Increased sleep duration precedes the improvement of other symptom domains during the treatment of acute mania: a retrospective chart review.

Igor I Galynker,Lisa J Cohen,Magdalena Szklarska-Imiolek,Hae-Joon Kim,Zimri S Yaseen,Siva S Koppolu,Thomas M Salvanti,Barney Vaughan

doi:10.1186/s12888-016-0808-7

Igor I Galynker, Lisa J Cohen + Show 6 more

Open Access

https://doi.org/10.1186/s12888-016-0808-7

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Journal: BMC Psychiatry	Publication Date: Apr 12, 2016
Citations: 27	License type: cc-by

Affiliation: Mount Sinai Beth Israel

Abstract

BackgroundUnderstanding trajectories of symptom changes may help gauge treatment response and better identify therapeutic targets in treatment of acute mania. We examined how symptoms of sleep disturbance, mania, and psychosis resolved in a naturalistic treatment setting, hypothesizing that improvement in sleep would precede improvement in manic and psychotic symptoms.MethodsCharts of 100 patients with admitting diagnoses of bipolar mixed or manic episode were retrospectively reviewed. Medications and demographic variables were recorded, and the Clinician-Administered Rating Scale for Mania (CARS-M) mania and psychosis ratings and sleep hours were determined for 8 observation points. Times to minimum symptom level in each domain were compared via Wilcoxon signed-rank tests. Symptom correlations and trajectories and medication effects were explored using repeated measures ANOVA and regression models.ResultsManic and psychotic symptom resolution was linear over the time of hospitalization. In contrast, sleep showed a slow initial response, followed by rapid increase to peak, preceding peak improvement in mania and psychosis (p < 0.001). Rate of sleep restoration was a predictor of rate but not of magnitude of treatment response for symptoms mania and psychosis. Patterns of medication use did not affect symptom trajectories.ConclusionsIn acute mania, improvement in sleep with treatment is dissociable from resolution in symptoms of mania and psychosis, but there appears to be no therapeutic advantage to patient oversedation. Sleep improves first and may be both a predictor of the rate of treatment response and a useful therapeutic target.

Highlights

Understanding trajectories of symptom changes may help gauge treatment response and better identify therapeutic targets in treatment of acute mania
Bipolar disorder is a disorder of mood, which is distinguished from other mood disorders by manic episodes – sustained periods of decreased sleep and increased energy, as well as elevated or irritable mood and, in some instances, psychosis
Animal models indicate that sleep deprivation may trigger a manic episode [5], while in humans, chronotherapy with sleep deprivation is effective in elevating mood in depression as well as in depression with psychotic features [6, 7]

Summary

Introduction

Understanding trajectories of symptom changes may help gauge treatment response and better identify therapeutic targets in treatment of acute mania. Knowledge of the relationships between and trajectories of these symptom domains may help better identify therapeutic targets as a manic episode progresses from its onset to its resolution. Animal models indicate that sleep deprivation may trigger a manic episode [5], while in humans, chronotherapy with sleep deprivation is effective in elevating mood in depression (via the reset of circadian rhythms disrupted by CLOCK gene dysfunction) as well as in depression with psychotic features [6, 7]. A recent study found that poor sleep quality continues during euthymia, and that sleep disturbance may be a prodromal sign or trigger of a change in mood episode [11]. Studies examining environmental disturbances to circadian/social rhythms’ contributions to mania onset suggest they do so via sleep disturbance [12]

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