1
|
Öksüz E, Mersin S, Uçgun T, Sarikoc G. Experiences of nurses providing care to hospitalized patients with acute mania in Türkiye: A phenomenological study. Arch Psychiatr Nurs 2024; 50:33-39. [PMID: 38789231 DOI: 10.1016/j.apnu.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 10/01/2023] [Accepted: 03/07/2024] [Indexed: 05/26/2024]
Abstract
The main purpose of this study was to determine the experiences of nurses who care for hospitalized patients experiencing an acute manic episode. This qualitative study was carried out with 15 nurses working in a psychiatric ward in Türkiye. Data were collected through semi-structured in-depth individual interviews and focus-group interviews in which the face-to-face interview technique was used. Two main themes emerged from the analysis of the qualitative data: (1) the difficulties experienced and (2) the most effective elements of care. Under the first main theme, the following sub-themes emerged: difficulties in setting boundaries, safety concerns, difficulties in managing the patient's demands, inability to choose the appropriate word(s), and the "emotional whirlwind" experienced. The second main theme, on the other hand, included the following sub-themes: meeting basic needs, ensuring treatment compliance, encouragement to engage in physical activity, and having a sufficient number of qualified personnel. The study revealed that the nurses had difficulties in caring for their manic patients. On the basis of these results, it is recommended that nurses be given counseling and training on setting boundaries, ensuring safety, managing the patient's demands, coping with their own emotions, and communicating better. In addition, the study identified the importance of nursing interventions to meet patients' basic needs, encourage them to engage in physical activity, and ensure treatment compliance, and the importance of there being an adequate number of qualified personnel. These results may help students and other nurses in terms of assessing and setting priorities in cases needing acute psychiatric care.
Collapse
Affiliation(s)
- Emine Öksüz
- University of Health Sciences Turkey, Gulhane Faculty of Nursing, Psychiatric and Mental Health Nursing Department, Ankara, Turkey.
| | - Sevinç Mersin
- Bilecik Şeyh Edebali University, Faculty of Health Sciences, Psychiatric and Mental Health Nursing Department, Bilecik, Turkey.
| | - Tuğçe Uçgun
- Başkent University, Faculty of Health Sciences, Department of Mental Health and Psychiatric Nursing, Ankara, Turkey.
| | - Gamze Sarikoc
- University of Health Sciences Turkey, Gulhane Faculty of Nursing, Psychiatric and Mental Health Nursing Department, Ankara, Turkey.
| |
Collapse
|
2
|
Roguski A, Ritter P, Smith DJ. Sensitivity to light in bipolar disorder: implications for research and clinical practice. Br J Psychiatry 2024; 224:143-146. [PMID: 38174418 PMCID: PMC7615859 DOI: 10.1192/bjp.2023.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Circadian dysfunction is a core feature of bipolar disorder and may be due, at least in part, to abnormalities of non-visual photoreception. We critically review the evidence for light hypersensitivity in bipolar disorder and discuss how this may shape future research and clinical innovation, with a focus on a possible novel mechanism of action for lithium.
Collapse
Affiliation(s)
- Amber Roguski
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Philipp Ritter
- Clinic for Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technical University of Dresden, Dresden, Germany
| | - Daniel J. Smith
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
| |
Collapse
|
3
|
Orhan M, Korten N, Mans N, van Schaik D, Kupka R, Stek M, Steenhuis D, van Dijk M, Swartz HA, van Oppen P, Dols A. Feasibility and Acceptability of Group Interpersonal and Social Rhythm Therapy for Recurrent Mood Disorders: A Pilot Study. Am J Psychother 2024; 77:1-6. [PMID: 38013432 DOI: 10.1176/appi.psychotherapy.20220067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
OBJECTIVE Interpersonal and social rhythm therapy (IPSRT) was developed to empower patients with mood disorders by stabilizing underlying disturbances in circadian rhythms and by using strategies from interpersonal psychotherapy. Group IPSRT has not been studied with a transdiagnostic sample of patients across the life span with either major depressive disorder or bipolar disorder. METHODS Thirty-eight outpatients, ages 26-80, with major depressive disorder or bipolar disorder in any mood state were recruited from clinics in the Netherlands and were treated with 20 sessions (two per week) of group IPSRT. Recruitment results, dropout rates, and session adherence were used to assess feasibility. The modified Client Satisfaction Questionnaire (CSQ) and a feedback session were used to measure treatment acceptability. Changes in mood symptoms, quality of life, and mastery were also measured. RESULTS Participants' mean±SD age was 65.4±10.0 years. Participants were diagnosed as having major depressive disorder (N=14, 37%) or bipolar disorder (N=24, 63%). The dropout rate was relatively low (N=9, 24%). High CSQ scores (32.3±5.2 of 44.0 points) and low dropout rates indicated the acceptability and feasibility of group IPSRT for major depressive disorder and bipolar disorder. Quality of life 3 months after completion of treatment was significantly higher than at baseline (p<0.01, Cohen's d=-0.69). No significant differences were found between pre- and postintervention depressive symptom scores. CONCLUSIONS Twice-weekly group IPSRT for older outpatients with major depressive disorder or bipolar disorder was feasible and acceptable. Future research should evaluate the short- and long-term efficacy of group IPSRT for major depressive disorder and bipolar disorder among patients of all ages.
Collapse
Affiliation(s)
- Melis Orhan
- Clinical Psychology Program, Institute of Psychology, Leiden University, Leiden, the Netherlands (Orhan); Northwest Clinics, Alkmaar, the Netherlands (Korten); Department of Psychiatry, Vrije Universiteit Amsterdam, Amsterdam (Orhan, Korten, van Schaik, Kupka, Stek, van Oppen, Dols); GGZ inGeest Mental Health Care, Amsterdam (Mans, van Schaik, Kupka, Stek, Steenhuis, van Dijk, van Oppen); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Swartz); Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands (Dols)
| | - Nicole Korten
- Clinical Psychology Program, Institute of Psychology, Leiden University, Leiden, the Netherlands (Orhan); Northwest Clinics, Alkmaar, the Netherlands (Korten); Department of Psychiatry, Vrije Universiteit Amsterdam, Amsterdam (Orhan, Korten, van Schaik, Kupka, Stek, van Oppen, Dols); GGZ inGeest Mental Health Care, Amsterdam (Mans, van Schaik, Kupka, Stek, Steenhuis, van Dijk, van Oppen); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Swartz); Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands (Dols)
| | - Nina Mans
- Clinical Psychology Program, Institute of Psychology, Leiden University, Leiden, the Netherlands (Orhan); Northwest Clinics, Alkmaar, the Netherlands (Korten); Department of Psychiatry, Vrije Universiteit Amsterdam, Amsterdam (Orhan, Korten, van Schaik, Kupka, Stek, van Oppen, Dols); GGZ inGeest Mental Health Care, Amsterdam (Mans, van Schaik, Kupka, Stek, Steenhuis, van Dijk, van Oppen); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Swartz); Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands (Dols)
| | - Digna van Schaik
- Clinical Psychology Program, Institute of Psychology, Leiden University, Leiden, the Netherlands (Orhan); Northwest Clinics, Alkmaar, the Netherlands (Korten); Department of Psychiatry, Vrije Universiteit Amsterdam, Amsterdam (Orhan, Korten, van Schaik, Kupka, Stek, van Oppen, Dols); GGZ inGeest Mental Health Care, Amsterdam (Mans, van Schaik, Kupka, Stek, Steenhuis, van Dijk, van Oppen); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Swartz); Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands (Dols)
| | - Ralph Kupka
- Clinical Psychology Program, Institute of Psychology, Leiden University, Leiden, the Netherlands (Orhan); Northwest Clinics, Alkmaar, the Netherlands (Korten); Department of Psychiatry, Vrije Universiteit Amsterdam, Amsterdam (Orhan, Korten, van Schaik, Kupka, Stek, van Oppen, Dols); GGZ inGeest Mental Health Care, Amsterdam (Mans, van Schaik, Kupka, Stek, Steenhuis, van Dijk, van Oppen); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Swartz); Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands (Dols)
| | - Max Stek
- Clinical Psychology Program, Institute of Psychology, Leiden University, Leiden, the Netherlands (Orhan); Northwest Clinics, Alkmaar, the Netherlands (Korten); Department of Psychiatry, Vrije Universiteit Amsterdam, Amsterdam (Orhan, Korten, van Schaik, Kupka, Stek, van Oppen, Dols); GGZ inGeest Mental Health Care, Amsterdam (Mans, van Schaik, Kupka, Stek, Steenhuis, van Dijk, van Oppen); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Swartz); Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands (Dols)
| | - Deborah Steenhuis
- Clinical Psychology Program, Institute of Psychology, Leiden University, Leiden, the Netherlands (Orhan); Northwest Clinics, Alkmaar, the Netherlands (Korten); Department of Psychiatry, Vrije Universiteit Amsterdam, Amsterdam (Orhan, Korten, van Schaik, Kupka, Stek, van Oppen, Dols); GGZ inGeest Mental Health Care, Amsterdam (Mans, van Schaik, Kupka, Stek, Steenhuis, van Dijk, van Oppen); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Swartz); Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands (Dols)
| | - Moniek van Dijk
- Clinical Psychology Program, Institute of Psychology, Leiden University, Leiden, the Netherlands (Orhan); Northwest Clinics, Alkmaar, the Netherlands (Korten); Department of Psychiatry, Vrije Universiteit Amsterdam, Amsterdam (Orhan, Korten, van Schaik, Kupka, Stek, van Oppen, Dols); GGZ inGeest Mental Health Care, Amsterdam (Mans, van Schaik, Kupka, Stek, Steenhuis, van Dijk, van Oppen); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Swartz); Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands (Dols)
| | - Holly A Swartz
- Clinical Psychology Program, Institute of Psychology, Leiden University, Leiden, the Netherlands (Orhan); Northwest Clinics, Alkmaar, the Netherlands (Korten); Department of Psychiatry, Vrije Universiteit Amsterdam, Amsterdam (Orhan, Korten, van Schaik, Kupka, Stek, van Oppen, Dols); GGZ inGeest Mental Health Care, Amsterdam (Mans, van Schaik, Kupka, Stek, Steenhuis, van Dijk, van Oppen); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Swartz); Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands (Dols)
| | - Patricia van Oppen
- Clinical Psychology Program, Institute of Psychology, Leiden University, Leiden, the Netherlands (Orhan); Northwest Clinics, Alkmaar, the Netherlands (Korten); Department of Psychiatry, Vrije Universiteit Amsterdam, Amsterdam (Orhan, Korten, van Schaik, Kupka, Stek, van Oppen, Dols); GGZ inGeest Mental Health Care, Amsterdam (Mans, van Schaik, Kupka, Stek, Steenhuis, van Dijk, van Oppen); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Swartz); Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands (Dols)
| | - Annemieke Dols
- Clinical Psychology Program, Institute of Psychology, Leiden University, Leiden, the Netherlands (Orhan); Northwest Clinics, Alkmaar, the Netherlands (Korten); Department of Psychiatry, Vrije Universiteit Amsterdam, Amsterdam (Orhan, Korten, van Schaik, Kupka, Stek, van Oppen, Dols); GGZ inGeest Mental Health Care, Amsterdam (Mans, van Schaik, Kupka, Stek, Steenhuis, van Dijk, van Oppen); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Swartz); Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands (Dols)
| |
Collapse
|
4
|
Meyer N, Lok R, Schmidt C, Kyle SD, McClung CA, Cajochen C, Scheer FAJL, Jones MW, Chellappa SL. The sleep-circadian interface: A window into mental disorders. Proc Natl Acad Sci U S A 2024; 121:e2214756121. [PMID: 38394243 PMCID: PMC10907245 DOI: 10.1073/pnas.2214756121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
Sleep, circadian rhythms, and mental health are reciprocally interlinked. Disruption to the quality, continuity, and timing of sleep can precipitate or exacerbate psychiatric symptoms in susceptible individuals, while treatments that target sleep-circadian disturbances can alleviate psychopathology. Conversely, psychiatric symptoms can reciprocally exacerbate poor sleep and disrupt clock-controlled processes. Despite progress in elucidating underlying mechanisms, a cohesive approach that integrates the dynamic interactions between psychiatric disorder with both sleep and circadian processes is lacking. This review synthesizes recent evidence for sleep-circadian dysfunction as a transdiagnostic contributor to a range of psychiatric disorders, with an emphasis on biological mechanisms. We highlight observations from adolescent and young adults, who are at greatest risk of developing mental disorders, and for whom early detection and intervention promise the greatest benefit. In particular, we aim to a) integrate sleep and circadian factors implicated in the pathophysiology and treatment of mood, anxiety, and psychosis spectrum disorders, with a transdiagnostic perspective; b) highlight the need to reframe existing knowledge and adopt an integrated approach which recognizes the interaction between sleep and circadian factors; and c) identify important gaps and opportunities for further research.
