ابعاد کنترل روانشناختی والدین: ارتباطات با پرخاشگری فیزیکی و رابطه پیش دبستانی در روسیه

Sleep deprivation is a potentially useful non-pharmacological treatment for depression. A relationship between sleep loss and the onset of mania has been reported, so it is possible that a switch from depression into mania after sleep deprivation might be expected in bipolar depressed patients who are treated with sleep deprivation. In a sample of 206 bipolar depressed treated with three cycles of sleep deprivation, alone or in combination with heterogeneous medications, we observed a 4.85% switch rate into mania and a 5.83% switch rate into hypomania. These percentages are comparable to those observed with antidepressant drug treatments.

The potential usefulness of sleep deprivation in the treatment of bipolar depressed patients has been suggested (American Psychiatric Association, 1995). A common risk when treating bipolar depression is the occurrence of a switch from depression into mania, and in bipolar patients a close relationship has been observed between sleep loss and the onset of mania (e.g. Wehr, 1992 and Barbini et al., 1996). Few data are available, however, on the rate of switch from depression into mania after therapeutic sleep deprivation in bipolar patients. In their review on the effects of sleep deprivation in depression, Wu and Bunney (1990) cited 10 studies that had reported switches from depression into hypomania or mania, with a 30% rate of switch after therapeutic sleep deprivation in bipolar depressed patients. Years of publication of the 10 studies ranged from 1974 to 1982. In more recent studies on the effects of sleep deprivation, switches into mania disappear except for rapid-cycling bipolar patients. Wehr et al. (1982) report the spontaneous occurrence of sleep deprivation before the switch into a manic phase in 13/15 rapid-cycling bipolar patients, while therapeutic sleep deprivation caused 7/9 drug-free depressed rapid-cycling bipolar patients to switch into mania. More recently, the relationship between sleep loss and the onset of mania in patients with rapid-cycling bipolar disorder has been well established (Leibenluft et al., 1996). A major problem in the literature about sleep deprivation is the diagnostic heterogeneity of the samples, because many of the study groups included patients with endogenous, reactive, unipolar, bipolar, secondary, and schizoaffective depression (Leibenluft and Wehr, 1992). Therefore, on the basis of the available data, the rate of switch from depression into mania that should be expected after sleep deprivation in non-rapid-cycling bipolar patients cannot be reliably estimated. In the present study, we report the rate of switches from depression into mania observed in a sample of 206 bipolar depressed inpatients treated with therapeutic sleep deprivation.