Psychiatric Comorbidity and Pharmacotherapy in Sleep Disorders

Extract

The decision to devote this issue of CNS Spectrums to sleep disorders was two-fold. First, sleep disorders are of relatively high prevalence in the population with a significant impact on public health and safety. Unfortunately, their significance has been underestimated. Hence, the training of subspecialists capable to deal competently with the diagnosis and treatment of these disorders that afflict all age groups has lagged behind the training of other subspecialists. Second, the presence of psychiatric symptoms in many individuals afflicted with these disorders and the bona fide psychiatric comorbidity of many such patients have been underestimated. Psychiatric comorbidity raises some compelling issues about the need that at least selected patients presenting with a sleep problem should undergo a thorough psychiatric evaluation along with a specialized evaluation, if deemed necessary.

Although the majority of patients with sleep disorder would benefit from an initial psychiatric evaluation, such a practice may not be available at all sleep centers. A psychiatric evaluation should first assess the nature and origin of psychiatric symptoms and determine the presence of a primary or secondary psychiatric disorder. Once a reliable diagnosis has been established, the proper course of treatment can be outlined. As with most other psychiatric conditions, a combined course of pharmacotherapy and psychotherapy has the best chance of restoring functionality and preventing relapses. Thus, the role the psychiatrist can play in optimizing the care of patients with a sleep disorder cannot be overemphasized.