Collapse
Affiliation(s)
- Nicholas Meyer
- Insomnia and Behavioural Sleep Medicine Clinic, University College London Hospitals NHS Foundation Trust, LondonWC1N 3HR, United Kingdom
- Department of Psychosis Studies, Institute of Psychology, Psychiatry, and Neuroscience, King’s College London, LondonSE5 8AF, United Kingdom
| | - Renske Lok
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA94305
| | - Christina Schmidt
- Sleep & Chronobiology Group, GIGA-Institute, CRC-In Vivo Imaging Unit, University of Liège, Liège, Belgium
- Psychology and Neuroscience of Cognition Research Unit, Faculty of Psychology, Speech and Language, University of Liège, Liège4000, Belgium
| | - Simon D. Kyle
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, OxfordOX1 3QU, United Kingdom
| | - Colleen A. McClung
- Translational Neuroscience Program, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA15219
| | - Christian Cajochen
- Centre for Chronobiology, Department for Adult Psychiatry, Psychiatric Hospital of the University of Basel, BaselCH-4002, Switzerland
- Research Cluster Molecular and Cognitive Neurosciences, Department of Biomedicine, University of Basel, BaselCH-4055, Switzerland
| | - Frank A. J. L. Scheer
- Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital, Boston, MA02115
- Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Department of Neurology, Brigham and Women’s Hospital, Boston, MA02115
- Division of Sleep Medicine, Harvard Medical School, Boston, MA02115
| | - Matthew W. Jones
- School of Physiology, Pharmacology and Neuroscience, Faculty of Health and Life Sciences, University of Bristol, BristolBS8 1TD, United Kingdom
| | - Sarah L. Chellappa
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, SouthamptonSO17 1BJ, United Kingdom
| |
Collapse
|
5
|
Ballard R, Parkhurst JT, Gadek LK, Julian KM, Yang A, Pasetes LN, Goel N, Sit DK. Bright Light Therapy for Major Depressive Disorder in Adolescent Outpatients: A Preliminary Study. Clocks Sleep 2024; 6:56-71. [PMID: 38390946 PMCID: PMC10885037 DOI: 10.3390/clockssleep6010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Bright light therapy (BLT) has not been well-studied in adolescents with major depressive disorder, particularly in outpatient settings. METHODS We conducted an 8-week clinical trial of BLT in adolescents recruited from a primary care practice with moderate to severe major depression. Acceptability and feasibility were defined by daily use of the light box and integration into daily routines. To assess treatment effects, we utilized the Short Mood and Feelings Questionnaire (SMFQ) and actigraphic sleep variables. RESULTS Of the nine enrolled adolescents, the rate of daily use of the light therapy box was 100% at week 2, 78% at week 4 (n = 7), and 67% at weeks 6 and 8 (n = 6). Participants were better able to integrate midday BLT compared to morning BLT into their day-to-day routines. Mean depression scores improved during the 2-week placebo lead-in (dim red light-DRL) and continued to show significant improvement through 6 weeks of BLT. Sleep efficiency increased significantly (p = 0.046), and sleep onset latency showed a trend toward a significant decrease (p = 0.075) in the BLT phase compared to the DRL phase. CONCLUSION Bright light treatment that was self-administered at home was feasible, acceptable, and effective for adolescent outpatients with depression. Findings support the development of larger, well-powered, controlled clinical trials of BLT in coordination with primary care.
Collapse
Affiliation(s)
- Rachel Ballard
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Box 10, Chicago, IL 60611, USA
| | - John T Parkhurst
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Box 10, Chicago, IL 60611, USA
| | - Lisa K Gadek
- Lake Forest Pediatrics, Lake Bluff, IL 60044, USA
| | - Kelsey M Julian
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Box 10, Chicago, IL 60611, USA
| | - Amy Yang
- Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St., Suite 1000, Chicago, IL 60611, USA
| | - Lauren N Pasetes
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 425, Chicago, IL 60612, USA
| | - Namni Goel
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 425, Chicago, IL 60612, USA
| | - Dorothy K Sit
- Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St., Suite 1000, Chicago, IL 60611, USA
| |
Collapse
|
6
|
Dollish HK, Tsyglakova M, McClung CA. Circadian rhythms and mood disorders: Time to see the light. Neuron 2024; 112:25-40. [PMID: 37858331 PMCID: PMC10842077 DOI: 10.1016/j.neuron.2023.09.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/09/2023] [Accepted: 09/20/2023] [Indexed: 10/21/2023]
Abstract
The importance of time is ever prevalent in our world, and disruptions to the normal light/dark and sleep/wake cycle have now become the norm rather than the exception for a large part of it. All mood disorders, including seasonal affective disorder (SAD), major depressive disorder (MDD), and bipolar disorder (BD), are strongly associated with abnormal sleep and circadian rhythms in a variety of physiological processes. Environmental disruptions to normal sleep/wake patterns, light/dark changes, and seasonal changes can precipitate episodes. Moreover, treatments that target the circadian system have proven to be therapeutic in certain cases. This review will summarize much of our current knowledge of how these disorders associate with specific circadian phenotypes, as well as the neuronal mechanisms that link the circadian clock with mood regulation. We also discuss what has been learned from therapies that target circadian rhythms and how we may use current knowledge to develop more individually designed treatments.
Collapse
Affiliation(s)
- Hannah K Dollish
- Department of Psychiatry, University of Pittsburgh School of Medicine, 450 Technology Drive, Suite 223, Pittsburgh, PA 15219, USA
| | - Mariya Tsyglakova
- Department of Psychiatry, University of Pittsburgh School of Medicine, 450 Technology Drive, Suite 223, Pittsburgh, PA 15219, USA
| | - Colleen A McClung
- Department of Psychiatry, University of Pittsburgh School of Medicine, 450 Technology Drive, Suite 223, Pittsburgh, PA 15219, USA.
| |
Collapse
|
7
|
Madsen HØ, Hageman I, Martiny K, Faurholt-Jepsen M, Kolko M, Henriksen TEG, Kessing LV. BLUES - stabilizing mood and sleep with blue blocking eyewear in bipolar disorder - a randomized controlled trial study protocol. Ann Med 2023; 55:2292250. [PMID: 38109922 PMCID: PMC10732202 DOI: 10.1080/07853890.2023.2292250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 11/26/2023] [Indexed: 12/20/2023] Open
Abstract
INTRODUCTION Chronotherapeutic interventions for bipolar depression and mania are promising interventions associated with rapid response and benign side effect profiles. Filtering of biologically active short wavelength (blue) light by orange tinted eyewear has been shown to induce antimanic and sleep promoting effects in inpatient mania. We here describe a study protocol assessing acute and long-term stabilizing effects of blue blocking (BB) glasses in outpatient treatment of bipolar disorder. PATIENTS AND METHODS A total of 150 outpatients with bipolar disorder and current symptoms of (hypo)-mania will be randomized 1:1 to wear glasses with either high (99%) (intervention group) or low (15%) (control group) filtration of short wavelength light (<500 nm). Following a baseline assessment including ratings of manic and depressive symptoms, sleep questionnaires, pupillometric evaluation and 48-h actigraphy, participants will wear the glasses from 6 PM to 8 AM for 7 consecutive days. The primary outcome is the between group difference in change in Young Mania Rating Scale scores after 7 days of intervention (day 9). Following the initial treatment period, the long-term stabilizing effects on mood and sleep will be explored in a 3-month treatment paradigm, where the period of BB treatment is tailored to the current symptomatology using a 14-h antimanic schedule during (hypo-) manic episodes (BB glasses or dark bedroom from 6 PM to 8 AM) and a 2-h maintenance schedule (BB glasses on two hours prior to bedtime/dark bedroom) during euthymic and depressive states.The assessments will be repeated at follow-up visits after 1 and 3 months. Throughout the 3-month study period, participants will perform continuous daily self-monitoring of mood, sleep and activity in a smartphone-based app. Secondary outcomes include between-group differences in actigraphic sleep parameters on day 9 and in day-to-day instability in mood, sleep and activity, general functioning and objective sleep markers (actigraphy) at weeks 5 and 15. TRIAL REGISTRATION The trial will be registered at www.clinicaltrials.gov prior to initiation and has not yet received a trial reference. ADMINISTRATIVE INFORMATION The current paper is based on protocol version 1.0_31.07.23. Trial sponsor: Lars Vedel Kessing.
Collapse
Affiliation(s)
- Helle Østergaard Madsen
- Copenhagen Affective Disorder Research Centre (CADIC), Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Ida Hageman
- Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Klaus Martiny
- Copenhagen Affective Disorder Research Centre (CADIC), Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maria Faurholt-Jepsen
- Copenhagen Affective Disorder Research Centre (CADIC), Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Miriam Kolko
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Tone E. G. Henriksen
- Department of Research and Innovation, Division of Mental Health Care, Valen Hospital, Fonna Health Authority, Kvinnherad, Norway
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Centre (CADIC), Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
8
|
Maruani J, Reynaud E, Chambe J, Palagini L, Bourgin P, Geoffroy PA. Efficacy of melatonin and ramelteon for the acute and long-term management of insomnia disorder in adults: A systematic review and meta-analysis. J Sleep Res 2023; 32:e13939. [PMID: 37434463 DOI: 10.1111/jsr.13939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/28/2023] [Accepted: 04/28/2023] [Indexed: 07/13/2023]
Abstract
Melatonin has gained growing interest as a treatment of insomnia, despite contradictory findings, and a low level of evidence. A systematic review and meta-analysis was conducted following PRISMA criteria, to assess the efficacy of melatonin and ramelteon compared with placebo on sleep quantity and quality in insomnia disorder, while also considering factors that may impact their efficacy. This review included 22 studies, with 4875 participants, including 925 patients treated with melatonin, 1804 treated with ramelteon and 2297 receiving a placebo. Most studies evaluated the acute efficacy of prolonged release (PR) melatonin in insomnia disorder. Compared with placebo, PR melatonin appears efficacious with a small to medium effect size on subjective sleep onset latency (sSOL) (p = 0.031; weighted difference = -6.30 min), objective sleep onset latency (oSOL) (p < 0.001; weighted difference = -5.05 min), and objective sleep efficiency (oSE) (p = 0.043; weighted difference = 1.91%). For the subgroup mean age of patients ≥55, PR melatonin was efficacious on oSE with a large effect size (p < 0.001; weighted difference = 2.95%). Ramelteon was efficacious with a large effect size at 4 weeks on objective total sleep time (oTST) (p = 0.010; weighted difference = 17.9 min), subjective total sleep time (sTST) (p = 0.006; weighted difference = 11.7 min), sSOL (p = 0.009; weighted difference = -8.74 min), and oSOL (p = 0.017; weighted difference = -14 min). Regarding long-term effects, ramelteon has a large effect size on oTST (p < 0.001; weighted difference = 2.02 min) and sTST (p < 0.001; weighted difference = 14.5 min). PR melatonin and ramelteon appear efficacious compared with placebo for insomnia symptoms with PR melatonin showing mostly small to medium effect sizes. PR melatonin for individuals with a mean age ≥ 55 and ramelteon show larger effect sizes.
