Case series of aripiprazole monotherapy in bipolar disorder with delayed sleep-wake phase syndrome

Patients with bipolar disorder (BD) who also experience delayed sleep-wake phase (DSWP) disorder/syndrome may tend to be younger, have a higher risk of relapse, and exhibit more severe impairments in social functioning. However, few studies have explored this area, and there are currently no established treatment guidelines, prompting us to investigate this further through a case series.

We report on a chart review of 15 patients diagnosed with bipolar disorder (BD) and delayed sleep-wake phase (DSWP) syndrome, who received Aripiprazole (APZ) monotherapy for 12 to 135 weeks.

Efficacy was observed within the first two weeks, indicated by reductions in Clinical Global Impressions-Severity (CGI-S) scores and an advancement of the sleep-wake cycle. By the final visit, 93.3% (14/15) of participants had achieved clinical remission (defined as CGI-S < 3), with their social functioning returning to normal. The most common adverse events were extrapyramidal side effects and weight gain, but both were reversible.

In summary, APZ monotherapy may be an effective and safe treatment option for BD patients with DSWP syndrome. Our chart review highlights the potential value of further systematic investigation through a clinical trial.