Insomnia 305.qxp

نویسنده

  • Linda Kohn
چکیده

THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, FOURTH EDITION (DSM-IV) DEFINES PRIMARY INSOMNIA AS A COMPLAINT OF DIFFICULTY initiating and/or maintaining sleep or of nonrestorative sleep lasting for at least 1 month.1 The revised version of the International Classification of Sleep Disorders, Revised (ICSD-R) uses the term psychophysiologic insomnia and regards insomnia of 6 months duration as chronic.2 Contemporary understanding of psychophysiologic insomnia refers to underlying conditioned physiologic arousal3-5 and learned sleep-preventing associations,6,7 with these components being regarded as mutually reinforcing (ICSD-R). However, it is also recognised that the presenting complaint usually reflects mental more than somatic preoccupation,8-10 and so an interaction between behavioral, physiologic, and cognitive factors in the development and persistence of psychophysiologic insomnia has been proposed.11-15 Sleep disturbance presenting in a psychiatric condition has been regarded as “secondary” to (DSM-IV) or, more descriptively, as “associated with” mental disorder (ICSD-R). The latter can be readily observed, whereas causality would need to be carefully evidenced. To take the example of depression, there is in fact strong evidence that preexisting insomnia is a risk factor for first incidence and recurrence of a depressive episode.16-20 These findings are rein-

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تاریخ انتشار 2004