title: Increased sleep duration precedes the improvement of other symptom domains during the treatment of acute mania: a retrospective chart review.
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.
authors.affiliation: Mount Sinai Beth Israel Medical Center, Psychiatry and Behavioral Sciences, 317 E 17th St., 9 Fierman Hall, New York, NY, 10003, USA. igalynke@chpnet.org.
authors.forename: Igor I
authors.initials: II
authors.lastname: Galynker
authors.affiliation: Mount Sinai Beth Israel Medical Center, Psychiatry and Behavioral Sciences, 317 E 17th St., 9 Fierman Hall, New York, NY, 10003, USA.
authors.forename: Zimri S
authors.initials: ZS
authors.lastname: Yaseen
authors.affiliation: Mount Sinai Beth Israel Medical Center, Psychiatry and Behavioral Sciences, 317 E 17th St., 9 Fierman Hall, New York, NY, 10003, USA.
authors.forename: Siva S
authors.initials: SS
authors.lastname: Koppolu
authors.affiliation: Mount Sinai Beth Israel Medical Center, Psychiatry and Behavioral Sciences, 317 E 17th St., 9 Fierman Hall, New York, NY, 10003, USA.
authors.forename: Barney
authors.initials: B
authors.lastname: Vaughan
authors.affiliation: Mount Sinai Beth Israel Medical Center, Psychiatry and Behavioral Sciences, 317 E 17th St., 9 Fierman Hall, New York, NY, 10003, USA.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Szklarska-Imiolek
authors.affiliation: Mount Sinai Beth Israel Medical Center, Psychiatry and Behavioral Sciences, 317 E 17th St., 9 Fierman Hall, New York, NY, 10003, USA.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Cohen
authors.affiliation: Mount Sinai Beth Israel Medical Center, Psychiatry and Behavioral Sciences, 317 E 17th St., 9 Fierman Hall, New York, NY, 10003, USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Salvanti
authors.affiliation: Mount Sinai Beth Israel Medical Center, Psychiatry and Behavioral Sciences, 317 E 17th St., 9 Fierman Hall, New York, NY, 10003, USA.
authors.forename: Hae-Joon
authors.initials: HJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012890:Sleep / Q000502:physiology*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Bipolar disorder; Mania; Psychosis; Sleep