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CLINICAL SYNTHESIS   |    
Parasomnias: A Review for Psychiatrists
Thomas D. Hurwitz, M.D.; Michael Howell, M.D.; Imran S. Khawaja, M.B.B.S.
FOCUS 2014;12:16-30. doi:10.1176/appi.focus.12.1.16
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Author Information and CME Disclosure

Thomas D. Hurwitz, M.D., Department of Psychiatry, Minneapolis VA Medical Center; Minnesota Regional Sleep Disorders Center at Hennepin County Medical Center; Director, Sleep Medicine Clinic, Minneapolis VA Health Care System; Assistant Professor of Psychiatry, University of Minnesota Medical School, Minneapolis, MN

Michael Howell, M.D., Medical Director, Fairview Southdale Sleep Center; Minnesota Regional Sleep Disorders Center at Hennepin County Medical Center; Director of Training, University of Minnesota Sleep Medicine Fellowship; Assistant Professor of Neurology, University of Minnesota Medical School, Minneapolis, MN

Imran S. Khawaja, M.B.B.S., Medical Director, Minnesota Regional Sleep Disorders Center at Hennepin County Medical Center; Assistant Professor of Psychiatry, University of Minnesota Medical School, Minneapolis, MN

Thomas. Hurwitz, Michael Howell, and Imran Khawaja report no competing interests.

Address correspondence to Thomas D. Hurwitz, M.D., Minneapolis VAMC, 116A, 1 Veterans Dr., Minneapolis, MN 55417; e-mail: hurwi001@umn.edu

An erratum to this article has been published | view the erratum
Abstract

The category of sleep disorders known as parasomnias includes behavioral disturbances occurring during sleep or states of mixed sleep and wakefulness. They can be minimal and confined to vocalizations or minor movements or of a magnitude that can lead to serious injury, disruption of relationships, and diagnostic ambiguity. Many can be mistakenly thought to represent manifestations of psychiatric disorders. Careful evaluation and therapy can prevent inappropriate psychiatric diagnosis, avoid ineffective treatment, and ameliorate the sleep disorders. Herein, many parasomnias will be brought to the attention of practicing psychiatrists who can learn to recognize enough of the most important clinical features to ensure appropriate consultation with a sleep medicine specialist.

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Figure 1. Polysomnography of a 25-Year-Old Man With a History of Childhood Sleep Terrorsa

a During this 30-second epoch of polysomnography, there was an abrupt arousal from non-REM stage N3 sleep with moaning, arm flailing movement. Patient was amnestic for this episode.

Figure 2. Polysomnography of a 70-Year-Old Man Admitted to the Emergency Room for Treatment of Injuries Sustained During Sleepa

a During this 30-second epoch of polysomnography, there was increased muscle tone in the chin electromyogram as well as upper and lower extremity movement during stage REM. The technologist entered the room to ensure that the patient would not injure himself if we were to “throw himself out of bed.”

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Table 1.Characteristics of Parasomnias
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References Container
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CME Activity

Add a subscription to complete this activity and earn CME credit.
Sample questions:
1.
Changes in the diagnostic formulation of insomnia in DSM-5 include which of the following:

See Doghramji: Table 1. DSM-5 Criteria for Insomnia Disorder p 6
2.
The risk of insomnia is greatest in which of the following populations:

See Doghramji: Prevalence, p 3
3.
A 75-year old woman requests a psychiatric consultation for frequently interrupted sleep; she falls asleep readily but awakens about six times per night, getting only about 6 hours of sleep between her bedtime of 11 p.m. and rising at 8 a.m. She is apparently in good health but is fatigued and very worried about getting inadequate sleep. A sleep laboratory study revealed no sleep disorder requiring medical management. Which of the following is the first best treatment choice?

See Byrne: Behavioral Strategies of CBT-I, Sleep Restriction Treatment p 35