Collapse
Affiliation(s)
- Julia Maruani
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat - Claude Bernard, Paris, France
- Université Paris Cité, NeuroDiderot, Inserm, Paris, France
- Centre ChronoS, GHU Paris - Psychiatry & Neurosciences, Paris, France
| | - Eve Reynaud
- Sleep Disorders Center - CIRCSom (International Research Center for ChronoSomnology), University Hospital of Strasbourg 1, Strasbourg, France
- CNRS UPR 3212 & Strasbourg University, Institute for Cellular and Integrative Neurosciences, Strasbourg, France
| | - Juliette Chambe
- CNRS UPR 3212 & Strasbourg University, Institute for Cellular and Integrative Neurosciences, Strasbourg, France
- General Medicine Department, Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Laura Palagini
- Department of Clinical Experimental Medicine, Psychiatric Unit, School of Medicine, University of Pisa, Pisa, Italy
| | - Patrice Bourgin
- Sleep Disorders Center - CIRCSom (International Research Center for ChronoSomnology), University Hospital of Strasbourg 1, Strasbourg, France
- CNRS UPR 3212 & Strasbourg University, Institute for Cellular and Integrative Neurosciences, Strasbourg, France
| | - Pierre A Geoffroy
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat - Claude Bernard, Paris, France
- Université Paris Cité, NeuroDiderot, Inserm, Paris, France
- Centre ChronoS, GHU Paris - Psychiatry & Neurosciences, Paris, France
- Sleep Disorders Center - CIRCSom (International Research Center for ChronoSomnology), University Hospital of Strasbourg 1, Strasbourg, France
- CNRS UPR 3212 & Strasbourg University, Institute for Cellular and Integrative Neurosciences, Strasbourg, France
| |
Collapse
|
9
|
Soehner AM, Wallace ML, Edmiston K, Chase HW, Lockovich J, Aslam H, Stiffler R, Graur S, Skeba A, Bebko G, Benjamin OE, Wang Y, Phillips ML. Neurobehavioral Reward and Sleep-Circadian Profiles Predict Present and Next-Year Mania/Hypomania Symptoms. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:1251-1261. [PMID: 37230386 PMCID: PMC10665544 DOI: 10.1016/j.bpsc.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 04/21/2023] [Accepted: 04/22/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Heightened reward sensitivity/impulsivity, related neural activity, and sleep-circadian disruption are important risk factors for bipolar spectrum disorders, the defining feature of which is mania/hypomania. Our goal was to identify neurobehavioral profiles based on reward and sleep-circadian features and examine their specificity to mania/hypomania versus depression vulnerability. METHODS At baseline, a transdiagnostic sample of 324 adults (18-25 years) completed trait measures of reward sensitivity (Behavioral Activation Scale), impulsivity (UPPS-P-Negative Urgency), and a functional magnetic resonance imaging card-guessing reward task (left ventrolateral prefrontal activity to reward expectancy, a neural correlate of reward motivation and impulsivity, was extracted). At baseline, 6-month follow-up, and 12-month follow-up, the Mood Spectrum Self-Report Measure - Lifetime Version assessed lifetime predisposition to subthreshold-syndromal mania/hypomania, depression, and sleep-circadian disturbances (insomnia, sleepiness, reduced sleep need, rhythm disruption). Mixture models derived profiles from baseline reward, impulsivity, and sleep-circadian variables. RESULTS Three profiles were identified: 1) healthy (no reward or sleep-circadian disruption; n = 162); 2) moderate-risk (moderate reward and sleep-circadian disruption; n = 109); and 3) high-risk (high impulsivity and sleep-circadian disruption; n = 53). At baseline, the high-risk group had significantly higher mania/hypomania scores than the other groups but did not differ from the moderate-risk group in depression scores. Over the follow-up period, the high-risk and moderate-risk groups exhibited elevated mania/hypomania scores, whereas depression scores increased at a faster rate in the healthy group than in the other groups. CONCLUSIONS Cross-sectional and next-year predisposition to mania/hypomania is associated with a combination of heightened reward sensitivity and impulsivity, related reward circuitry activity, and sleep-circadian disturbances. These measures can be used to detect mania/hypomania risk and provide targets to guide and monitor interventions.
Collapse
Affiliation(s)
- Adriane M Soehner
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Meredith L Wallace
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kale Edmiston
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Henry W Chase
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jeannette Lockovich
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Haris Aslam
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Richelle Stiffler
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Simona Graur
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Alex Skeba
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Genna Bebko
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Osasumwen E Benjamin
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Yiming Wang
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Mary L Phillips
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Biostatistics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
10
|
Cruz-Sanabria F, Violi M, Bazzani A, Bruno S, Massoni L, Bertelloni CA, Dell'Oste V, Frumento P, Faraguna U, Dell'Osso L, Carmassi C. Chronotype is differentially associated with lifetime mood and panic-agoraphobic spectrum symptoms in patients with bipolar disorder and healthy controls. CNS Spectr 2023; 28:726-738. [PMID: 36942635 DOI: 10.1017/s1092852923001207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVE Although the association between chronotype and mood disorders has been consistently reported, conversely, attempts to measure the association between chronotype and anxiety symptoms have generated inconsistent results. We aimed at evaluating whether chronotype (assessed through subjective and objective measures) is associated with lifetime mood and panic-agoraphobic spectrum symptoms in healthy controls (HCs) and in patients with bipolar disorder (BD). METHODS Overall, 173 subjects, patients with BD in euthymic phase (n = 76) and HC (n = 97), were evaluated through the reduced Morningness-Eveningness Questionnaire (rMEQ), actigraphy monitoring and mood and panic-agoraphobic spectrum self-report (MOODS-SR and PAS-SR). The discrepancy between objective (actigraphic-based) versus subjective (rMEQ-based) circadian typology was estimated through the Circadian Classification Discrepancy Index (CCDI). RESULTS rMEQ-based evening chronotype (ET) was associated with higher scores in MOODS-SR depressive and rhythmicity and vegetative functions domains in HC and BD.Both ET and morning chronotypes (MT) were associated with higher PAS-SR scores in BD only. Actigraphic-based MT was associated with higher MOODS-SR depressive scores in HC. Likewise, the discrepancy between actigraphic-based and rMEQ-based circadian typology was associated with depressive symptoms in HC only. CONCLUSION Self-reported ET was consistently associated with mood symptoms, while associations with panic-agoraphobic symptoms only emerged in BD and involved both extreme chronotypes. The discrepancy between the preferred circadian typology (rMEQ-based) and the actual one (actigraphic-based) could contribute to depressive symptoms in HC. These results pave the way for interventional studies targeting circadian typology in an attempt to prevent or treat mental health disorders.
Collapse
Affiliation(s)
- Francy Cruz-Sanabria
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Miriam Violi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Bazzani
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Simone Bruno
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Leonardo Massoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Valerio Dell'Oste
- Department of Biotechnology Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - Paolo Frumento
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Ugo Faraguna
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Calambrone, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| |
Collapse
|
11
|
Carlucci M, Lett T, Chavez S, Malinowski A, Lobaugh NJ, Petronis A. Diurnal oscillations of MRI metrics in the brains of male participants. Nat Commun 2023; 14:7044. [PMID: 37923728 PMCID: PMC10624685 DOI: 10.1038/s41467-023-42588-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 10/16/2023] [Indexed: 11/06/2023] Open
Abstract
Regulation of biological processes according to a 24-hr rhythm is essential for the normal functioning of an organism. Temporal variation in brain MRI data has often been attributed to circadian or diurnal oscillations; however, it is not clear if such oscillations exist. Here, we provide evidence that diurnal oscillations indeed govern multiple MRI metrics. We recorded cerebral blood flow, diffusion-tensor metrics, T1 relaxation, and cortical structural features every three hours over a 24-hr period in each of 16 adult male controls and eight adult male participants with bipolar disorder. Diurnal oscillations are detected in numerous MRI metrics at the whole-brain level, and regionally. Rhythmicity parameters in the participants with bipolar disorder are similar to the controls for most metrics, except for a larger phase variation in cerebral blood flow. The ubiquitous nature of diurnal oscillations has broad implications for neuroimaging studies and furthers our understanding of the dynamic nature of the human brain.
Collapse
Affiliation(s)
- Matthew Carlucci
- The Krembil Family Epigenetics Laboratory, The Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, M5T 1R8, ON, Canada
- Institute of Biotechnology, Life Sciences Center, Vilnius University, Vilnius, LT-10257, Lithuania
| | - Tristram Lett
- Center for Population Neuroscience and Precision Medicine (PONS), Clinic for Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, 10117, Germany
| | - Sofia Chavez
- Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alexandra Malinowski
- The Krembil Family Epigenetics Laboratory, The Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, M5T 1R8, ON, Canada
| | - Nancy J Lobaugh
- Brain Health Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Art Petronis
- The Krembil Family Epigenetics Laboratory, The Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, M5T 1R8, ON, Canada.
- Institute of Biotechnology, Life Sciences Center, Vilnius University, Vilnius, LT-10257, Lithuania.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
12
|
Maruani J, Stern E, Boiret C, Leseur J, Romier A, Lejoyeux M, Geoffroy PA. Predictors of cognitive behavioral therapy for insomnia (CBT-I) effects in insomnia with major depressive episode. Psychiatry Res 2023; 329:115527. [PMID: 37839317 DOI: 10.1016/j.psychres.2023.115527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/30/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023]
Abstract
Insomnia plays a critical role in the onset and maintenance of Major Depressive Episode (MDE). Cognitive behavioral therapy for insomnia (CBT-I) can successfully improve the sleep of patients with insomnia and MDE. Nonetheless, the factors influencing CBT-I's effects in MDE remain uncertain. This study aimed to identify predictors of insomnia improvement following CBT-I, as well as predictors of insomnia response, remission in patients with MDE and specific insomnia subtypes. Initially, we compared a 4-session weekly CBT-I treatment to baseline sleep education (SE) in a control group. This confirmed CBT-I's positive effects and the need to explore predictive factors. Notably, treatment-resistant depression (TRD) predicted reduced insomnia severity with CBT-I. Patients exhibiting seasonal fluctuations in depressive symptoms and sleep patterns throughout the year, or having daytime dysfunction, experienced enhanced CBT-I efficacy, especially for early awakenings insomnia. Conversely, shorter sleep duration predicted a less favorable response to CBT-I, less improvement in daytime dysfunction and sleep disturbance worries. Additionally, MDE with suicide attempts predicted a poorer improvement of daytime dysfunction. Further research is essential to comprehensively grasp the mechanisms behind CBT-I's heightened effectiveness in MDE patients with TRD and seasonal fluctuations.
Collapse
Affiliation(s)
- Julia Maruani
- Département de Psychiatrie et D'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris F-75018, France; Université Paris Cité, NeuroDiderot, Inserm, FHU I2-D2, Paris F-75019, France; Centre ChronoS, GHU Paris - Psychiatrie & Neurosciences, 1 rue Cabanis, Paris 75014, France.
| | - Emilie Stern
- Centre ChronoS, GHU Paris - Psychiatrie & Neurosciences, 1 rue Cabanis, Paris 75014, France; Université Paris Cité, Laboratoire de Psychopathologie et Processus de Santé, Boulogne-Billancourt F-92100, France
| | - Charlotte Boiret
- Université Paris Cité, NeuroDiderot, Inserm, FHU I2-D2, Paris F-75019, France
| | - Jeanne Leseur
- Département de Psychiatrie et D'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris F-75018, France
| | - Alix Romier
- Département de Psychiatrie et D'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris F-75018, France; Université Paris Cité, NeuroDiderot, Inserm, FHU I2-D2, Paris F-75019, France
| | - Michel Lejoyeux
- Département de Psychiatrie et D'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris F-75018, France; Université Paris Cité, NeuroDiderot, Inserm, FHU I2-D2, Paris F-75019, France; Centre ChronoS, GHU Paris - Psychiatrie & Neurosciences, 1 rue Cabanis, Paris 75014, France
| | - Pierre A Geoffroy
- Département de Psychiatrie et D'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris F-75018, France; Université Paris Cité, NeuroDiderot, Inserm, FHU I2-D2, Paris F-75019, France; Centre ChronoS, GHU Paris - Psychiatrie & Neurosciences, 1 rue Cabanis, Paris 75014, France; CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg F-67000, France.
| |
Collapse
|
13
|
Swartz HA, Daversa C, Frank E. History of the International Society for Bipolar Disorders: 30 years and counting. Bipolar Disord 2023; 25:535-539. [PMID: 37994524 DOI: 10.1111/bdi.13384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Affiliation(s)
- Holly A Swartz
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Chad Daversa
- International Society for Bipolar Disorders, Pittsburgh, Pennsylvania, USA
| | - Ellen Frank
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Health Rhythms, Inc., Long Island City, New York, USA
| |
Collapse
|
14
|
Meesters Y, van Tuinen EJD, Gordijn MCM. 35 years of light treatment for mental disorders in the Netherlands. Ann Med 2023; 55:2269574. [PMID: 37857364 PMCID: PMC10588530 DOI: 10.1080/07853890.2023.2269574] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Light therapy (LT) for Seasonal Affective Disorders (SAD) has been a well-known and effective treatment for 40 years. The psychiatric university clinic of Groningen, the Netherlands was an early adopter and started research and treatment of SAD in 1987. Research projects on mechanisms, the role of the circadian system, treatment optimization, and investigating new areas for the effects of light treatment have been carried out ever since, leading to a widespread interest across the country. OBJECTIVE To provide an overview and description of the historical development of LT for mental disorders in the Netherlands. METHODS A non-systematic, review of research on light treatment for mental problems in the Netherlands, published since 1987 was conducted. RESULTS The fields of LT and chronotherapy are strongly based in the scientific interests of both chrono-biologists and therapists in the Netherlands. LT has shown effectiveness in treating mood disorders. Likewise, results for other mental disorders have shown some promise, but so far, the outcomes are not always unequivocal and have not always been based on robust data. Ongoing research is discussed. CONCLUSIONS LT, and in addition exposure to the right light at the right time is an important issue in mental health. Over the past 3 decades research on light and LT in the Netherlands has become well established and is still growing.
