Nightmares in Patients with Major Depressive Disorder, Bipolar Disorder, and Psychotic Disorders: A Systematic Review.
Marine Ambar Akkaoui, Michel Lejoyeux, Marie-Pia d'Ortho, Pierre A Geoffroy
Journal of Clinical Medicine December 9, 2020 DOI: 10.3390/jcm9123990 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Peer reviewed |
|---|---|
| Population | Patients with mood disorders or psychotic disorders, compared with healthy controls |
| Topics | Dreaming Depression |
| Keywords | Sleep disorders Suicide Mood disorders Psychotic disorders Bad dreams |
| Key findings | Nightmares were more than twice as frequent in people with mood or psychotic disorders as in healthy controls. Frequent nightmares were associated with higher suicidality scores and more frequent history of suicide attempt, while nightmare-related distress, not frequency, was associated with psychiatric disorder severity. The authors argue these findings have major clinical and therapeutic implications and call for studies of whether nightmare treatment improves the underlying psychiatric disorder. |
Abstract
Chronic nightmares are very common in psychiatric disorders, affecting up to 70% of patients with personality or post-traumatic stress disorders. In other psychiatric disorders, the relationships with nightmares are poorly known. This review aimed to clarify the relationship between nightmares and both mood and psychotic disorders. We performed a systematic literature search using the PubMed, Cochrane Library and PsycINFO databases until December 2019, to identify studies of patients suffering from either a mood disorder or a psychotic disorder associated with nightmares. From the 1145 articles screened, 24 were retained, including 9 studies with patients with mood disorders, 11 studies with patients with psychotic disorders and 4 studies with either psychotic or mood disorders. Nightmares were more frequent in individuals with mood or psychotic disorders than in healthy controls (more than two-fold). Patients with frequent nightmares had higher suicidality scores and had more frequently a history of suicide attempt. The distress associated with nightmares, rather than the frequency of nightmares, was associated with the severity of the psychiatric disorder. Further studies assessing whether nightmare treatment not only improves patient-sleep perception but also improves underlying psychiatric diseases are needed. In conclusion, nightmares are overrepresented in mood and psychotic disorders, with the frequency associated with suicidal behaviors and the distress associated with the psychiatric disorder severity. These findings emphasize major clinical and therapeutic implications.
Comparable studies
Other systematic reviews and meta-analyses on dreaming, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Dreaming as mind wandering: evidence from functional neuroimaging and first-person content reports. | 2013 | Systematic review with meta-analytic comparison | |
| Lucid dreaming incidence: A quality effects meta-analysis of 50 years of research | 2016 | Meta-analysis | |
| The effectiveness of lucid dreaming therapy in patients with nightmares: A systematic review. Adults with chronic and recurring nightmares | 2023 | Systematic review | |
| The relationships between insomnia, nightmares, and dreams: A systematic review Individuals without a concomitant psychopathology, including those with insomnia or... | 2024 | Systematic review | |
| Psychosocial treatments for nightmares in adults and children: a systematic review | 2023 | Systematic review |
Citations in the library
Cited by 22
- Nightmare Distress as a Risk Factor for Suicide Among Adolescents with Major Depressive Disorder Nature and Science of Sleep September 1, 2022
- Bad dream, nightmares and psychopathology: a systematic review Frontiers in Psychiatry October 8, 2024
- Dreams and nightmares: Clinical aspects, management, and links to psychiatric disorders L'Encephale April 9, 2026
- Nightmares matter: rethinking suicide risk assessment and intervention in depression Sleep April 8, 2026
- The association between dream activity and alexithymia during pregnancy: A cross-sectional study in a sample of pregnant women. Journal of Sleep Research August 1, 2025
and 17 more in the library
Cites 19
- Aetiology and treatment of nightmare disorder: State of the art and future perspectives Journal of Sleep Research January 29, 2019
- Prevalence and Correlates of Frequent Nightmares: A Community-Based 2-Phase Study Sleep June 1, 2010
- Nightmares in Patients with Psychosis: The Relation with Sleep, Psychotic, Affective, and Cognitive Symptoms The Canadian Journal of Psychiatry August 1, 2015
- Childhood sleep disturbance and risk of psychotic experiences at 18: UK birth cohort The British Journal of Psychiatry May 8, 2015
- Nightmares in the general population: identifying potential causal factors Social Psychiatry and Psychiatric Epidemiology July 15, 2017
and 14 more in the library