Çocuk ve Ergenlerde Psikotik Bozukluklar ve Uyku
Özet
Uyku bozuklukları, şizofreni ve diğer psikiyatrik hastalıkların gelişiminde ve sürdürülmesinde kritik bir transdiagnostik faktör olarak kabul edilmektedir. Şizofreni tanılı bireylerin %30-80’inde görülen bu sorunlar; insomni, sirkadiyen ritim bozuklukları ve kâbuslar gibi geniş bir yelpazeyi kapsar. Özellikle uykuyu başlatma ve sürdürme güçlüğü, hastaların yaşam kalitesini düşürürken; kâbuslar, pozitif psikotik belirtilerin şiddeti ve intihar riski ile doğrudan ilişkilendirilmiştir. Nörobiyolojik araştırmalar, bu hastalarda talamokortikal iletişimdeki bozulmaların bir yansıması olarak "uyku iğciği" yoğunluğunda azalma ve sirkadiyen ritim düzensizliklerini saptamıştır. Dopaminerjik ve gabaerjik sistemlerdeki disfonksiyonun hem psikoz hem de uyku bozukluklarının ortak temelini oluşturabileceği düşünülmektedir. Tedavi tarafında, insomni için bilişsel davranışçı terapi (BDT-I) altın standart olarak önerilmekte; farmakolojik olarak ise antipsikotikler ve melatoninin uyku parametrelerini iyileştirdiği gözlenmektedir. Sonuç olarak, çocuk ve ergen popülasyonunda veriler kısıtlı olsa da uyku bozukluklarının erken tanısı ve tedavisi, psikozun seyrini değiştirebilecek stratejik bir müdahale alanı olarak önemini korumaktadır.
Sleep disorders are recognized as a critical transdiagnostic factor in the emergence and maintenance of psychiatric disorders, including schizophrenia. These issues, seen in 30-80% of individuals diagnosed with schizophrenia, encompass a broad spectrum such as insomnia, circadian rhythm disturbances, and nightmares. Particularly, difficulties in initiating and maintaining sleep reduce patients' quality of life, while nightmares have been directly associated with the severity of positive psychotic symptoms and increased suicide risk. Neurobiological research has identified reductions in "sleep spindle" density and circadian rhythm irregularities as reflections of disrupted thalamocortical communication in these patients. It is suggested that dysfunction in dopaminergic and GABAergic systems may form the shared basis for both psychosis and sleep disturbances. Regarding treatment, cognitive behavioral therapy for insomnia (CBT-I) is considered the gold standard, while pharmacologically, antipsychotics and melatonin have been observed to improve sleep parameters. In conclusion, although data in the child and adolescent population are limited, the early diagnosis and treatment of sleep disorders remain vital as a strategic intervention area that could alter the course of psychosis.
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