griffn

Vice

Affective reactions to auditory hallucinations in psychotic, evangelical and control groups. Br J Clin Psychol. 2001;40(4):361–370.

52.

Andrew

Gray

Snowden

. The relationship between trauma and beliefs about hearing voices: A study of psychiatric and non-psychiatric voice hearers. Psychol Med. 2008;38(10):1409–1417.

53.

Neria

Bromet

Sievers

, Trauma exposure and posttraumatic stress disorder in psychosis: Findings from a first-admission cohort. J Consult Clin Psychol. 2002;70(1):246–251.

54.

Mueser

Goodman

Trumbetta

, Trauma and posttraumatic stress disorder in severe mental illness. J Consult Clin Psychol. 1998;66(3):493–499.

55.

Tribl

Wetter

Schredl

Dreaming under antidepressants: A systematic review on evidence in depressive patients and healthy volunteers. Sleep Med Rev. 2013;17(2):133–142.

56.

Desseilles

Dang-Vu

Sterpenich

, Cognitive and emotional processes during dreaming: A neuroimaging view. Conscious Cogn. 2011;20(4):998–1008.

57.

Gujar

McDonald

Nishida

, A role for REM sleep in recalibrating the sensitivity of the human brain to specific emotions. Cereb Cortex. 2011;21(1):115–123.

58.

Nishida

Pearsall

Buckner

, REM sleep, prefrontal theta, and the consolidation of human emotional memory. Cereb Cortex. 2009;19(5):1158–1166.

59.

Freeman

Garety

Kuipers

, A cognitive model of persecutory delusions. Br J Clin Psychol. 2002;41(Pt 4):331–347.

60.

Krakow

Hollifield

Schrader

, A controlled study of imagery rehearsal for chronic nightmares in sexual assault survivors with PTSD: A preliminary report. J Trauma Stress. 2000;13(4):589–609.

61.

Davis

Wright

. Randomized clinical trial for treatment of chronic nightmares in trauma-exposed adults. J Trauma Stress. 2007;20(2):123–133.

62.

Davis

Rhudy

Pruiksma

, Physiological predictors of response to exposure, relaxation, and rescripting therapy for chronic nightmares in a randomized clinical trial. J Clin Sleep Med. 2011;7(6):622–631.

63.

Thünker

Pietrowsky

Effectiveness of a manualized imagery rehearsal therapy for patients suffering from nightmare disorders with and without a comorbidity of depression or PTSD. Behav Res Ther. 2012;50(9):558–564.

64.

Casement

Swanson

. A meta-analysis of imagery rehearsal for post-trauma nightmares: Effects on nightmare frequency, sleep quality, and posttraumatic stress. Clin Psychol Rev. 2012;32(6):566–574.

65.

Forbes

Phelps

McHugh

, Imagery rehearsal in the treatment of posttraumatic nightmares in Australian veterans with chronic combat-related PTSD: 12-month follow-up data. J Trauma Stress. 2003;16(5):509–513.

66.

Sheaves

The phenomenology of nightmares in the context of psychosis, with a case series of imagery rescripting. London (GB): King's College London; 2013.

67.

Ohayon

Morselli

. Parasomnias prevalence of nightmares and their relationship to psychopathology and daytime functioning in insomnia subjects. Sleep. 1997;20(5):340–348.