The relationship between insomnia and affective disorders has been well established since ancient medicine came into being. Brilliant descriptions accomplished by famous clinicians testify that the interest about the association between sleep and affective disorders was kept alive in Italy until the first decades of last century. Afterwards, sleep researchers, other than psychiatrists, were interested to correlate insomnia to psychopathology. They confirmed that insomnia is ubiquitous in depressive and anxiety disorders, that chronic insomniacs suffer mainly from affective symptoms (more than 70% of patients according to several reports), and that the incidence of the depressive episodes in these patients is double compared to non insomniacs patients. Hypnological literature confirmed that insomnia constantly precedes the onset and parallels the course of depressive episodes and its disappearance is a reliable index of rapid recovery. On the contrary persistence of sleep complains after depressive recovery is associated with a 4 to 6 times higher likely hood of relapses, compared to patients with recovered sleep. Clinicians classically consider chronic insomnia associated to depression just a symptom of the depressive clinical cohort, even if present DSM taxonomy includes it within the framework of the psychiatric comorbidity. In this perspective insomnia is an early depressive symptom when it anticipates the episode or a residual phenomenon when its persistence is beyond depressive recovery. Recent longitudinal and psychobiological studies led to hypothesize that chronic insomnia may represent a vulnerability marker of affective pathology, a psychobiological index of mood instability. Therefore early diagnosis and appropriated treatment are nowadays becaming crucial for psychiatrists, previously focused to face with sedative effects of tryciclic antidepressants responsible for severe impairment of vigilance during the day.

I profondi rapporti tra insonnia e disturbi affettivi sono noti sin dagli esordi della medicina. In Italia l’interesse è stato molto vivo fino agli inizi del secolo scorso ed è rintracciabile nelle pagine magistrali che molti clinici dedicarono alla loro descrizione. Negli anni successivi sono stati principalmente gli studiosi del sonno a confermare l’ubiquitarietà dell’insonnia nella depressione e nei disturbi d’ansia ed a mostrare che negli insonni cronici i fenomeni psicopatologici del versante affettivo rappresentano l’evento più comune, presente per alcuni in oltre il 70% dei pazienti e che l’insorgenza della depressione è più che doppia rispetto ai controlli non insonni. La letteratura ipnologica ha inoltre verificato le iniziali osservazioni secondo le quali l’insonnia precede costantemente l’episodio depressivo, evolve parallelamente ad esso e la sua risoluzione è indice attendibile di rapida guarigione. La psichiatria attuale ricomprende l’insonnia associata a depressione nel concetto descrittivo della comorbilità, dopo averla a lungo considerata parte integrante del quadro clinico affettivo. In quest’ottica l’insonnia si configurava come sintomo depressivo precoce quando anticipa l’episodio o come fenomeno residuo quando persiste oltre la sua risoluzione. Gli studi longitudinali e le indagini psicobiologiche sul sonno più recenti lasciano ipotizzare che l’insonnia cronica può rappresentare anche un fattore di vulnerabilità, un indice psicobiologico di instabilità della sfera affettiva. La diagnosi tempestiva ed il trattamento adeguato in questa prospettiva assumono un ruolo ben più importante di quello attribuito loro dalla maggioranza degli psichiatri, fino a ieri impegnati a contenere la sonnolenza dei trattamenti antidepressivi di prima generazione, i cui effetti sedativi inevitabilmente compromettevano la vigilanza durante il giorno.

Insonnia e vulnerabilità ai disturbi di ansia e dell’umore

PALAGINI L.
Primo
;
2004

Abstract

The relationship between insomnia and affective disorders has been well established since ancient medicine came into being. Brilliant descriptions accomplished by famous clinicians testify that the interest about the association between sleep and affective disorders was kept alive in Italy until the first decades of last century. Afterwards, sleep researchers, other than psychiatrists, were interested to correlate insomnia to psychopathology. They confirmed that insomnia is ubiquitous in depressive and anxiety disorders, that chronic insomniacs suffer mainly from affective symptoms (more than 70% of patients according to several reports), and that the incidence of the depressive episodes in these patients is double compared to non insomniacs patients. Hypnological literature confirmed that insomnia constantly precedes the onset and parallels the course of depressive episodes and its disappearance is a reliable index of rapid recovery. On the contrary persistence of sleep complains after depressive recovery is associated with a 4 to 6 times higher likely hood of relapses, compared to patients with recovered sleep. Clinicians classically consider chronic insomnia associated to depression just a symptom of the depressive clinical cohort, even if present DSM taxonomy includes it within the framework of the psychiatric comorbidity. In this perspective insomnia is an early depressive symptom when it anticipates the episode or a residual phenomenon when its persistence is beyond depressive recovery. Recent longitudinal and psychobiological studies led to hypothesize that chronic insomnia may represent a vulnerability marker of affective pathology, a psychobiological index of mood instability. Therefore early diagnosis and appropriated treatment are nowadays becaming crucial for psychiatrists, previously focused to face with sedative effects of tryciclic antidepressants responsible for severe impairment of vigilance during the day.
2004
Palagini, L.; C., Gentili; Guazzelli, M
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11392/2506950
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