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Circadian rhythm sleep disorders: clinical picture, diagnosis and treatment

Luca G, Van Den Broecke S, Rev Med Suisse 2020 Jun 17;16(698):1237-1242



Circadian rhythm sleep disorders (CRSD) represent sleep-wake disturbances due to a disruption of endogenous circadian system or to a desynchronization between internal sleep-wake rhythms and the external environment. They comprise seven diagnostic entities grouped in two main categories: endogenous and exogenous. The patients typically describe chronic excessive daytime sleepiness and/or insomnia symptoms, impacting their daytime functioning. The exact prevalence of CRSD is probably underestimated. The diagnosis is based on sleep diary coupled with actigraphy. Several therapeutic options are validated to allow the realignment between endogenous circadian rhythm and the external environment. The correct diagnostic of CRSD is important to improve the patient's quality of life and to propose them appropriate treatment.

Sleep Quality and Sleep Disturbance Perception in Dual Disorder Patients

Luca G, Peris L. Sleep Quality and Sleep Disturbance Perception in Dual Disorder Patients. J Clin Med. 2020 Jun 26;9(6): E2015. doi: 10.3390/jcm9062015. OPEN



Background: Sleep problems are particularly frequent in psychiatric disorders, but their bidirectional intersection is poorly clarified. An especial link between substance use and sleep seems to exist. While dual disorder patients are certainly at higher risk of experiencing sleep problems, very limited research is available today. Methods: Forty-seven dual disorder hospitalized patients were included in this first study. A complete psychiatric evaluation was performed, and sleep habits, patterns and potential disorders were evaluated with specific sleep scales, as well as anxiety. Results: The global prevalence of insomnia symptoms was considerably higher compared with the general population. Different abuse patterns as a function of concurrent psychiatric diagnosis were found, with no significant gender differences. The association between the investigated sleep parameters and any specific substance of abuse was minor. The addict behavior started in more than half of the patients prior to the main psychiatric diagnosis and close to the beginning of sleep problems. Men had a higher prevalence of insomnia symptoms, together with a higher incidence of anxiety. Overall, subjective daytime functioning was not altered as a consequence of poor sleep. Conclusion: Dual disorder patients face significant sleep disturbances, with low sleep quality. The role of sleep in addiction and dual disorders deserves greater research.

Projets en cours

  • Clinical efficacy of a structured group of psychoeducation for patients with schizophrenia.
  • La prise en charge sous contrainte en Psychiatrie.
  • La prescription inappropriée et la poly médication chez la personne âgée.
  • The paradox of shared decision-making and perceived coercion in psychiatry (projet inter cantonal VD, FR, NE et VS).
  • L’anxiété et la démence chez la personne âgée.
  • A cognitive training program for ADHD (collaboration avec l’Université de Fribourg).
  • Distinction entre états psychopathologiques et états extraordinaires de conscience (collaboration avec l’Université de Fribourg).
  • Anxiété en temps du COVID-19.
  • Le personnel de la santé et l'épidémie de COVID-19.
  • Les troubles du sommeil chez l'enfant et l'adolescent suivis en pédopsychiatrie. Résultat ou cause ?
  • Télépsychiatrie pour le traitement de l’enfant et l’adolescent. Un projet pilote.

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