1104 Distress from Unusual Thought Content Moderates the Association Between Manic Symptoms and Sleep Disturbance

Abstract Introduction Sleep impairment is a hallmark feature of bipolar disorder and a marker of relapse risk, yet not all individuals with elevated mania symptoms exhibit impaired sleep. Psychosis-related distress may identify individuals who are more vulnerable to the sleep-disruption observed in mania. This study tested whether subjective distress from prodromal symptom subtypes moderates the relationship between manic symptoms and sleep in a non-clinical young adult sample. Methods Forty-two participants (ages 18–59; 54.8% female; seeking help for sleep) completed the Mood Disorder Questionnaire (MDQ), Sleep Condition Indicator (SCI), and the Prodromal Questionnaire (PQ-16), from which three previously proposed distress subscales were computed: Negative Symptoms (NSd), Unusual Thought Content/Paranoia (UTCd), and Perceptual Abnormalities/Hallucinations (PAd). All predictors were mean-centered. Three models were conducted predicting SCI total scores from MDQ scores, each including one distress subscale as the moderator, covarying for age and sex. Additional models tested whether mania symptoms or distress scores alone predicted SCI scores. Results A significant interaction emerged for the UTCd subscale indicating that higher MDQ scores predicted poorer sleep only among participants reporting elevated distress from unusual thoughts (β = –0.43, p = .015). When UTCd was low, manic symptoms were not associated with subjective sleep. In contrast, neither the NSd subscale (p = .49) nor the PAd subscale (trend-level; p = .064) significantly moderated the relationship. Critically, neither MDQ symptoms alone (p = .99) nor PQ distress scores alone (p = .74) predicted SCI scores in separate models, indicating that subjective sleep disruption emerged only when considering their interaction. Conclusion Subjective distress from unusual thought content (UTCd), rather than mania severity or prodromal symptoms alone, plays a critical role in determining when manic symptoms are linked to poor perceived sleep. This suggests that affective reactivity to unusual thoughts may initiate sleep deterioration during periods of emerging mania. Clinically, findings underscore the importance of assessing subjective distress levels, not just symptom presence, when monitoring individuals at risk for bipolar-spectrum conditions. Interventions that target distress tolerance, cognitive appraisal of unusual thoughts, and coping responses may help prevent sleep disruption and support early intervention efforts. Support (if any) This work was supported by the U.S. Department of Defense.