Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Sep 20, 2018; 8(3): 75-78
Published online Sep 20, 2018. doi: 10.5498/wjp.v8.i3.75
Successful treatment of nightmares may reduce psychotic symptoms in schizophrenia
Mary V Seeman
Mary V Seeman, Department of Psychiatry, University of Toronto, Toronto, ON M5P 3L6, Canada
Author contributions: Seeman MV is the sole author.
Conflict-of-interest statement: There was no support for this manuscript and no conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mary V Seeman, DSc, FRCP (C), MD, Emeritus Professor, Department of Psychiatry, University of Toronto, 260 Heath St. W., Suite 605, Toronto, ON M5P 3L6, Canada. mary.seeman@utoronto.ca
Telephone: +1-416-4863456
Received: May 21, 2018
Peer-review started: May 21, 2018
First decision: June 6, 2018
Revised: June 27, 2018
Accepted: June 29, 2018
Article in press: June 29, 2018
Published online: September 20, 2018

Nightmares occur more frequently in patients with schizophrenia than they do in the general population. Nightmares are profoundly distressing and may exacerbate daytime psychotic symptoms and undermine day-to-day function. Clinicians do not often ask about nightmares in the context of psychotic illness and patients may underreport them or, if nightmares are reported, they may be disregarded; it may be assumed that they will disappear with antipsychotic medication and that they do not, therefore, require separate intervention. This is a missed opportunity because Image Rehearsal Therapy, among other psychological and pharmacological interventions, has proven effective for nightmares in non-schizophrenia populations and should be considered at an early stage of psychotic illness as an important adjunct to standard treatment. There is active ongoing research in this field, which will undoubtedly benefit patients with schizophrenia in the future.

Keywords: Sleep, Nightmares, Psychosis, Nightmare-inducing drugs, Image rehearsal therapy

Core tip: A substantial percentage of persons suffering from psychotic illness such as schizophrenia experience frightening nightmares that aggravate their disease symptoms. New treatments for nightmares in the general population are starting to be applied to schizophrenia patients, as are new treatments for other associated sleep problems. This is very promising research that clinicians need to heed, as the lessening of nightmare distress will also help to alleviate daytime psychotic symptoms.