Collapse
Affiliation(s)
- Y. Meesters
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - E. J. D. van Tuinen
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - M. C. M. Gordijn
- Chronobiology Unit, Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, the Netherlands
- Chrono@Work, Groningen, the Netherlands
| |
Collapse
|
15
|
Uguz F, Sharma V, Boyce P, Clark CT, Galbally M, Koukopoulos A, Marsh W, Stevens A, Viguera A. Prophylactic Management of Women With Bipolar Disorder During Pregnancy and the Perinatal Period: Clinical Scenario-Based Practical Recommendations From A Group of Perinatal Psychiatry Authors. J Clin Psychopharmacol 2023; 43:434-452. [PMID: 37683233 DOI: 10.1097/jcp.0000000000001740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
ABSTRACT Many women with bipolar disorder experience episodes of illness or relapses over the perinatal period, especially in the immediate postpartum period. Risks associated with treated/untreated psychopathologies and fetal exposure to bipolar medications make the management of bipolar disorder during these periods challenging for clinicians and patients. In light of the available effectiveness and reproductive safety data, the current clinical update based on the opinions of a group of international perinatal psychiatry authors recommends general considerations and specific management strategies for each possible clinical scenario, including mixed features, predominant polarity, diagnosis of subtypes of bipolar disorder, severity of previous episodes, and risk of recurrence of mood episodes.
Collapse
Affiliation(s)
- Faruk Uguz
- From the Department of Psychiatry, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Verinder Sharma
- Schulich School of Medicine and Dentistry, The University of Western Ontario; Lawson Health Research Institute; Parkwood Institute Mental Health, Perinatal Mental Health Clinic, London Health Sciences Center, London, Ontario, Canada
| | - Philip Boyce
- Westmead Institute of Medical Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Crystal T Clark
- Department of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Megan Galbally
- Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Alexia Koukopoulos
- University Hospital Policlinico Umberto I, La Sapienza University of Rome; Centro Lucio Bini, Rome, Italy
| | - Wendy Marsh
- Department of Psychiatry, University of Massachusetts Medical School/UMass Memorial Medical Center, Worcester, MA.
| | - Anja Stevens
- Centre for Bipolar Disorders, Dimence Group, Deventer, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Psychiatry, the Netherlands
| | - Adele Viguera
- Cleveland Clinic, Cleveland Clinic Neurological Institute, Cleveland, OH
| |
Collapse
|
16
|
Ballard R, Parkhurst J, Julian K, Pasetes LN, Fawcett A, Li A, Goel N, Sit DK. Light Therapy for Adolescent Depression: A Scoping Review. Curr Psychiatry Rep 2023; 25:373-386. [PMID: 37490215 DOI: 10.1007/s11920-023-01437-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE Depressive disorders in adolescents are a major health concern associated with developmental, social, and educational impairment. Bright Light Therapy (BLT) is a feasible and effective treatment for depressive disorders in adults, but few controlled trials have been conducted with children or adolescents. This scoping review focuses on the current state of knowledge for BLT in the treatment of adolescent depression. We reviewed the literature for novel data and methodologic approaches using BLT and pediatric and young adult populations. RECENT FINDINGS BLT is a tolerable treatment with few side effects. However, there is a marked lack of well-powered studies to support BLT as a treatment for depressive disorders in adolescent populations. Given evidence of tolerability and positive treatment effect on depression in the adult literature, research is needed to establish the efficacy, feasibility, and acceptability of BLT in adolescents.
Collapse
Affiliation(s)
- Rachel Ballard
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 10, 60611, Chicago, IL, USA
| | - John Parkhurst
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 10, 60611, Chicago, IL, USA
| | - Kelsey Julian
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 10, 60611, Chicago, IL, USA
| | - Lauren N Pasetes
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 425, 60612, Chicago, IL, USA
| | - Andrea Fawcett
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 10, 60611, Chicago, IL, USA
| | - Addie Li
- Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St., Suite 1000, 60611, Chicago, IL, USA
| | - Namni Goel
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 425, 60612, Chicago, IL, USA
| | - Dorothy K Sit
- Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St., Suite 1000, 60611, Chicago, IL, USA.
| |
Collapse
|
17
|
Cruz-Sanabria F, Faraguna U, Violi M, Bruno S, Gravina D, Bonelli C, Bazzani A, Massoni L, Musetti L, Simoncini M, Frumento P, Dell'Osso L, Carmassi C. Effects of exogenous melatonin on sleep and circadian rhythm parameters in bipolar disorder with comorbid delayed sleep-wake phase disorder: An actigraphic study. J Psychiatr Res 2023; 165:96-104. [PMID: 37487294 DOI: 10.1016/j.jpsychires.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/02/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023]
Abstract
The present study evaluates the effect of exogenous melatonin (exo-MEL) on sleep and circadian parameters in patients with bipolar disorder (BD) and delayed sleep-wake phase disorder (DSWPD). BD euthymic patients (n = 83, mean age = 45.13 ± 13.68, males 56%) were evaluated for chronotype (reduced Morningness-Eveningness Questionnaire [rMEQ]), sleep quality (Pittsburgh Sleep Quality Index), sleep and circadian parameters (actigraphic monitoring). Patients that fulfilled criteria for DSWPD (n = 25) were treated for three months with exo-MEL 2 mg administered approximately 4 h before the sleep onset time (SOT) actigraphically-determined at baseline. Sleep and circadian parameters at baseline (T0) and after the exo-MEL treatment (T1) were compared using paired Wilcoxon test. In patients that completed the treatment (n = 19), the rMEQ score increased between T0 (median = 8.0 [IQR = 7.0, 11.0]) and T1 (median = 13.5 [IQR = 9.3, 15.0], p-value = 0.006), the SOT was advanced between T0 (median = 00:55 [IQR = 00:25, 01:39] and T1 (median = 00:09 [IQR = 23:41, 01:04], p-value = 0.039), the sleep efficiency and total sleep time increased (T0: median = 84.4 [IQR = 81.3, 89.4]; T1 (median = 90.3 [IQR = 85.5, 92.9] %, p-value = 0.01, and T0: median = 7.20 [IQR = 6.15, 8.15]; T1: median = 7.7 [IQR = 7.0, 9.3] hours, p-value = 0.04, respectively). These results indicate that in BD with comorbid DSWPD, the self-reported chronotype, the sleep onset time, and sleep efficiency and duration were modified after a personalized treatment with exo-MEL, suggesting its potential efficacy in improving sleep patterns in BD. The absence of proper control groups and of treatment randomization constitute limitations of our study and further randomized controlled trials are required to confirm our results.
Collapse
Affiliation(s)
- Francy Cruz-Sanabria
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, via Savi 10, 56126, Pisa, Italy.
| | - Ugo Faraguna
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, via Savi 10, 56126, Pisa, Italy; Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Viale del Tirreno, 341/A/B/C, 56128, Calambrone, Pisa, Italy
| | - Miriam Violi
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56127, Pisa, Italy
| | - Simone Bruno
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, via Savi 10, 56126, Pisa, Italy
| | - Davide Gravina
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56127, Pisa, Italy
| | - Chiara Bonelli
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56127, Pisa, Italy
| | - Andrea Bazzani
- Institute of Management, Scuola Superiore Sant'Anna, piazza Martiri della libertà 33, 56127, Pisa, Italy
| | - Leonardo Massoni
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56127, Pisa, Italy
| | - Laura Musetti
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56127, Pisa, Italy
| | - Marly Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56127, Pisa, Italy
| | - Paolo Frumento
- Department of Political Sciences, University of Pisa, via Serafini 3, 56126, Pisa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56127, Pisa, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56127, Pisa, Italy
| |
Collapse
|
18
|
Chakrabarti S, Jolly AJ, Singh P, Yadhav N. Role of adjunctive nonpharmacological strategies for treatment of rapid-cycling bipolar disorder. World J Psychiatry 2023; 13:495-510. [PMID: 37701540 PMCID: PMC10494771 DOI: 10.5498/wjp.v13.i8.495] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/23/2023] [Accepted: 07/11/2023] [Indexed: 08/17/2023] Open
Abstract
Rapid-cycling bipolar disorder (RCBD) is a phase of bipolar disorder defined by the presence of ≥ 4 mood episodes in a year. It is a common phenomenon characterized by greater severity, a predominance of depression, higher levels of disability, and poorer overall outcomes. It is resistant to treatment by conventional pharmacotherapy. The existing literature underlines the scarcity of evi-dence and the gaps in knowledge about the optimal treatment strategies for RCBD. However, most reviews have considered only pharmacological treatment options for RCBD. Given the treatment-refractory nature of RCBD, nonpharmacological interventions could augment medications but have not been adequately examined. This review carried out an updated and comprehensive search for evidence regarding the role of nonpharmacological therapies as adjuncts to medications in RCBD. We identified 83 reviews and meta-analyses concerning the treatment of RCBD. Additionally, we found 42 reports on adjunctive nonpharmacological treatments in RCBD. Most of the evidence favoured concomitant electroconvulsive therapy as an acute and maintenance treatment. There was pre-liminary evidence to suggest that chronotherapeutic treatments can provide better outcomes when combined with medications. The research on adjunctive psychotherapy was particularly scarce but suggested that psychoeducation, cognitive behavioural therapy, family interventions, and supportive psychotherapy may be helpful. The overall quality of evidence was poor and suffered from several methodological shortcomings. There is a need for more methodologically sound research in this area, although clinicians can use the existing evidence to select and individualize nonpharmacological treatment options for better management of RCBD. Patient summaries are included to highlight some of the issues concerning the implementation of adjunctive nonpharmacological treatments.
Collapse
Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh UT, India
| | - Amal J Jolly
- Department of Psychiatry, Black Country Healthcare NHS Foundation Trust, Dudley DY2 8PS, West Midlands, United Kingdom
| | - Pranshu Singh
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
| | - Nidhi Yadhav
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh UT, India
| |
Collapse
|
19
|
Marilac Soalheiro L, de Jesus Brandão B, Paiva RVN, Dias Carvalho L, Menezes Paranhos RD, Ribeiro Barbosa PC, Guerrero-Vargas NN, Tamura EK. Familiarity of Brazilian psychologists with basic concepts in sleep science and chronobiology. Chronobiol Int 2023; 40:1072-1083. [PMID: 37661786 DOI: 10.1080/07420528.2023.2250870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/05/2023]
Abstract
Desynchronization of circadian rhythms and sleep-wake patterns impacts biochemical, physiological, and behavioral functions, including mental processes. The complex relationship between circadian rhythms and mental health makes it challenging to determine causality between circadian desynchronization and mental disorders. Regarding the fact that psychologists act as the front line for initial mental health care, we aimed to assess the knowledge and use of sleep science and basic chronobiology by professional psychologists in Brazil. Data were collected via an online questionnaire completed by 1384 professional psychologists between October 2018 and May 2019. Our findings revealed that ±80% of psychologists reported that at least half of their patients presented some sleep-related complaints; however, only ±27% routinely inquired about sleep quality even in the absence of patient complaints. Additionally, only ±66% initiated treatments to understand these complaints, potentially influenced by the lack of prior academic exposure to biological rhythms as reported by ±76% of Brazilian psychologists interviewed. Importantly, ±15% did not believe in an association between mental health and biological rhythms, and even a significant ±67% were unfamiliar with the term chronobiology and ±63% were not able to describe any other biological rhythm except for the sleep-wake cycle. These results demonstrate that fundamental concepts in chronobiology and sleep science are unknown to a substantial proportion of Brazilian psychologists. In conclusion, we propose that this subject could be more effectively integrated into psychologists' academic training, potentially promoting benefits through the incorporation of a chronobiological approach in mental health practice.
Collapse
Affiliation(s)
| | | | | | - Lázaro Dias Carvalho
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Ilhéus, Brazil
| | | | - Paulo César Ribeiro Barbosa
- Department of Human Sciences and Philosophy, Universidade Estadual de Feira de Santana, Feira de Santana, Brazil
| | - Natali N Guerrero-Vargas
- Department of Anatomy, Faculty of Medicine, Universidad Nacional Autonóma de México, México City, México
| | - Eduardo Koji Tamura
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Ilhéus, Brazil
| |
Collapse
|
20
|
Kosanovic Rajacic B, Sagud M, Pivac N, Begic D. Illuminating the way: the role of bright light therapy in the treatment of depression. Expert Rev Neurother 2023; 23:1157-1171. [PMID: 37882458 DOI: 10.1080/14737175.2023.2273396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Despite the growing number of different therapeutic options, treatment of depression is still a challenge. A broader perspective reveals the benefits of bright light therapy (BLT). It stimulates intrinsically photosensitive retinal ganglion cells, which induces a complex cascade of events, including alterations in melatonergic, neurotrophic, GABAergic, glutamatergic, noradrenergic, serotonergic systems, and HPA axis, suggesting that BLT effects expand beyond the circadian pacemaker. AREAS COVERED In this review, the authors present and discuss recent data of BLT in major depressive disorder, non-seasonal depression, bipolar depression or depressive phase of bipolar disorder, and seasonal affective disorder, as well as in treatment-resistant depression (TRD). The authors further highlight BLT effects in various depressive disorders compared to placebo and report data from several studies suggesting a response to BLT in TRD. Also, the authors report data showing that BLT can be used both as a monotherapy or in combination with other pharmacological treatments. EXPERT OPINION BLT is an easy-to-use and low-budget therapy with good tolerability. Future studies should focus on clinical and biological predictors of response to BLT, on defining specific populations which may benefit from BLT and establishing treatment protocols regarding timing, frequency, and duration of BLT.
