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BMC Psychiatry
Published in: BMC Psychiatry 1/2016

Open Access 01-12-2016 | Research article

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

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

Published in: BMC Psychiatry | Issue 1/2016

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Abstract

Background

Understanding 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.

Methods

Charts 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.

Results

Manic 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.

Conclusions

In 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.
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Metadata
Title
Increased sleep duration precedes the improvement of other symptom domains during the treatment of acute mania: a retrospective chart review
Authors
Igor I. Galynker
Zimri S. Yaseen
Siva S. Koppolu
Barney Vaughan
Magdalena Szklarska-Imiolek
Lisa J. Cohen
Thomas M. Salvanti
Hae-Joon Kim
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2016
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-016-0808-7

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