Circadian biomarkers, circadian genes and bipolar disorders

Bipolar disorder with seasonal pattern: clinical characteristics and gender influences

Bipolar disorder (BD) has a multifactorial etiology with heterogeneous clinical presentations. Around 25% of BD patients may present with a depressive seasonal pattern (SP). However, there are limited scientific data on the prevalence of SP, its clinical manifestations, and any gender influence. Four hundred and fifty-two BD I and II cases (62% female), recruited from three French university-affiliated psychiatric departments, were assessed for SP. Clinical, treatment, and sociodemographic variables were obtained from structured interviews. One hundred and two (23%) cases met DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) criteria for SP, with similar frequency according to gender. Multivariate analysis showed a significant association between SP and BD II (odds ratio [OR] = 1.99, p = 0.01), lifetime history of rapid cycling (OR = 2.05, p = 0.02), eating disorders (OR = 2.94, p = 0.003), and total number of depressive episodes (OR = 1.13, p = 0.002). Seventy-one percent of cases were correctly classified by this analysis. However, when stratifying the analyses by gender, SP was associated with BD II subtype (OR = 2.89, p = 0.017) and total number of depressive episodes (OR = 1.21, p = 0.0018) in males but with rapid cycling (OR = 3.02, p = 0.0027) and eating disorders (OR = 2.60, p = 0.016) in females. This is the first study to identify different associations between SP and clinical characteristics of BD according to gender. The authors suggest that SP represents a potentially important specifier of BD. These findings indicate that seasonality may reflect increased severity or complexity of disorder.

Chronobiology of mood disorders

OBJECTIVE

As part of a series of papers examining chronobiology ['Getting depression clinical guidelines right: time for change?' Kuiper et al. Acta Psychiatr Scand 2013;128(Suppl. 444):24-30; and 'Manipulating melatonin in managing mood' Boyce & Hopwood. ActaPsychiatrScand 2013;128(Suppl. 444):16-23], in this article, we review and synthesise the extant literature pertaining to the chronobiology of depression and provide a preliminary model for understanding the neural systems involved.

METHOD

A selective literature search was conducted using search engines such as MEDLINE/PubMed, combining terms associated with chronobiology and mood disorders.

RESULTS

We propose that understanding of sleep-wake function and mood can be enhanced by simultaneously considering the circadian system, the sleep homoeostat and the core stress system, all of which are likely to be simultaneously disrupted in major mood disorders. This integrative approach is likely to allow flexible modelling of a much broader range of mood disorder presentations and phenomenology.

CONCLUSION

A preliminary multifaceted model is presented, which will require further development and testing. Future depression research should aim to examine multiple systems concurrently in order to derive a more sophisticated understanding of the underlying neurobiology.

Time and its representations: at the crossroads between psychoanalysis and neuroscience

Representations of time and time measurements depend on subjective constructs that vary according to changes in our concepts, beliefs and technological advances. Similarly, the past, the future and also the present are subjective representations that depend on each individual's psychic time and biological time. Nonetheless, the construction of these representations is influenced by objective factors (cognitive, physiological and physical) related to neuroscience. Thus, studying representation of time lies at the crossroads between neuroscience and psychoanalysis. Furthermore, these objective factors are supposed to meet criteria of scientific validity, such as reproducibility. However, reproducibility depends on the individual's state that will not be exactly the same later, due precisely to the passage of time. The criteria of scientific validity are therefore only applicable if we place ourselves at time "t". This does not take into account lifespan biological changes. In fact, it is not neuroscience that is opposed to psychoanalysis based on this notion of subjectivity, illustrated by the concept of temporality, but rather the use and interpretation of neuroscience centered on taking snapshots. We can assume that focusing on present time, in particular instantaneity rather than infinity, prevents us from facing our own finitude. Individuals with autism provide us a good illustration of this idea. Through their autistic behaviors, they are totally focused on the present moment and create repeated discontinuity out of continuity. The hypothesis stated here is that children with autism need to create stereotyped discontinuity because discontinuity repeated at regular intervals might have been fundamentally lacking in their physiological development, due to circadian rhythm alterations. In conclusion, the question is raised that both the current use of neuroscience and the current representation of time might be a means of managing our fear of death, giving us the illusion of controlling the uncontrollable, in particular the passage of time.