Collapse
Affiliation(s)
- Biljana Kosanovic Rajacic
- Department for Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marina Sagud
- Department for Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine University of Zagreb, Zagreb, Croatia
| | - Nela Pivac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ruder Boskovic Institute, Zagreb, Croatia
- University of Applied Sciences Hrvatsko Zagorje Krapina, Croatian Zagorje Polytechnic Krapina, Krapina, Croatia
| | - Drazen Begic
- Department for Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine University of Zagreb, Zagreb, Croatia
| |
Collapse
|
21
|
Marx W, Manger SH, Blencowe M, Murray G, Ho FYY, Lawn S, Blumenthal JA, Schuch F, Stubbs B, Ruusunen A, Desyibelew HD, Dinan TG, Jacka F, Ravindran A, Berk M, O'Neil A. Clinical guidelines for the use of lifestyle-based mental health care in major depressive disorder: World Federation of Societies for Biological Psychiatry (WFSBP) and Australasian Society of Lifestyle Medicine (ASLM) taskforce. World J Biol Psychiatry 2023; 24:333-386. [PMID: 36202135 PMCID: PMC10972571 DOI: 10.1080/15622975.2022.2112074] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/24/2022] [Accepted: 08/07/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The primary objectives of these international guidelines were to provide a global audience of clinicians with (a) a series of evidence-based recommendations for the provision of lifestyle-based mental health care in clinical practice for adults with Major Depressive Disorder (MDD) and (b) a series of implementation considerations that may be applicable across a range of settings. METHODS Recommendations and associated evidence-based gradings were based on a series of systematic literature searches of published research as well as the clinical expertise of taskforce members. The focus of the guidelines was eight lifestyle domains: physical activity and exercise, smoking cessation, work-directed interventions, mindfulness-based and stress management therapies, diet, sleep, loneliness and social support, and green space interaction. The following electronic bibliographic databases were searched for articles published prior to June 2020: PubMed, EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register), CINAHL, PsycINFO. Evidence grading was based on the level of evidence specific to MDD and risk of bias, in accordance with the World Federation of Societies for Biological Psychiatry criteria. RESULTS Nine recommendations were formed. The recommendations with the highest ratings to improve MDD were the use of physical activity and exercise, relaxation techniques, work-directed interventions, sleep, and mindfulness-based therapies (Grade 2). Interventions related to diet and green space were recommended, but with a lower strength of evidence (Grade 3). Recommendations regarding smoking cessation and loneliness and social support were based on expert opinion. Key implementation considerations included the need for input from allied health professionals and support networks to implement this type of approach, the importance of partnering such recommendations with behaviour change support, and the need to deliver interventions using a biopsychosocial-cultural framework. CONCLUSIONS Lifestyle-based interventions are recommended as a foundational component of mental health care in clinical practice for adults with Major Depressive Disorder, where other evidence-based therapies can be added or used in combination. The findings and recommendations of these guidelines support the need for further research to address existing gaps in efficacy and implementation research, especially for emerging lifestyle-based approaches (e.g. green space, loneliness and social support interventions) where data are limited. Further work is also needed to develop innovative approaches for delivery and models of care, and to support the training of health professionals regarding lifestyle-based mental health care.
Collapse
Affiliation(s)
- Wolfgang Marx
- Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Sam H Manger
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
- Australasian Society of Lifestyle Medicine, Melbourne, Australia
| | - Mark Blencowe
- Australasian Society of Lifestyle Medicine, Melbourne, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Fiona Yan-Yee Ho
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR
| | - Sharon Lawn
- Lived Experience Australia Ltd, Adelaide, Australia
- Flinders University, College of Medicine and Public Health, Adelaide, Australia
| | - James A. Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham NC 27710
| | - Felipe Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Anu Ruusunen
- Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
| | - Hanna Demelash Desyibelew
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | | | - Felice Jacka
- Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Arun Ravindran
- Department of Psychiatry & Institute of Medical Sciences, University of Toronto. Centre for Addiction and Mental Health, Toronto, Canada
| | - Michael Berk
- Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Adrienne O'Neil
- Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| |
Collapse
|
22
|
Futenma K, Takaesu Y, Komada Y, Shimura A, Okajima I, Matsui K, Tanioka K, Inoue Y. Delayed sleep-wake phase disorder and its related sleep behaviors in the young generation. Front Psychiatry 2023; 14:1174719. [PMID: 37275982 PMCID: PMC10235460 DOI: 10.3389/fpsyt.2023.1174719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/08/2023] [Indexed: 06/07/2023] Open
Abstract
Delayed sleep-wake phase disorder (DSWPD) is a sleep disorder in which the habitual sleep-wake timing is delayed, resulting in difficulty in falling asleep and waking up at the desired time. Patients with DSWPD frequently experience fatigue, impaired concentration, sleep deprivation during weekdays, and problems of absenteeism, which may be further complicated by depressive symptoms. DSWPD is typically prevalent during adolescence and young adulthood. Although there are no studies comparing internationally, the prevalence of DSWPD is estimated to be approximately 3% with little racial differences between Caucasians and Asians. The presence of this disorder is associated with various physiological, genetic and psychological as well as behavioral factors. Furthermore, social factors are also involved in the mechanism of DSWPD. Recently, delayed sleep phase and prolonged sleep duration in the young generation have been reported during the period of COVID-19 pandemic-related behavioral restrictions. This phenomenon raises a concern about the risk of a mismatch between their sleep-wake phase and social life that may lead to the development of DSWPD after the removal of these restrictions. Although the typical feature of DSWPD is a delay in circadian rhythms, individuals with DSWPD without having misalignment of objectively measured circadian rhythm markers account for approximately 40% of the cases, wherein the psychological and behavioral characteristics of young people, such as truancy and academic or social troubles, are largely involved in the mechanism of this disorder. Recent studies have shown that DSWPD is frequently comorbid with psychiatric disorders, particularly mood and neurodevelopmental disorders, both of which have a bidirectional association with the pathophysiology of DSWPD. Additionally, patients with DSWPD have a strong tendency toward neuroticism and anxiety, which may result in the aggravation of insomnia symptoms. Therefore, future studies should address the effectiveness of cognitive-behavioral approaches in addition to chronobiological approaches in the treatment of DSWPD.
Collapse
Affiliation(s)
- Kunihiro Futenma
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Yoko Komada
- Institute for Liberal Arts, Tokyo Institute of Technology, Tokyo, Japan
| | - Akiyoshi Shimura
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
| | - Isa Okajima
- Department of Psychological Counseling, Faculty of Humanities, Tokyo Kasei University, Tokyo, Japan
| | - Kentaro Matsui
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
- Department of Clinical Laboratory, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kosuke Tanioka
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Yuichi Inoue
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
| |
Collapse
|
23
|
Hickie IB, Merikangas KR, Carpenter JS, Iorfino F, Scott EM, Scott J, Crouse JJ. Does circadian dysrhythmia drive the switch into high- or low-activation states in bipolar I disorder? Bipolar Disord 2023; 25:191-199. [PMID: 36661342 PMCID: PMC10947388 DOI: 10.1111/bdi.13304] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Emerging evidence suggests a role of circadian dysrhythmia in the switch between "activation" states (i.e., objective motor activity and subjective energy) in bipolar I disorder. METHODS We examined the evidence with respect to four relevant questions: (1) Are natural or environmental exposures that can disrupt circadian rhythms also related to the switch into high-/low-activation states? (2) Are circadian dysrhythmias (e.g., altered rest/activity rhythms) associated with the switch into activation states in bipolar disorder? (3) Do interventions that affect the circadian system also affect activation states? (4) Are associations between circadian dysrhythmias and activation states influenced by other "third" factors? RESULTS Factors that naturally or experimentally alter circadian rhythms (e.g., light exposure) have been shown to relate to activation states; however future studies need to measure circadian rhythms contemporaneously with these natural/experimental factors. Actigraphic measures of circadian dysrhythmias are associated prospectively with the switch into high- or low-activation states, and more studies are needed to establish the most relevant prognostic actigraphy metrics in bipolar disorder. Interventions that can affect the circadian system (e.g., light therapy, lithium) can also reduce the switch into high-/low-activation states. Whether circadian rhythms mediate these clinical effects is an unknown but valuable question. The influence of age, sex, and other confounders on these associations needs to be better characterised. CONCLUSION Based on the reviewed evidence, our view is that circadian dysrhythmia is a plausible driver of transitions into high- and low-activation states and deserves prioritisation in research in bipolar disorders.
Collapse
Affiliation(s)
- Ian B. Hickie
- Youth Mental Health and Technology Team, Brain and Mind Centre, Faculty of Medicine and HealthUniversity of SydneyNew South WalesSydneyAustralia
| | - Kathleen R. Merikangas
- Genetic Epidemiology Research Branch, Division of Intramural Research ProgramNational Institute of Mental HealthBethesdaMarylandUSA
| | - Joanne S. Carpenter
- Youth Mental Health and Technology Team, Brain and Mind Centre, Faculty of Medicine and HealthUniversity of SydneyNew South WalesSydneyAustralia
| | - Frank Iorfino
- Youth Mental Health and Technology Team, Brain and Mind Centre, Faculty of Medicine and HealthUniversity of SydneyNew South WalesSydneyAustralia
| | - Elizabeth M. Scott
- Youth Mental Health and Technology Team, Brain and Mind Centre, Faculty of Medicine and HealthUniversity of SydneyNew South WalesSydneyAustralia
| | - Jan Scott
- Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUK
- Norwegian University of Science and TechnologyTrondheimNorway
- Université de ParisParisFrance
| | - Jacob J. Crouse
- Youth Mental Health and Technology Team, Brain and Mind Centre, Faculty of Medicine and HealthUniversity of SydneyNew South WalesSydneyAustralia
| |
Collapse
|
24
|
Esaki Y, Obayashi K, Saeki K, Fujita K, Iwata N, Kitajima T. Habitual light exposure and circadian activity rhythms in bipolar disorder: A cross-sectional analysis of the APPLE cohort. J Affect Disord 2023; 323:762-769. [PMID: 36538951 DOI: 10.1016/j.jad.2022.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 10/04/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Circadian activity rhythm disruption is a core feature in bipolar disorder. We investigated whether light exposure in daily life is associated with circadian activity rhythms in patients with bipolar disorder. METHODS In a cross-sectional study, we enrolled 194 outpatients with bipolar disorder who were participants of the Association between Pathology of Bipolar Disorder and Light Exposure in Daily Life (APPLE) cohort study. The participants' physical activity and daytime illuminance were measured using an actigraph over 7 consecutive days. Nighttime illuminance in the bedroom was measured using a portable photometer. Circadian activity rhythm parameters were calculated using cosinor analysis and a nonparametric circadian rhythm analysis. RESULTS The median daytime illuminance and nighttime illuminance were 224.5 lx (interquartile range, 154.5-307.5 lx) and 2.3 lx (0.3-9.4 lx), respectively. Multivariable linear regression analysis, adjusted for potential confounding factors, showed that higher daytime illuminance was significantly associated with higher amplitude and most active continuous 10-hour period, advanced acrophase, higher interdaily stability, and lower intradaily variability. Higher nighttime illuminance was significantly associated with lower relative amplitude, delayed onset of the least active continuous 5-hour period, and higher intradaily variability. LIMITATIONS As this was a cross-sectional study, the results do not necessarily imply that light exposure alters circadian activity rhythms. CONCLUSIONS Daytime light exposure was associated with a positive effect and nighttime light exposure with a negative effect on circadian activity rhythms in bipolar disorder.
