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J Clin Psychiatry. 1993 Jul;54(7):244-55; discussion 256-9.

Sleep disorders related to another mental disorder (nonsubstance/primary): a DSM-IV literature review.

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Sleep and Chronobiology Center, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, PA 15213.



Disturbances of the sleep/wake cycle are fundamental clinical symptoms for patients with many of the mental disorders. This review of the literature on research in sleep and mental disorders from 1966 to 1991 highlights the major developments and findings that are central to the development of a DSM-IV diagnosis of sleep disorders related to another mental disorder (nonsubstance/primary).


As a framework, the review discusses the classification criteria listed in the International Classification of Sleep Disorders (ICSD, 1990) for sleep disorders associated with mental disorders. Research relevant to the classification system is reviewed and the merits of modifying the DSM-III-R criteria based on the accumulated research are discussed.


Overall, the review supports the notion of consistent biological alterations in the sleep/wake cycle for patients with many of the mental disorders.


On the basis of this evidence, sleep disorders related to another mental disorder warrant separate diagnostic classification within a nosology for sleep disorders. The review also reveals the historical development of sleep research as a tool within the field of psychiatry for characterizing the biological bases of mental disorders.

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