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Schlafmedizinische Differenzialdiagnostik in Psychiatrie und Psychotherapie

Sleep medicine differential diagnostics in psychiatry and psychotherapy

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Zusammenfassung

Klagen über einen gestörten Schlaf oder erhöhte Tagesmüdigkeit gehören zu den häufigsten Beschwerden, die Patienten gegenüber ihrem Psychiater und Psychotherapeuten beklagen. Solche Beschwerden können Symptom einer psychiatrischen Störung sein, aber auch hinweisend auf andere oder zusätzliche Erkrankungen. Deshalb sind Grundkenntnisse in der schlafmedizinischen Differenzialdiagnostik von erheblicher klinischer Bedeutung für Psychiater und Psychotherapeuten. In der vorliegenden Übersicht wird nach einer Darstellung der diagnostischen Methoden das differenzialdiagnostische Vorgehen orientiert an den klassischen Leitsymptomen, nämlich Ein- und Durchschlafstörungen, gestörte nächtliche Motorik und erhöhte Tagesmüdigkeit, dargestellt.

Summary

Complaints about disturbed sleep or increased daytime sleepiness are among the most frequent symptoms reported to psychiatrists by patients. Such complaints can be symptoms of an underlying psychiatric disorder or indicative of a separate or comorbid sleep disorder. Hence, basic knowledge in the differential diagnosis of sleep medicine pathologies is pivotal for psychiatrists and psychotherapists. In the present overview following a description of the diagnostic methods, the diagnostic work-up according to the major symptomatic clusters, namely disturbances in initiating and maintaining sleep, abnormal nocturnal movements and excessive daytime sleepiness will be presented.

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Literatur

  1. Riemann D, Hajak G (2009) Insomnias: I. Aetiology, pathophysiology and diagnostics. Nervenarzt 80(9):1060–1069

    Article  CAS  PubMed  Google Scholar 

  2. Pollmächer T (2011) Schlafstörungen. In: Moeller HJ, Laux G, Kapfhammer HP (Hrsg) Psychiatrie, Psychosomatik, Psychotherapie, 4. Aufl., Kapitel 63, Bd 2. Springer, Berlin, S 913–954

  3. Buysse DJ, Reynoldd CR 3rd, Monk TH et al (1989) The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 28(2):193–213

    Article  CAS  PubMed  Google Scholar 

  4. Johns MW (1994) Sleepiness in different situations measured by the Epworth Sleepiness Scale. Sleep 17(8):703–710

    CAS  PubMed  Google Scholar 

  5. Walters AS, LeBrocq C, Dhar A et al (2003) Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. Sleep Med 4(2):121–132

    Article  PubMed  Google Scholar 

  6. Fulda S, Hornyak M, Müller K et al (2008) Development and validation of the Munich Parasomnia Screening (MUPS): a questionnaire for parasomnias and nocturnal behaviours. Somnologie 12:56–65

    Article  Google Scholar 

  7. Reynolds CF 3rd, Coble PA, Kupfer DJ, Holzer BD (1982) Application of the multiple sleep latency test in disorders of excessive sleepiness. Electroencephalogr Clin Neurophysiol 53(4):443–452

    Article  PubMed  Google Scholar 

  8. Sangal RB, Thomas L, Mitler MM (1992) Maintenance of wakefulness test and multiple sleep latency test. Measurement of different abilities in patients with sleep disorders. Chest 101(4):898–902

    Article  CAS  PubMed  Google Scholar 

  9. Jewett ME, Dijk DH, Kronauer RE, Dinges DF (1999) Dose-response relationship between sleep duration and human psychomotor vigilance and subjective alertness. Sleep 22(2):171–179

    CAS  PubMed  Google Scholar 

  10. American Academy of Sleep Medicine (AASM) (2005) The international classification of sleep disorders: diagnostic and coding manual, 2. Aufl., American Academy of Sleep Medicine, Westchester

  11. Happe S, Walther BW (Hrsg) (2009) Schlafmedizin in der Praxis: Die Internationale Schlafklassifikation in Fallberichten. Ecomed MEDIZIN Verlag, Heidelberg

  12. Riemann D, Berger M, Voderholzer U (2001) Sleep and depression – results from psychobio-logical studies: an overview. Biol Psychol 57:67–103

    Article  CAS  PubMed  Google Scholar 

  13. Pollmächer T, Wetter T (2012) Schlafstörungen. In Gründer G, Benkert O (Hrsg) Handbuch der Psychopharmakotherapie. 2. Aufl. Springer, Heidelberg, S 1067–1083

  14. Monti JM (1997) Disturbances of sleep and wakefulness associated with the use of antihypertensive agents. Life Sci 41:1979–1988

    Article  Google Scholar 

  15. Gann H, Calker D van, Riemann D (2004) Die Bedeutung des Schlafs für gesunde Alkoholkonsumenten und alkoholabhängige Patienten. Nervenarzt 75:431–441

    Article  CAS  PubMed  Google Scholar 

  16. NIH (National Institutes of health state of the science conference statement) (2005) Manifestations and management of chronic insomnia in adults, June 13–15. Sleep 28:1049–1057

