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

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.

The nosological status of unipolar mania and hypomania within UK Biobank according to objective and subjective measures of diurnal rest and activity

“…Sleep duration in UM has not been extensively studied, but loss of sleep is an important trigger for mania in BD, 40 and increased sleep duration can contribute to improvements in manic symptoms. 41 We found that short sleep duration was more likely in UM, whether selfreported or objectively assessed. Although objective measures of sleep and activity had a similar pattern of negative outcomes for both mood disorder groups, average activity levels may represent a useful differentiator between UM and BD.…”

“…Sleep duration in UM has not been extensively studied, but loss of sleep is an important trigger for mania in BD, 40 and increased sleep duration can contribute to improvements in manic symptoms 41 . We found that short sleep duration was more likely in UM, whether self‐reported or objectively assessed.…”

Efficacy of a Contextualized Measurement of Life Satisfaction: A Pilot Study on the Assessment of Progress in Eating Disorder Therapy

“…This paper aimed to assess the importance and validity, in the context of the clinical treatment of patients with eating disorders, of a POLS (Present Overall Life Satisfaction) indicator, namely the Life Satisfaction Chart (LSCh), which includes the perspective of the personal-history time axis obtained by means of a novel graphical technique. The LSCh was developed by the integration of two previous techniques, the “Life Line” [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ] and the “Life Chart Methodology-retrospective (LShM-r)” [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ], after adapting them to the measurements of a client or patient’s degree of wellbeing and suffering.…”