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Guest Editorial
Highlighting Bipolar II Disorder
Gordon Parker, MD, PhD, DSc, FRANZCP
(PDF)

In Review
Neurobiological Findings in Bipolar II Disorder Compared With Findings in Bipolar I Disorder
Brent M McGrath, BSc, MSc, Phillip H Wessels, MD, FRCPC, Emily C Bell, BSc, MSc, Michele Ulrich, BSc, Peter H Silverstone, MB, BS, MD, MRCPsych, FRCPC
(PDF)

Bipolar II Disorder: An Overview of Recent Developments
George Hadjipavlou, MA, MD, Hiram Mok, MA, MB, BCh, BAO, FRCPC, Lakshmi N Yatham, MBBS, MRCPsych, FRCPC3 (PDF)

Review Paper
Bipolar Disorder: It’s All in Your Mind? The Neuropsychological Profile of a Biological Disorder
Gin S Malhi, BSc, MB, ChB, MRCPsych, FRANZCP, Belinda Ivanovski, Ssc Psychol, M Clin Psychol, Viktoria Szekeres, BSc,Psychol
(PDF)

Original Research
Impact of Culture on Depressive Symptoms of Elderly Chinese Immigrants
Glenda MacQueen, MD, PhD, FRCPC
Daniel WL Lai, PhD
(PDF)

Development and Reliability of a Pictorial Mental Disorders Screen for Young Adolescents
Nicole Smolla, PhD, Jean-Pierre Valla, MD, MSc, Lise Bergeron, PhD, Claude Berthiaume, MSc, Marie St-Georges, MPs
(PDF)

Command Hallucinations Among Asian Patients With Schizophrenia
Theresa MY Lee, MBBS, MMed, Siow Ann Chong, MBBS, MMed, Yiong Huat Chan, PhD, Gangaharan Sathyadevan, MBBS, MRCPsych
(PDF)

The Centre for Addiction and Mental Health Concurrent Disorders Screener
Juan C Negrete, MD, FRCPC, Jane Collins, MSc, Nigel E Turner, PhD, Wayne Skinner, MSW
(PDF)

Validation de la version française du questionnaire de Sociotropie-Autonomie de Beck et collègues
Mathilde M Husky, MSc, Olivier S Grondin, MSc, Philippe D Compagnone, PhD
(PDF)

Brief Communication
Depressive Symptoms and Alcohol Consumption Among Nonalcoholic Depression Patients Treated With Desipramine
Benjamin I Goldstein, MD, PhD, Ayal Schaffer, MD, FRCPC, Anthony Levitt, MD, FRCPC, Ari Zaretsky, MD, FRCPC, Russell T Joffe, MD, FRCPC, Virginia Wesson, MD, R Michael Bagby, PhD
Pierre Bleau, MD, FRCPC
(PDF)

Letters to the Editor
(PDF)

Safety of Clozapine in 2 Successive Pregnancies

Revisiting the Diagnostic Challenges of Secondary Mania and Bipolar Disorder in a Patient With Borderline Hyperthyroidism

Dyslipidaemia and Psychiatric Patients

Dream Contents in Patients With Major Depressive Disorder

Sensory Deprivation and Disorders of Perception

Re: The Internet’s Impact on the Practice of Psychiatry

Response: The Internet’s Impact on the Practice of Psychiatry

Denial and Avoidance in an Unusual Case of Death From Breast Cancer

Interferon-Induced Mania

Drug-Induced Psychosis After Long-Term Treatment With Levetiracetam

Priapism

An Ounce of Prevention: “COPEing with Toddler Behaviour”

Internet Gaming Addiction

Letters to the Editor

Dream Contents in Patients With Major Depressive Disorder

Dear Editor:
The ancients attributed great importance to dreams. Special temples built by the ancient Chinese, Egyptians, Greeks, and Romans were sanctuaries to which people retreated to understand the meaning of their dreams. Hippocrates (469–399 BC) and Galen (ca 130 AD) believed dreams could have psychological and diagnostic utility (1). Dreaming is one of the interesting aspects of human beings, and physicians could find important information about their patients by exploring their dreams. Dreaming also has several psychological functions, one of which is mood regulation, in healthy subjects (2).

We observed that many of our patients with depression remembered repetitive dreams that were exhausting or frightening. In this case-controlled study, we examined the dream contents of 41 patients who met DSM-IV criteria for major depressive disorder (MDD) and 82 matched healthy subjects. We conducted the study at the Kerman psychiatric hospital in Iran. Subjects were requested to freely remember their recurrent dreams in the previous 2 months. Each dream that received at least a point 4 from Schredl’s dream questionnaire, was considered a recurrent dream (3). We organized dream contents into 14 main categories, using the Hall/Van de Castle major categories (4).

Results

The mean (SD) age of patients was 32.77 (7.83) years; 24 (58.54%) were women and 17 (46.41%) were men. Forty (97.6%) patients and 68 (82.9%) healthy subjects had at least one recurrent dream in the previous 2 months (odds ratio [OR] 68; 95%CI, 10.25 to 13.20; P = 0.02). In 40 (97.6%) patients and 10 (12.2%) control subjects, the recurrent dreams were frightening (OR 10, 95%CI, 1.33 to 208.92; P = 0.015).

Frequency distribution of dream content categories among patients with depression was as follows: death (87.80%), separation (70.73%), frightening animals (60.97%), frightening situations (58.53%), natural disasters (59.09%), aggression (48.78%), falling (43.90%), waste matters (43.90%), blood (41.49%), negative emotions (41.46%), bizarre elements (39.02%), punishment (26.83%), suicide and homicide (24.39%), and sexual harm (21.95%). All categories of dream content were more prevalent among patients with depression than among the control group.

Conclusion

In this study, we observed that many patients with depression whose chief complaint was not disturbing dreams had recurring and frightening dreams, when asked directly.

Exploring dream contents in patients with depression may be important from clinical points of view. For example, Agargun and others showed an association between repetitive and frightening dreams and suicidal tendency (5). Diminishing frequency or even disappearance of recurrent dreams in patients with MDD show the effectiveness of treatment with antidepressants (6). We recommend that physicians pay more attention to dream contents in patients with MDD, because these themes are unpleasant for patients, and trying to reduce them could help patients’ improvement.

References

1. Hempel AG, Felthous AR, Meloy JR. Psychotic dream-related aggression: a critical review and proposal. Aggression and Violent Behavior 2002;269:1–22.

2. Cartwright R, Luten A, Young M, Mercer P, Bears M. Role of REM sleep and dream affect in overnight mood regulation: a study of normal volunteers. Psychiatry Res 1998;81(1):1–8.

3. Schredl M. Messung der Traumerinnerung: skala and daten gesunder personen. Somnologie 2003;6:34–8.

4. Domboff GW. New direction in the study of dream content using the Hall/Van de Castle coding system. Dreaming 1999;9:115–38.

5. Agargun MY, Cilli AS, Kara H, Tarhan N, Kincir F, OZ H. Repetitive and frightening dreams and suicidal behavior in patients with major depression. Compr Psychiatry 1998;39:198–202.

6. Kirschner NT. Changes in dream content after drug treatment. Dreaming 1999;9:195–200.

Alireza Ghaffari Nejad, MD;
Rahyl Zahra Sanatinia, MD;
Kiarash Yousofi, MD,
Kerman,Iran