    Google Scholar 

  17. Reynolds CF, Redline S (2010) The DSM-V sleep-wake disorders nosology: an update and an invitation to the sleep community. Sleep 33:10–11

    PubMed  Google Scholar 

  18. Deutsche Gesellschaft für Schlafforschung und Schlafmedizin (DGSM) (2009) Nicht-erholsamer Schlaf/Schlafstörungen (S3 Leitlinie). Somnologie 13:4–160

    Article  Google Scholar 

  19. Allen RP, Picchietti D, Hening WA et al (2003) Restless legs syndrome: diagnostic criteria, special considerations and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med 4:101–119

    Article  PubMed  Google Scholar 

  20. Trenkwalder C, Benes H, Hornyak M et al (2008) Restless Legs Syndrom (RLS) und Periodic Limb Movement Disorder (PLMD). In: Diener HC, Putzki N (Hrsg) Leitlinien für Diagnostik und Therapie in der Neurologie. Thieme, Stuttgart, S 56–68 (http://www.uni-duesseldorf.de/WWW/AWMF/ll/ll_neuro.htm)

  21. Hornvak M, Benes H, Eisensehr I et al (2009) Depressive Erkrankungen beim Restless-legs-Sndrom. Pathogenese, Diagnose und Implikationen für die Therapie. Nervenarzt 80:1160–1168

    Article  Google Scholar 

  22. Pressman MR (2007) Factors that predispose, prime and precipitate NREM parasomnias in adults: clinical and forensic implications. Sleep Med Rev 11:5–30

    Article  PubMed  Google Scholar 

  23. Cartwright RD (2010) Parasomnias due to medications or substances. In: Thorpy MJ, Plazzi G (Hrsg) The parasomnias and other sleep-related movement disorders. Cambridge University Press, Cambridge, S 42–53

  24. Thomas A, Bonanni L, Onofrj M (2007) Symptomatic REM sleep behaviour disorder. Neurol Sci 28:21–36

    Article  Google Scholar 

  25. Iranzo A, Molinuevo JL, Santamaría J et al (2006) Rapid-eye-movement sleep behaviour disorder as an early marker for a neurodegenerative disorder: a descriptive study. Lancet Neurol 5:572–577

    Article  PubMed  Google Scholar 

  26. Derry CP, Davey M, Johns M et al (2006) Distinguishing sleep disorders from seizures. Arch Neurol 63:705–710

    Article  PubMed  Google Scholar 

  27. Tinuper P, Provini F, Bisulli F et al (2007) Movement disorders in sleep: guidelines for differentiating epileptic from non-epileptic motor phenomena arising from sleep. Sleep Med Rev 11:255–267

    Article  PubMed  Google Scholar 

  28. Ohayon MM (2008) From wakefulness to excessive sleepiness: what we know and still need to know. Sleep Med Rev 2:129–141

    Article  Google Scholar 

  29. Nofzinger EA, Thase ME, Reynolds CF 3rd et al (1991) Hypersomnia in bipilar depression: a comparison with narcolepsy using the multiple sleep latency test. Am J Psychiatry 148(9):1177–1181

    CAS  PubMed  Google Scholar 

  30. Mayer G, Pollmächer T (Hrsg) (2007) Narkolepsie – Neue Chancen in Diagnostik und Therapie. Thieme, Stuttgart

  31. Arnulf I, Rico TJ, Mignot E (2012) Diagnosis, disease course and management of patients with Kleine-Levin syndrome. Lancet Neurol 11:918–928

    Article  PubMed  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. T. Pollmächer, T.C. Wetter, S. Happe, K. Richter, J. Acker und D. Riemann geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Zentrum für psychische Gesundheit, Klinikum Ingolstadt, Krumenauerstr. 25, 85049, Ingolstadt, Deutschland

    T. Pollmächer

  2. Klinik und Poliklinik für Psychiatrie und Psychotherapie, Schlafmedizinisches Zentrum, Universität Regensburg am Bezirksklinikum, Regensburg, Deutschland

    T.C. Wetter

  3. Abteilung für Neurologie, Klinik Maria Frieden, Telgte, Deutschland

    S. Happe

  4. Psychiatrische Klinik, Klinikum Nord, Nürnberg, Deutschland

    K. Richter & J. Acker

  5. Zentrum für Schlafmedizin, Abteilung für Psychiatrie und Psychotherapie, Universitätsklinik Freiburg, Freiburg, Deutschland

    D. Riemann

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  1. T. Pollmächer
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  2. T.C. Wetter
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  3. S. Happe
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  4. K. Richter
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  5. J. Acker
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  6. D. Riemann
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Correspondence to T. Pollmächer.

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Pollmächer, T., Wetter, T., Happe, S. et al. Schlafmedizinische Differenzialdiagnostik in Psychiatrie und Psychotherapie. Nervenarzt 85, 57–66 (2014). https://doi.org/10.1007/s00115-013-3895-4

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  • DOI: https://doi.org/10.1007/s00115-013-3895-4

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