Collapse
Affiliation(s)
- Yuichi Esaki
- Department of Psychiatry, Okehazama Hospital, Aichi, Japan; Department of Psychiatry, Fujita Health University School of Medicine, Aichi, Japan.
| | - Kenji Obayashi
- Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan
| | - Keigo Saeki
- Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan
| | - Kiyoshi Fujita
- Department of Psychiatry, Okehazama Hospital, Aichi, Japan; The Neuroscience Research Center, Aichi, Japan
| | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, Aichi, Japan
| | - Tsuyoshi Kitajima
- Department of Psychiatry, Fujita Health University School of Medicine, Aichi, Japan
| |
Collapse
|
25
|
Kahawage P, Bullock B, Meyer D, Gottlieb J, Crowe M, Swartz HA, Yatham LN, Inder M, Porter RJ, Nierenberg AA, Meesters Y, Gordijn M, Haarman BCM, Murray G. Social Rhythm Disruption is Associated with Greater Depressive Symptoms in People with Mood Disorders: Findings from a Multinational Online Survey During COVID-19. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:831-840. [PMID: 35535550 PMCID: PMC9096005 DOI: 10.1177/07067437221097905] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Societal restrictions imposed to prevent transmission of COVID-19 may challenge circadian-driven lifestyle behaviours, particularly amongst those vulnerable to mood disorders. The overarching aim of the present study was to investigate the hypothesis that, in the routine-disrupted environment of the COVID-19, amongst a sample of people living with mood disorders, greater social rhythm disruption would be associated with more severe mood symptoms. METHODS We conducted a two-wave, multinational survey of 997 participants (MAge=39.75±13.39,Female=81.6%) who self-reported a mood disorder diagnosis (i.e., major depressive disorder or bipolar disorder). Respondents completed questionnaires assessing demographics, social rhythmicity (The Brief Social Rhythm Scale), depression symptoms (Patient Health Questionnaire-9), sleep quality and diurnal preference (The Sleep, Circadian Rhythms and Mood questionnaire) and stressful life events during the COVID-19 pandemic (The Social Readjustment Rating Scale). RESULTS The majority of participants indicated COVID-19-related social disruption had affected the regularity of their daily routines to at least some extent (n = 788, 79.1%). As hypothesised, lower social rhythmicity was associated with greater depressive symptoms when tested cross-sectionally (standardised β = -.25, t = -7.94, P = 0.000) and when tested using a 2-level hierarchical linear model across two time points (b = -0.14, t = -3.46, df = 264, P ≤ 0.001). CONCLUSIONS These results are consistent with the social zeitgeber hypothesis proposing that mood disorders are sensitive to life events that disrupt social rhythms.
Collapse
Affiliation(s)
- Piyumi Kahawage
- Centre for Mental Health, 3783Swinburne University of Technology, Melbourne, Australia
| | - Ben Bullock
- Centre for Mental Health, 3783Swinburne University of Technology, Melbourne, Australia
| | - Denny Meyer
- Centre for Mental Health, 3783Swinburne University of Technology, Melbourne, Australia
| | - John Gottlieb
- Department of Psychiatry and Behavioural Sciences, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Marie Crowe
- Department of Psychological Medicine, 2494University of Otago, Christchurch, New Zealand
| | - Holly A Swartz
- Department of Psychiatry, 6614University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lakshmi N Yatham
- Department of Psychiatry, 8166University of British Columbia, Vancouver, Canada
| | - Maree Inder
- Department of Psychological Medicine, 2494University of Otago, Christchurch, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, 2494University of Otago, Christchurch, New Zealand
| | - Andrew A Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, 2348Massachusetts General Hospital, 1811Harvard Medical School, Boston, MA, USA
| | - Ybe Meesters
- Department of Psychiatry Groningen, 3647University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marijke Gordijn
- Chrono@Work & Chronobiology Unit, Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, the Netherlands
| | - Bartholomeus C M Haarman
- Department of Psychiatry Groningen, 3647University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Greg Murray
- Centre for Mental Health, 3783Swinburne University of Technology, Melbourne, Australia
| |
Collapse
|
26
|
Dondé C, Jaffiol A, Khouri C, Pouchon A, Tamisier R, Lejoyeux M, d'Ortho MP, Polosan M, Geoffroy PA. Sleep disturbances in early clinical stages of psychotic and bipolar disorders: A meta-analysis. Aust N Z J Psychiatry 2022; 56:1068-1079. [PMID: 34971518 DOI: 10.1177/00048674211068395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To provide a qualitative view and quantitative measure of sleep disturbances across and between early stages - clinical ultra high-risk and first episode - of psychotic and bipolar disorders. METHODS Electronic databases (PubMed, Cochrane, Embase, PsychINFO) were searched up to March 2021 for studies comparing sleep measures between individuals with an early stage and controls. Standard mean deviations (Cohen's d effect sizes) were calculated for all comparisons and pooled with random-effects models. Chi-square tests were used for direct between-subgroups (ultra high-risk vs first episode) comparisons of standard mean deviations. The effects of age, sex ratio, symptoms and treatment were examined in meta-regression analyses. RESULTS A database search identified 13 studies that contrasted sleep measures between individuals with an early stage (N = 537) and controls (N = 360). We observed poorer subjective sleep quality (standard mean deviation = 1.32; 95% confidence interval, [1.01, 1.62]), shorter total sleep time (standard mean deviation =-0.44; 95% confidence interval, [-0.67, -0.21]), lower sleep efficiency (standard mean deviation = -0.72; 95% confidence interval, [-1.08, -0.36]), longer sleep onset latency (standard mean deviation = 0.75; 95% confidence interval, [0.45, 1.06]) and longer duration of wake after sleep onset (standard mean deviation = 0.49; 95% confidence interval, [0.21, 0.77]) were observed in early stages compared to controls. No significant differences were observed for any of the reported electroencephalographic parameters of sleep architecture. No significant between-subgroups differences were observed. Meta-regressions revealed a significant effect of the age and the antipsychotic status on subjective measures of sleep. CONCLUSION The early stage population presents with significant impairments of subjective sleep quality continuity, duration and initiation. Systematic assessments of sleep in early intervention settings may allow early identification and treatment of sleep disturbances in this population.
Collapse
Affiliation(s)
- Clément Dondé
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Adult Psychiatry Department, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - Antoine Jaffiol
- Univ. Grenoble Alpes, CHU Grenoble Alpes, Adult Psychiatry Department, 38000 Grenoble, France
| | - Charles Khouri
- Univ. Grenoble Alpes, CHU Grenoble Alpes, HP2, Clinical Pharmacology Department, INSERM CIC1406, 38000 Grenoble, France
| | - Arnaud Pouchon
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Adult Psychiatry Department, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - Renaud Tamisier
- Univ. Grenoble Alpes, INSERM, CHU Grenoble Alpes, HP2, Pneumology and Physiology Department, Thorax and vessels pole, 38000 Grenoble, France
| | - Michel Lejoyeux
- Université de Paris, Psychiatry and Addictology Department, AP-HP, GHU Paris Nord, DMU Neurosciences, Bichat Hospital - Claude Bernard, GHU Paris - Psychiatry & Neurosciences, Paris, France
| | - Marie-Pia d'Ortho
- Université de Paris, NeuroDiderot, Inserm U1141, Sleep Medicine and Clinical Physiology Department, AP-HP, GHU Paris Nord, DMU DREAM, Bichat Hospital, Paris, France
| | - Mircea Polosan
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Adult Psychiatry Department, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - Pierre A Geoffroy
- Université de Paris, Psychiatry and Addictology Department, AP-HP, GHU Paris Nord, DMU Neurosciences, Bichat Hospital - Claude Bernard, GHU Paris - Psychiatry & Neurosciences, Paris, France.,Université de Paris, NeuroDiderot, Inserm U1141, Sleep Medicine and Clinical Physiology Department, AP-HP, GHU Paris Nord, DMU DREAM, Bichat Hospital, Paris, France
| |
Collapse
|
27
|
Kjørstad K, Faaland PM, Sivertsen B, Kallestad H, Langsrud K, Vethe D, Vestergaard CL, Harris A, Pallesen S, Scott J, Vedaa Ø. Sleep and work functioning in nurses undertaking inpatient shifts in a blue-depleted light environment. BMC Nurs 2022; 21:187. [PMID: 35850690 PMCID: PMC9290304 DOI: 10.1186/s12912-022-00973-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Blue-depleted light environments (BDLEs) may result in beneficial health outcomes for hospital inpatients in some cases. However, less is known about the effects on hospital staff working shifts. This study aimed to explore the effects of a BDLE compared with a standard hospital light environment (STLE) in a naturalistic setting on nurses' functioning during shifts and sleep patterns between shifts. METHODS Twenty-five nurses recruited from St. Olavs Hospital in Trondheim, Norway, completed 14 days of actigraphy recordings and self-reported assessments of sleep (e.g., total sleep time/sleep efficiency) and functioning while working shifts (e.g., mood, stress levels/caffeine use) in two different light environments. Additionally, participants were asked to complete several scales and questionnaires to assess the symptoms of medical conditions and mental health conditions and the side effects associated with each light environment. RESULTS A multilevel fixed-effects regression model showed a within-subject increase in subjective sleepiness (by 17%) during evening shifts in the BDLE compared with the STLE (p = .034; Cohen's d = 0.49) and an 0.2 increase in number of caffeinated beverages during nightshifts in the STLE compared with the BDLE (p = .027; Cohen's d = 0.37). There were no significant differences on any sleep measures (either based on sleep diary data or actigraphy recordings) nor on self-reported levels of stress or mood across the two conditions. Exploratory between-group analyses of questionnaire data showed that there were no significant differences except that nurses working in the BDLE reported perceiving the lighting as warmer (p = .009) and more relaxing (p = .023) than nurses working in the STLE. CONCLUSIONS Overall, there was little evidence that the change in the light environment had any negative impact on nurses' sleep and function, despite some indication of increased evening sleepiness in the BDLE. We recommend further investigations on this topic before BDLEs are implemented as standard solutions in healthcare institutions and propose specific suggestions for designing future large-scale trials and cohort studies. TRIAL REGISTRATION The study was registered before data collection was completed on the ISRCTN website ( ISRCTN21603406 ).
Collapse
Affiliation(s)
- Kaia Kjørstad
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Patrick M Faaland
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Research and Development, St. Olavs University Hospital, Trondheim, Norway
| | - Børge Sivertsen
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes gt. 7, 5015, Bergen, Norway.,Department of Research and Innovation, Helse-Fonna, Haugesund, HF, Norway
| | - Håvard Kallestad
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Research and Development, St. Olavs University Hospital, Trondheim, Norway
| | - Knut Langsrud
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Research and Development, St. Olavs University Hospital, Trondheim, Norway
| | - Daniel Vethe
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Research and Development, St. Olavs University Hospital, Trondheim, Norway
| | - Cecilie L Vestergaard
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Research and Development, St. Olavs University Hospital, Trondheim, Norway
| | - Anette Harris
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.,Optentia, The Vaal Triangle Campus of the North-West University, Vanderbijlpark, South Africa
| | - Jan Scott
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Øystein Vedaa
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway. .,Department of Research and Development, St. Olavs University Hospital, Trondheim, Norway. .,Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes gt. 7, 5015, Bergen, Norway.
| |
Collapse
|
28
|
Esaki Y, Obayashi K, Saeki K, Fujita K, Iwata N, Kitajima T. Effect of nighttime bedroom light exposure on mood episode relapses in bipolar disorder. Acta Psychiatr Scand 2022; 146:64-73. [PMID: 35253206 DOI: 10.1111/acps.13422] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 02/26/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVE A previous cross-sectional study reported that nighttime light is associated with increased occurrence of manic symptoms in bipolar disorder; however, the longitudinal association between nighttime light and subsequent mood episode relapses remains unclear. We determined whether bedroom nighttime light was associated with mood episode relapses in patients with bipolar disorder. METHODS This prospective cohort study included 172 outpatients with bipolar disorder who participated in an Association between the Pathology of Bipolar Disorder and Light Exposure in Daily Life (APPLE) cohort study. A portable photometer was used to measure illuminance in the bedroom from bedtime to rising time during 7 consecutive nights for baseline assessment. Then, the participants were assessed at a 2-year follow-up for mood episode relapses. RESULTS Of the 172 participants, 157 (91%) completed the 2-year follow-up, and 39 (22%) experienced manic or hypomanic episodes (with or without mixed features), during that time. In the Cox proportional-hazards model, the hazard ratio (HR) for manic/hypomanic episode relapses was significantly higher when the average nighttime illuminance was ≥3 lux (n = 71) than when it was <3 lux (n = 101; HR, 2.54; 95% confidence interval (CI), 1.33-4.84). In the multivariable model adjusted for a propensity score in relation to nighttime light, the relationship remained significant (HR, 2.17; 95% CI, 1.04-4.52). The association between nighttime light and depressive episode relapses was not significantly different. CONCLUSIONS Keeping the bedroom dark at night may prevent hypomanic and manic episodes.
Collapse
Affiliation(s)
- Yuichi Esaki
- Department of Psychiatry, Okehazama Hospital, Aichi, Japan.,Department of Psychiatry, Fujita Health University School of Medicine, Aichi, Japan
| | - Kenji Obayashi
- Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan
| | - Keigo Saeki
- Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan
| | - Kiyoshi Fujita
- Department of Psychiatry, Okehazama Hospital, Aichi, Japan.,The Neuroscience Research Center, Aichi, Japan
| | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, Aichi, Japan
| | - Tsuyoshi Kitajima
- Department of Psychiatry, Fujita Health University School of Medicine, Aichi, Japan
| |
Collapse
|
29
|
Ludwig VM, Münch I, Wirz-Justice A, Ritter P. [Chronotherapy of affective disorders: principles and clinical aspects]. DER NERVENARZT 2022; 93:892-900. [PMID: 35687164 DOI: 10.1007/s00115-022-01323-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chronobiological processes play a critical role in the initial manifestation and course of affective disorders. Chronotherapeutic agents aim to improve sleep-wake cycle disturbances and affective symptoms by modulating the chronobiological neuronal circuitry. OBJECTIVE To review the different chronotherapeutic procedures, the current evidence situation and recommendations for clinical applications. METHOD Narrative review. RESULTS Chronotherapeutic interventions for patients with affective disorders can be nonpharmacological, e.g., light therapy, sleep deprivation, sleep phase advance and dark therapy, pharmacological in the form of melatonin and psychological consisting of interpersonal and social rhythm therapy or cognitive behavioral therapy for insomnia modified for patients with bipolar disorder. Nearly all these interventions show promising data regarding their efficacy in acute depressive or manic episodes or as maintenance therapy. For melatonin, there is less evidence for improvement of affective symptoms than for stabilizing the sleep-wake cycle. Some interventions are well-suited for an outpatient setting, e.g., light therapy, dark therapy and psychotherapy, while others, such as triple chronotherapy consisting of sleep deprivation, sleep phase advance and light therapy, are more suited for in-patient treatment. CONCLUSION Chronotherapeutic interventions are versatile in their application and can be combined with each other and used concomitantly with classical psychopharmacotherapy. With a benign side effect profile and good evidence for efficacy, they could play an important role in the treatment of affective disorders; however, this potential is used too rarely in the clinical context.
