Life events, sleep disturbance, and mania: An integrated model

Parental death by external causes during childhood and risk of psychiatric disorders in bereaved offspring

BACKGROUND

Previous studies have reported increased risks of psychiatric disorders in offspring who have lost a parent, but knowledge is lacking on the risks of several specific disorders and comorbidity. The present study investigated the influence of parental death by external causes during childhood and adolescence on risk of a range of psychiatric disorders and comorbidity.

METHOD

The study cohort comprised 655,477 individuals born 1970-2012 with a link to both parents. Data on deceased parent's cause and date of death between 1970 and 2012 and offspring's psychiatric disorders between 2008 and 2012 were retrieved from four longitudinal Norwegian registers. Data were analyzed with Cox regression.

RESULTS

Compared to nonexposed offspring, offspring exposed to parental death by external causes had a significantly increased risk of depressive disorders, reactions to stress, anxiety disorders, substance use disorders, developmental disorders, childhood behavioral and emotional disorders, psychotic disorders, bipolar disorder, personality disorders, and psychiatric comorbidity, but not eating disorders. These increased risks were especially evident following parental suicide and accidental falls and poisoning. No differences were evident depending on gender of the deceased or age at bereavement, and generally no significant interactions with gender of the bereaved offspring were evident.

CONCLUSIONS

The improved insight into several different psychiatric disorders and psychiatric comorbidity should guide postvention measures aimed at children and adolescents at greatest risk of future sequelae.

Does stress play a significant role in bipolar disorder? A meta-analysis

BACKGROUND

There is evidence that stressful life events (LE) play a crucial role in the etiology of bipolar affective disorder (BD). However, primary studies, as well as narrative reviews, have provided mixed results. The present meta-analysis combined and analyzed previous data in order to address these inconsistencies.

METHOD

Forty-two studies published in 53 records were identified by systematically searching MEDLINE, PsychINFO, and PSYCHINDEX using the terms "bipolar disorder" OR "manic-depressive" OR "bipolar affective disorder" OR "mania" AND "stress" OR "life event" OR "daily hassles" OR "goal attainment". Then, meta-analyses were conducted.

RESULTS

Individuals diagnosed with BD reported more LE before relapse when compared to euthymic phases. They also experienced more LE relative to healthy individuals and to physically ill patients. No significant difference in the number of LE was found when BD was compared to unipolar depression and schizophrenia.

LIMITATIONS

When interpreting the present meta-analytic findings one should keep in mind that most included studies were retrospective and often did not specify relevant information, e.g., if the LE were chronic or acute or if the individuals were diagnosed with BD I or II. We could not entirely rule out a publication bias.

CONCLUSION

The present meta-analyses found that individuals with BD were sensitive to LE, which corroborates recent theoretical models and psychosocial treatment approaches of BD. Childbirth, as a specific LE, affected individuals with BD more than individuals with unipolar depression. Future studies that investigate specific LE are warranted.

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

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.