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Fortschr Neurol Psychiatr 2010; 78(2): 70-80
DOI: 10.1055/s-0028-1109967
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Schlafstörungen bei schizophrenen Erkrankungen

Bedeutung und Optionen einer multimodalen HilfestellungSleep Disorders in SchizophreniaImportance and Options for a Multi-Dimensional SupportJ. Staedt1 , M. Hauser2 , Y. Gudlowski2 , G. Stoppe3
  • 1Klinik für Psychiatrie, Psychotherapie und Psychosomatik-Memory Clinic, Vivantes Klinikum Spandau, Berlin
  • 2Früherkennungs- und Therapiezentrum für beginnende Psychosen Berlin/Brandenburg (FETZ), Klinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin
  • 3Bereich Allgemeine Psychiatrie, Universitäre Psychiatrische Kliniken, Basel
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Publication History

Publication Date:
11 January 2010 (online)

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Zusammenfassung

Ein- und Durchschlafstörungen und Störungen der zirkadianen Rhythmik finden sich sehr häufig im Rahmen schizophrener Erkrankungen. Schlafstörungen treten als Frühzeichen der Erstmanifestation sowie des Rezidivs auf und stehen in Beziehung zu Positivsymptomen und der Desorganisation des Denkens. In der schlafpolygrafischen Untersuchung finden sich bei schizophrenen Patienten typischerweise eine verlängerte Einschlaflatenz, eine Reduktion der Schlafeffizienz und eine Reduktion des Tiefschlafs, wobei speziell die Störungen des Tiefschlafs die neokortikale Plastizität und die Kognition negativ beeinflussen können. Im klinischen Alltag finden die erheblichen Schlafstörungen oft nicht die notwendige Berücksichtigung, zumal z. B. ältere Neuroleptika wie Haloperidol sogar die zirkadiane Rhythmik und damit den Schlaf-/Wachrhythmus Schizophrener negativ beeinflussen können. In der Übersicht werden daher zum besseren Verständnis die pathophysiologischen Veränderungen des Schlafes im Rahmen schizophrener Erkrankungen und deren potenzielle Auswirkungen diskutiert. Bezüglich der Therapie werden neben psychoedukativen Bausteinen auch schlafmedizinisch sinnvolle Neuroleptikabehandlungen diskutiert. Kenntnisse über Veränderungen des Schlafes im Rahmen schizophrener Erkrankungen ermöglichen die Berücksichtigung schlafhygienischer Maßnahmen im Therapieverlauf, die unter Umständen den Behandlungsverlauf positiv beeinflussen können.

Abstract

Difficulties initiating and maintaining sleep as well as circadian rhythm disorders are very common in schizophrenia. Sleeping disorders occur as early signs of the first manifestation of illness as well as early signs of relapse. They bear a relation to positive symptoms and disorganisation of thought. Polysomnographic investigations with schizophrenic patients typically demonstrate a prolonged sleep-onset latency and a decrease in sleep efficiency and slow wave sleep. In particular, distortions of deep sleep can affect neocortical plasticity and cognition negatively. The considerable sleeping disorders are often not sufficiently taken into account in clinical routine. Particularly older antipsychotic medication like Haloperidol can affect the circadian and sleep-wake rhythms negatively. Therefore, pathophysiological changes of sleep within the scope of schizophrenic disorders and their potential implications are discussed in this outline. Regarding therapy, psychoeducative approaches are discussed as well as the administration of antipsychotic medication in accordance with the recommendations of sleep medicine professionals.

Schlüsselwörter

Schlafstörungen - Schizophrenie - zirkadianer Rhythmus - Schlafhygiene

Key words

sleep disorders - schizophrenia - circadian rhythm - sleep hygiene

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Prof. Dr. Jürgen Staedt

Klinik für Psychiatrie
Psychotherapie und Psychosomatik-Memory Clinic
Vivantes Klinikum Spandau

Neue Bergstr. 6

13585 Berlin

Email: juergen.staedt@vivantes.de

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