Collapse
Affiliation(s)
- Vera Miriam Ludwig
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Deutschland.
| | - Ilka Münch
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Anna Wirz-Justice
- Zentrum für Chronobiologie, Universitäre Psychiatrische Kliniken Basel, Basel, Schweiz
| | - Philipp Ritter
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Deutschland
| |
Collapse
|
30
|
Insomnia, sleep loss, and circadian sleep disturbances in mood disorders: a pathway toward neurodegeneration and neuroprogression? A theoretical review. CNS Spectr 2022; 27:298-308. [PMID: 33427150 DOI: 10.1017/s1092852921000018] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The present paper aims at reviewing and commenting on the relationships between sleep and circadian phasing alterations and neurodegenerative/neuroprogressive processes in mood disorder. We carried out a systematic review, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, in PubMed, PsycINFO, and Embase electronic databases for literature related to mood disorders, sleep disturbances, and neurodegenerative/neuroprogressive processes in relation to (1) neuroinflammation, (2) activation of the stress system, (3) oxidative stress, (4) accumulation of neurotoxic proteins, and (5) neuroprotection deficit. Seventy articles were collectively selected and analyzed. Experimental and clinical studies revealed that insomnia, conditions of sleep loss, and altered circadian sleep may favor neurodegeneration and neuroprogression in mood disorders. These sleep disturbances may induce a state of chronic inflammation by enhancing neuroinflammation, both directly and indirectly, via microglia and astrocytes activation. They may act as neurobiological stressors that by over-activating the stress system may negatively influence neural plasticity causing neuronal damage. In addition, sleep disturbances may favor the accumulation of neurotoxic proteins, favor oxidative stress, and a deficit in neuroprotection hence contributing to neurodegeneration and neuroprogression. Targeting sleep disturbances in the clinical practice may hold a neuroprotective value for mood disorders.
Collapse
|
31
|
Spano L, Hennion V, Marie-Claire C, Bellivier F, Scott J, Etain B. Associations between circadian misalignment and telomere length in BD: an actigraphy study. Int J Bipolar Disord 2022; 10:14. [PMID: 35619042 PMCID: PMC9135941 DOI: 10.1186/s40345-022-00260-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/25/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Life expectancy is significantly decreased in bipolar disorder (BD). This is associated with accelerated cellular aging which can be estimated by telomere length (TL). However, specific determinants of shorter TL in BD are under-explored. This study examines whether circadian misalignment (i.e. mismatch between preferred and actual phase of circadian activity rhythms) is associated with shorter TL in BD. METHODS Euthymic individuals with BD (n = 101) undertook 21 consecutive days of actigraphy recording and completed the Composite Scale of Morningness (CSM) to assess phase preference for activities (chronotype). Polymerase chain reaction was used to measure TL in blood. Cluster analysis identified circadian aligned/misaligned subgroups as defined by preferred (CSM score) and actual phases of activity (actigraphically determined onset of active and inactive periods). We tested for any associations between TL and clusters, with adjustments for between-cluster differences in socio-demographic and illness factors. RESULTS We identified three clusters: an "Aligned Morning" cluster (n = 31) with preferred and actual timing of activity in the morning, an "Aligned Evening" cluster (n = 37) with preferred and actual timing of activity in the evening and a "Misaligned" cluster (n = 32) with an evening chronotype, but an earlier objective onset of active periods. After adjustment for confounders, we found that TL was significantly associated with circadian misalignment and older age. CONCLUSIONS Circadian misalignment may partly explain shorter TL in BD and could contribute to accelerated aging in these individuals.
Collapse
Affiliation(s)
- Luana Spano
- INSERM UMR-S 1144, Optimisation Thérapeutique en Neurospsychopharmacologie, OTeN, Université de Paris, 75006, Paris, France
| | - Vincent Hennion
- INSERM UMR-S 1144, Optimisation Thérapeutique en Neurospsychopharmacologie, OTeN, Université de Paris, 75006, Paris, France.,Université de Paris, Paris, France.,DMU Neurosciences, Département de Psychiatrie Et de Médecine Addictologique, AP-HP.Nord, GH Saint-Louis-Lariboisière-F. Widal, Paris, France
| | - Cynthia Marie-Claire
- INSERM UMR-S 1144, Optimisation Thérapeutique en Neurospsychopharmacologie, OTeN, Université de Paris, 75006, Paris, France
| | - Frank Bellivier
- INSERM UMR-S 1144, Optimisation Thérapeutique en Neurospsychopharmacologie, OTeN, Université de Paris, 75006, Paris, France.,Université de Paris, Paris, France.,DMU Neurosciences, Département de Psychiatrie Et de Médecine Addictologique, AP-HP.Nord, GH Saint-Louis-Lariboisière-F. Widal, Paris, France
| | - Jan Scott
- Université de Paris, Paris, France.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Bruno Etain
- INSERM UMR-S 1144, Optimisation Thérapeutique en Neurospsychopharmacologie, OTeN, Université de Paris, 75006, Paris, France. .,Université de Paris, Paris, France. .,DMU Neurosciences, Département de Psychiatrie Et de Médecine Addictologique, AP-HP.Nord, GH Saint-Louis-Lariboisière-F. Widal, Paris, France. .,Département de Psychiatrie et de Médecine Addictologique, Centre Expert Troubles Bipolaires, Hôpital Fernand Widal, 200, rue du Faubourg Saint Denis, 75010, Paris Cedex, France.
| |
Collapse
|
32
|
Peyravian N, Deo S, Daunert S, Jimenez JJ. The Anti-Inflammatory Effects of Cannabidiol (CBD) on Acne. J Inflamm Res 2022; 15:2795-2801. [PMID: 35535052 PMCID: PMC9078861 DOI: 10.2147/jir.s355489] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/18/2022] [Indexed: 01/21/2023] Open
Affiliation(s)
- Nadia Peyravian
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sapna Deo
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sylvia Daunert
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joaquin J Jimenez
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, USA
- Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Correspondence: Joaquin J Jimenez, Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, USA, Tel +1 305 243 6586, Email
| |
Collapse
|
33
|
Mitter P, De Crescenzo F, Loo Yong Kee K, Xia J, Roberts S, Kurtulumus A, Kyle SD, Geddes JR, Cipriani A. Sleep deprivation as a treatment for major depressive episodes: a systematic review and meta-analysis. Sleep Med Rev 2022; 64:101647. [DOI: 10.1016/j.smrv.2022.101647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/19/2022] [Indexed: 10/18/2022]
|
34
|
Meyrel M, Scott J, Etain B. Chronotypes and circadian rest-activity rhythms in bipolar disorders: a meta-analysis of self- and observer rating scales. Bipolar Disord 2022; 24:286-297. [PMID: 34486201 DOI: 10.1111/bdi.13122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 07/13/2021] [Accepted: 08/28/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Chronobiological models postulate that abnormalities in circadian rest/activity rhythms (CRAR) are core phenomena of bipolar disorders (BDs). We undertook a meta-analysis of published studies to determine whether self- or observer ratings of CRAR differentiate BD cases from comparators (typically healthy controls [HCs]). METHOD We undertook systematic searches of four databases to identify studies for inclusion in random effects meta-analyses and meta-regression analyses. Effect sizes (ES) for pooled analyses of self- and observer ratings were expressed as standardized mean differences with 95% confidence intervals (CIs). RESULTS The 30 studies meeting eligibility criteria included 2840 cases and 3573 controls. Compared with HC, BD cases showed greater eveningness (ES: 0.33; 95% CI: 0.12-0.54), lower flexibility of rhythms (ES: 0.36; 95% CI: 0.06-0.67), lower amplitude of rhythms (ES: 0.55; 95% CI: 0.39-0.70) and more disturbances across a range of CRAR (ES of 0.78-1.12 for general and social activities, sleep and eating patterns). Between study heterogeneity was high (I2 > 70%) and evidence indicated a potential publication bias for studies using the Biological Rhythms Interview of Assessment in Neuropsychiatry. Meta-regression analyses suggested significantly larger ES were observed in studies using observer ratings or including BD cases with higher levels of depressive symptoms. CONCLUSION This meta-analysis demonstrates that BD is associated with higher levels of self- or observer-rated CRAR disturbances compared with controls. However, further studies should examine the respective performance of individual instruments when used alone or in combination, to clarify their applicability and utility in clinical practice.
Collapse
Affiliation(s)
- Manon Meyrel
- Université de Paris, Paris, France.,Département de Psychiatrie et de Médecine Addictologique, APHP.Nord, DMU Neurosciences, GHU Lariboisière - Saint Louis - Fernand Widal, Paris, France
| | - Jan Scott
- Université de Paris, Paris, France.,Département de Psychiatrie et de Médecine Addictologique, APHP.Nord, DMU Neurosciences, GHU Lariboisière - Saint Louis - Fernand Widal, Paris, France.,Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Bruno Etain
- Université de Paris, Paris, France.,Département de Psychiatrie et de Médecine Addictologique, APHP.Nord, DMU Neurosciences, GHU Lariboisière - Saint Louis - Fernand Widal, Paris, France.,INSERM UMRS-1144, Université de Paris, Paris, France
| |
Collapse
|
35
|
McCarthy MJ, Gottlieb JF, Gonzalez R, McClung CA, Alloy LB, Cain S, Dulcis D, Etain B, Frey BN, Garbazza C, Ketchesin KD, Landgraf D, Lee H, Marie‐Claire C, Nusslock R, Porcu A, Porter R, Ritter P, Scott J, Smith D, Swartz HA, Murray G. Neurobiological and behavioral mechanisms of circadian rhythm disruption in bipolar disorder: A critical multi-disciplinary literature review and agenda for future research from the ISBD task force on chronobiology. Bipolar Disord 2022; 24:232-263. [PMID: 34850507 PMCID: PMC9149148 DOI: 10.1111/bdi.13165] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM Symptoms of bipolar disorder (BD) include changes in mood, activity, energy, sleep, and appetite. Since many of these processes are regulated by circadian function, circadian rhythm disturbance has been examined as a biological feature underlying BD. The International Society for Bipolar Disorders Chronobiology Task Force (CTF) was commissioned to review evidence for neurobiological and behavioral mechanisms pertinent to BD. METHOD Drawing upon expertise in animal models, biomarkers, physiology, and behavior, CTF analyzed the relevant cross-disciplinary literature to precisely frame the discussion around circadian rhythm disruption in BD, highlight key findings, and for the first time integrate findings across levels of analysis to develop an internally consistent, coherent theoretical framework. RESULTS Evidence from multiple sources implicates the circadian system in mood regulation, with corresponding associations with BD diagnoses and mood-related traits reported across genetic, cellular, physiological, and behavioral domains. However, circadian disruption does not appear to be specific to BD and is present across a variety of high-risk, prodromal, and syndromic psychiatric disorders. Substantial variability and ambiguity among the definitions, concepts and assumptions underlying the research have limited replication and the emergence of consensus findings. CONCLUSIONS Future research in circadian rhythms and its role in BD is warranted. Well-powered studies that carefully define associations between BD-related and chronobiologically-related constructs, and integrate across levels of analysis will be most illuminating.
