Sleep in Early Psychosis and Bipolar Disorder: Preliminary Results on Actigraphic and Self-Reported Markers of Vulnerability.

Background: Sleep disturbances are common in the early stages of psychosis and bipolar disorder and are increasingly regarded as transdiagnostic risk factors for symptom severity and suicidality. However, few studies have simultaneously examined both subjective and objective sleep changes during this early illness phase. Methods: This cross-sectional study included patients within 12 months of the onset of psychosis or bipolar disorder and matched healthy controls. Patients completed standardised questionnaires including the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), Mood Disorder Questionnaire (MDQ) and Prodromal Questionnaire-16 (PQ-16). Actigraphy was recorded for seven consecutive nights in both groups. Results: Twenty patients (11 with psychosis, 9 with bipolar disorder) and 20 healthy controls were assessed. Most patients reported poor sleep quality (70%), depressive symptoms (60%) and suicidal thoughts (65%). Poor sleep quality was strongly linked to depressive symptoms (r = 0.76) and prodromal features (r = 0.69). Actigraphy showed reduced total sleep time in patients compared to controls (388 vs. 449 min) and longer sleep latency in bipolar patients than in those with psychosis (161 vs. 80 min). Conclusion: Sleep disturbances are common during the first year of psychosis and bipolar disorder. Subjective sleep issues are closely linked to depression, prodromal psychotic symptoms and suicidal thoughts, while actigraphy shows disorder-specific differences. Routine evaluation of both subjective and objective sleep may serve as early indicators of vulnerability and guide intervention strategies in severe mental illness.