Altered sleep patterns are prominent in the majority of psychiatric disorders. This article examines the psychiatric disorders that are most often associated to sleep dysfunction as it is related in clinical practice and describes the polysomnographic findings. Patient's main complaints are related to difficulty in initiating and maintaining sleep (initial or middle insomnia, respectively) and poor quality of sleep. Early awakening or terminal insomnia is most described in the depressive conditions. Hypersomnia may be the main symptom in some depressive disorders, as seasonal depression, depression with atypical features or depressive episodes in bipolar disorder. Polysomnographic evaluation shows, in general, a significative reduction in the efficiency and total time of sleep, in detriment to the amount of slow wave sleep. The reduction of rapid eye movement (REM) sleep latency is mainly described for the depression, but has also been reported in other psychiatric disorders.

OBJECTIVE:To comprehend the stigma against people with mental disorders still persists in the culture of general hospitals and acts as a limiting factor in the implementation of psychiatric units in general hospitals in Brazil. METHODOLOGICAL PROCEDURES:A qualitative social survey was outlined based on action research strategy as of the agreement to adopt a psychiatric unit in a general hospital in Taubaté, Southeastern Brazil. Data was obtained through interviews, participant observation and talks on the psychiatric unit project given to the hospital's clinical staff. RESULTS:The investment made by the healthcare authority enabled the stigmatizing conceptions (violence, moral weakness and untreatability) present in the hospital culture in question to be resignifi ed by means of clinical and sanitary discussions, which enabled the implementation of the psychiatric unit. The analysis showed that these concepts persist in this context because of a healthcare system that limits the access of people with mental disorders. CONCLUSIONS:The attitude of the healthcare authority, who decided to adequately fund the general hospital's psychiatric unit and exerted his infl uence over the hospital, was decisive for the outcome of the case. The main diffi culty in implementing psychiatric units at general hospitals is not the overcoming the existing stigma in the culture of general hospitals, but rather a diffi culty which is strategic in nature: the lack of an affi rmative policy for these units.

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