[Nightmares and psychopathology]

Nightmares are long frightening dreams, quite common in psychiatric and general population; they may cause psychological distress and social or occupational dysfunction and are the most common form of parasomnia. They can be divided into post-traumatic nightmares, which are part of post-traumatic stress reaction, idiopathic and stress-induced. This article is a review of studies evaluating the relationship between nightmares and psychopathology, especially in regard to their intensity and content. For example, prepsychotic patients often report nightmares, particularly of body fragmentation and death of the dreamer. Nightmares have been repeatedly associated with the general level of psychopathology and with the personality factor "neuroticism". Nightmare distress, the impact on daily functioning caused by nightmares, may function as a mediating variable. Several studies in the last years have shown that nightmares can be treated with several cognitive-behavioral techniques. Have been also reported promising effects of pharmacological agents, especially prazosin, but they need to be evaluated in larger placebo-controlled trials. In summary, many findings on nightmares are preliminary and this field needs to be further investigated. Nevertheless psychiatry and general medicine need to pay more attention to nightmares; they are not merely a nightly symptom of anxiety, but a separate sleep disorder that should receive specific treatment.