Successful treatment of nightmares may reduce psychotic symptoms in schizophrenia

Abstract

Nightmares occur more frequently in patients with schizophrenia than they do in the general population. Nightmares are profoundly distressing and may exacerbate daytime psychotic symptoms and undermine day-to-day function. Clinicians do not often ask about nightmares in the context of psychotic illness and patients may underreport them or, if nightmares are reported, they may be disregarded; it may be assumed that they will disappear with antipsychotic medication and that they do not, therefore, require separate intervention. This is a missed opportunity because Image Rehearsal Therapy, among other psychological and pharmacological interventions, has proven effective for nightmares in non-schizophrenia populations and should be considered at an early stage of psychotic illness as an important adjunct to standard treatment. There is active ongoing research in this field, which will undoubtedly benefit patients with schizophrenia in the future.

Keywords: Sleep; Nightmares; Psychosis; Nightmare-inducing drugs; Image rehearsal therapy

Core tip: A substantial percentage of persons suffering from psychotic illness such as schizophrenia experience frightening nightmares that aggravate their disease symptoms. New treatments for nightmares in the general population are starting to be applied to schizophrenia patients, as are new treatments for other associated sleep problems. This is very promising research that clinicians need to heed, as the lessening of nightmare distress will also help to alleviate daytime psychotic symptoms.