Abstract
ObjectivesAcute mania is a serious medical condition that impacts men and women equally. Longtime presentation of manic symptoms is sex‐dependent; however, little is known about acute symptoms of mania. The objective of this study is to track and compare acute manic symptoms for sex differences during inpatient hospitalization.MethodsAll patients with bipolar mania admitted to a large university hospital between January and October 2017 were invited to participate in this longitudinal naturalistic follow‐up study. Manic (YMRS), depressive (MADRS), and psychotic (PAS) symptoms were tracked daily from admission to discharge.ResultsThe total YMRS scores decreased significantly overtime (p < .0001) in both male (n = 34) and female (n = 23) patients (p = .7). However, male patients scored significantly higher in sexual interest (p = .01), disruptive and aggressive behavior (p = .01), and appearance (p < .001) while females had better insight into their illness (p = .01). Males and females received similar doses of lithium (p = .1), but males received significantly higher doses of valproic acid (VPA) in comparison with females (p = .003). However, plasma lithium and VPA concentrations at discharge were not significantly different between sexes.ConclusionOur results show sex differences in the progression of certain domains of manic symptoms in a cohort of 23 female and 34 male patients admitted to a large academic center in Turkey. Males, in this sample, exhibited more sexual interest, disruptive and aggressive behaviors, better grooming, and less insight compared to females. While these results are concordant with our preclinical findings and with anecdotal clinical observations, replication in larger samples is needed.
Highlights
Bipolar disorder type I (BPI) is a serious medical condition characterized by the occurrence of one or more manic episodes
To explore the neurobiological aspect, we used our newly established lateral hypothalamic-kindled (LHK) rat mania model to examine sex differences in manic-like behaviors during mania induction (Abulseoud et al, 2014) and we found that male rats exhibited more sexual behavior, significantly increased locomotor activity during the light phase, and reduced rest interval, while females displayed significantly higher ethanol consumption and more frequent rearing behaviors (Abulseoud et al, 2015)
Plasma valproate (VPA) levels were measured by color spectrophotometry (Belal, ElKafrawy, Mahrous, Abdel-Khalek, & Abo-Gharam, 2016), and lithium levels are measured by flame photometric method (Levy & Katz, 1970)
Summary
Bipolar disorder type I (BPI) is a serious medical condition characterized by the occurrence of one or more manic episodes. Despite equal sex ratio in prevalence, men have significantly earlier age of onset of first mania (Grant et al, 2005; Kennedy et al, 2005), more substance use (Kessing, 2004; Nivoli et al, 2011), behavioral (Kawa et al, 2005), and legal problems (Baldassano et al, 2005), and are more likely to be treated with lithium (Karanti et al, 2015). BPI women are more likely to have lifetime history of attempted (Nivoli et al, 2011) and completed suicide (Clements et al, 2013). In contrast to these lifetime differences between male and female bipolar patients, sex differences in acute manic manifestations have received little attention. Only YMRS scores at admission were compared between subjects without further exploration of sex differences amid the course of manic symptoms during hospitalization or whether males and females received similar treatment
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