Rosh Psychiatry Board Practice Exam

In the context of acute anxiety, what might a significant change in sleep patterns indicate?

1. Possible insomnia

2. Potential substance abuse

3. Signs of depression

4. Impending mania

The correct answer is: Impending mania

A significant change in sleep patterns during acute anxiety often indicates a state of heightened arousal or unrest, which can be linked to impending mania. In manic episodes, individuals may experience decreased need for sleep, engage in racing thoughts, and exhibit increased energy levels. This contrast in sleep patterns, especially where sleep becomes markedly reduced or disrupted, can serve as an early warning sign that someone is moving toward a manic phase. While insomnia may also occur with anxiety or depression, the specific context of acute anxiety coupled with an unusual change in sleep suggests the possibility of a manic episode, particularly if this change is aligned with other symptoms of mania such as irritability, grandiosity, or impulsivity. The focus on sleep in the context of anxiety helps clarify the nature of the underlying mood disturbance and points toward the need for careful monitoring of mood regulation and psychiatric assessment.