Collapse
Affiliation(s)
- Michael J. McCarthy
- UC San Diego Department of Psychiatry & Center for Circadian BiologyLa JollaCaliforniaUSA
- VA San Diego Healthcare SystemSan DiegoCaliforniaUSA
| | - John F. Gottlieb
- Department of PsychiatryFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Robert Gonzalez
- Department of Psychiatry and Behavioral HealthPennsylvania State UniversityHersheyPennsylvaniaUSA
| | - Colleen A. McClung
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Lauren B. Alloy
- Department of PsychologyTemple UniversityPhiladelphiaPennsylvaniaUSA
| | - Sean Cain
- School of Psychological Sciences and Turner Institute for Brain and Mental HealthMonash UniversityMelbourneVictoriaAustralia
| | - Davide Dulcis
- UC San Diego Department of Psychiatry & Center for Circadian BiologyLa JollaCaliforniaUSA
| | - Bruno Etain
- Université de ParisINSERM UMR‐S 1144ParisFrance
| | - Benicio N. Frey
- Department Psychiatry and Behavioral NeuroscienceMcMaster UniversityHamiltonOntarioCanada
| | - Corrado Garbazza
- Centre for ChronobiologyPsychiatric Hospital of the University of Basel and Transfaculty Research Platform Molecular and Cognitive NeurosciencesUniversity of BaselBaselSwitzerland
| | - Kyle D. Ketchesin
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Dominic Landgraf
- Circadian Biology GroupDepartment of Molecular NeurobiologyClinic of Psychiatry and PsychotherapyUniversity HospitalLudwig Maximilian UniversityMunichGermany
| | - Heon‐Jeong Lee
- Department of Psychiatry and Chronobiology InstituteKorea UniversitySeoulSouth Korea
| | | | - Robin Nusslock
- Department of Psychology and Institute for Policy ResearchNorthwestern UniversityChicagoIllinoisUSA
| | - Alessandra Porcu
- UC San Diego Department of Psychiatry & Center for Circadian BiologyLa JollaCaliforniaUSA
| | | | - Philipp Ritter
- Clinic for Psychiatry and PsychotherapyCarl Gustav Carus University Hospital and Technical University of DresdenDresdenGermany
| | - Jan Scott
- Institute of NeuroscienceNewcastle UniversityNewcastleUK
| | - Daniel Smith
- Division of PsychiatryUniversity of EdinburghEdinburghUK
| | - Holly A. Swartz
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Greg Murray
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| |
Collapse
|
36
|
McGowan NM, Kim DS, de Andres Crespo M, Bisdounis L, Kyle SD, Saunders KEA. Hypnotic and Melatonin/Melatonin-Receptor Agonist Treatment in Bipolar Disorder: A Systematic Review and Meta-Analysis. CNS Drugs 2022; 36:345-363. [PMID: 35305257 DOI: 10.1007/s40263-022-00911-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is a chronic relapsing-remitting psychiatric disorder. Sleep and circadian rhythm disturbances persist during acute mood episodes of the disorder and during euthymia. However, the treatment potential of hypnotic agents that might be used to manage sleep disturbance in BD is not well understood. Similarly, melatonin and medications with a melatonin-receptor agonist mechanism of action may have chronotherapeutic potential for treating people with the disorder, but the impact of these substances on sleep and circadian rhythms and core symptoms in BD is unclear. OBJECTIVE Our aim was to conduct a systematic review and meta-analysis evaluating the current evidence for hypnotic and melatonin/melatonin-receptor agonist pharmacotherapy for symptoms of sleep disturbance, mania, and depression in patients with BD. METHODS AMED, Embase, MEDLINE and PsychINFO databases were searched for studies published in English from the date of inception to 31 October 2021. Studies included in this review were randomised controlled trials (RCTs) and non-controlled/non-randomised studies for BD that examined hypnotic medications selected based on a common pattern of usage for treating insomnia (i.e. chloral, clomethiazole, diphenhydramine, doxepin, doxylamine, promethazine, suvorexant, zaleplon, zolpidem, zopiclone, and eszopiclone) and melatonin and the melatonin-receptor agonist drugs ramelteon and agomelatine. Risk of bias was assessed using the RoB2 and AXIS tools. Pooled effect sizes for RCT outcomes were estimated using random-effects models. RESULTS A total of eleven studies (six RCTs and five experimental feasibility studies) involving 1279 participants were included. Each study examined melatonin or melatonin-receptor agonists. No studies of hypnotics were found that fulfilled the review inclusion criteria. Pilot feasibility studies suggested beneficial treatment effects for symptoms of sleep disturbance, depression, and mania. However, the pooled effect of the two available RCT studies assessing sleep quality via Pittsburgh Sleep Quality Index scores was not statistically significant (g = - 0.04 [95% CI - 0.81 to 0.73]) and neither was the pooled effect for depressive symptoms (four studies; g = - 0.10 [95% CI - 0.27 to 0.08]). Some RCT evidence suggests ramelteon might prevent relapse into depression in BD. The largest efficacy signal detected was for manic symptoms (four studies; g = - 0.44 [95% CI - 1.03 to 0.14]) but there was substantial heterogeneity between studies and patient characteristics. In the two RCTs assessing manic symptoms during acute mania, adjunctive melatonin demonstrated superior treatment effects versus placebo. CONCLUSIONS There is a paucity of studies examining pharmacological interventions for sleep and circadian rhythm disturbance in BD. Few studies assessed sleep-related symptoms, and none quantitatively examined endogenous melatonin patterns or other circadian rhythms. Melatonin may be a promising candidate for the adjunctive treatment of bipolar mania. However, dose-finding studies and studies with larger sample sizes are needed to confirm its efficacy. We recommend parallel monitoring of sleep and circadian rhythms in future trials. Chronobiology-informed trial designs are needed to improve the quality of future studies. PROTOCOL REGISTRATION PROSPERO (CRD42020167528).
Collapse
Affiliation(s)
- Niall M McGowan
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK. .,Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| | - David S Kim
- Medical Sciences Division, Clinical Medical School, The John Radcliffe Hospital, University of Oxford Academic Centre, Oxford, UK
| | - Marta de Andres Crespo
- Medical Sciences Division, Clinical Medical School, The John Radcliffe Hospital, University of Oxford Academic Centre, Oxford, UK
| | - Lampros Bisdounis
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.,Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Kate E A Saunders
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.,Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
| |
Collapse
|
37
|
Short communication: Do clinical guidelines for bipolar disorders adequately address sleep, circadian rhythm, activity and lifestyle problems? J Affect Disord 2022; 301:433-436. [PMID: 35063584 DOI: 10.1016/j.jad.2022.01.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/24/2022]
Abstract
Objectives Clinical practice guidelines (CPGs) for the treatment of bipolar disorder (BD) provide guidance to health care professionals and patients about the management of core aspects of BD. This study evaluated the overall quality of CPGs and examined the quantity, specificity, clarity and utility of recommendations about four key contemporary themes: sleep, circadian rhythms, activity and energy, and healthy lifestyles. Methods English language editions of CPGs for the treatment of BD were identified by a systematic search of the literature from 2007 onwards (i.e. 15 years). Blind independent ratings were combined to give consensus scores for the quality of each CPGs (using the 14-item International Center for Allied Health Evidence guideline checklist). Composite ratings of the quantity, specificity, clarity and utility of recommendations about the key themes were undertaken using a 0-3 scale. Results Twenty-five CPGs were eligible for review. Overall quality was high (median checklist score=10), but only 11 (44%) CPGs included even basic information about circadian rhythm disturbances. Combined scores for composite ratings about sleep and circadian rhythms were significantly correlated with overall quality of the CPG (sleep, r = 0.43; circadian rhythms, r = 0.42) but not with year of publication. Limitations No reliable scale exists for generating composite ratings of the four themes we examined. Conclusions Circadian rhythms and chronobiology represent neglected domains in CPGs. Incorporating this important theme into future editions of CPGs would aid health care professionals to identify, prevent, or intervene with these problems and improve outcomes for a significant proportion of individuals with BD.
Collapse
|
38
|
Bassett D, Boyce P, Lyndon B, Mulder R, Parker G, Porter R, Singh A, Bell E, Hamilton A, Morris G, Malhi GS. Guidelines for the management of psychosis in the context of mood disorders. Schizophr Res 2022; 241:187-196. [PMID: 35139458 DOI: 10.1016/j.schres.2022.01.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 01/17/2022] [Accepted: 01/22/2022] [Indexed: 12/19/2022]
Abstract
Psychotic episodes occur in a substantial proportion of patients suffering from major mood disorders (both unipolar and bipolar) at some point in their lives. The nature of these episodes is less well understood than the more common, non-psychotic periods of illness and hence their management is also less sophisticated. This is a concern because the risk of suicide is particularly high in this subtype of mood disorder and comorbidity is far more common. In some cases psychotic symptoms may be signs of a comorbid illness but the relationship of psychotic mood to other forms of psychosis and in particular its interactions with schizophrenia is poorly understood. Therefore, our targeted review draws upon extant research and our combined experience to provide clinical context and a framework for the management of these disorders in real-world practice - taking into consideration both biological and psychological interventions.
Collapse
Affiliation(s)
- Darryl Bassett
- Gaps in Guidelines Group, Australia; Consultant Psychiatrist, Perth, WA, Australia.
| | - Philip Boyce
- Gaps in Guidelines Group, Australia; Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Bill Lyndon
- Gaps in Guidelines Group, Australia; The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia
| | - Roger Mulder
- Gaps in Guidelines Group, Australia; Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Gordon Parker
- Gaps in Guidelines Group, Australia; School of Psychiatry, University of New South Wales. Sydney, Australia
| | - Richard Porter
- Gaps in Guidelines Group, Australia; Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ajeet Singh
- Gaps in Guidelines Group, Australia; The Geelong Clinic Healthscope, IMPACT-Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Erica Bell
- Gaps in Guidelines Group, Australia; Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, New South Wales, Australia
| | - Amber Hamilton
- Gaps in Guidelines Group, Australia; Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, New South Wales, Australia
| | - Grace Morris
- Gaps in Guidelines Group, Australia; Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, New South Wales, Australia
| | - Gin S Malhi
- Gaps in Guidelines Group, Australia; Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, New South Wales, Australia; Visiting Professor, Department of Psychiatry, University of Oxford, United Kingdom
| |
Collapse
|
39
|
Roloff T, Haussleiter I, Meister K, Juckel G. Sleep disturbances in the context of neurohormonal dysregulation in patients with bipolar disorder. Int J Bipolar Disord 2022; 10:6. [PMID: 35229223 PMCID: PMC8885957 DOI: 10.1186/s40345-022-00254-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 01/31/2022] [Indexed: 12/27/2022] Open
Abstract
Background Sleep dysfunction is a core symptom in bipolar disorder (BD), especially during major mood episodes. This study investigated the possible link between subjective and objective sleep disturbances in inter-episode BD, changes in melatonin and cortisol levels, and circadian melatonin alignment. The study included 21 euthymic BD patients and 24 healthy controls. Participants had to wear an actigraphy device, keep a weekly sleep diary and take salivary samples: five samples on the last evening to determine the dim light melatonin onset (DLMO) and one the following morning to measure rising cortisol. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI) and Regensburg Insomnia Scale (RIS), and circadian alignment by the phase angle difference (PAD). Results In comparison to healthy controls, BD patients had: (1) higher PSQI (5.52 ± 3.14 vs. 3.63 ± 2.18; p = 0.022) (significant after controlling for age and gender), and higher RIS scores (8.91 ± 5.43 vs. 5.83 ± 3.76; p = 0.031); (2) subjective a longer mean TST (p = 0.024) and TIB (p = 0.002) (both significant after controlling for age and gender), longer WASO (p = 0.019), and worse SE (p = 0.036) (significant after controlling for gender); (3) actigraphically validated earlier sleep onset (p = 0.002), less variation in sleep onset time (p = 0.005) and no longer TST (p = 0.176); (4) no differing melatonin levels (4.06 ± 2.77 vs. 3.35 ± 2.23 p = 0.352), an 1.65 h earlier DLMO (20.17 ± 1.63 vs. 21.82 ± 1.50; p = 0. 001) (significant after controlling for gender), and a phase advance of melatonin (6.35 ± 1.40 vs. 7.48 ± 1.53; p = 0.017) (significant after controlling for gender); and (5) no differing cortisol awakening response (16.97 ± 10.22 vs 17.06 ± 5.37 p = 0.969). Conclusions Patients with BD, even in euthymic phase, have a significantly worse perception of their sleep. Advanced sleep phases in BD might be worth further investigation and could help to explain the therapeutic effects of mood stabilizers such as lithium and valproate.
Collapse
Affiliation(s)
- Tom Roloff
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Alexandrinenstr. 1, 44791, Bochum, Germany
| | - Ida Haussleiter
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Alexandrinenstr. 1, 44791, Bochum, Germany
| | - Klara Meister
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Alexandrinenstr. 1, 44791, Bochum, Germany
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Alexandrinenstr. 1, 44791, Bochum, Germany.
| |
Collapse
|
40
|
Wirz-Justice A, Terman AM. CME: Light Therapy: Why, What, for Whom, How, and When (And a Postscript about Darkness). PRAXIS 2022; 110:56-62. [PMID: 35105211 DOI: 10.1024/1661-8157/a003821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Light therapy has become established as an evidence-based treatment for Seasonal Affective Disorder. Light impacts the timing and stability of circadian rhythms as expressed in sleep, mood, alertness, and cognition. Forty years of clinical trials and open treatment have led to guidelines for patient selection, using light alone or in combination with antidepressants (or lithium for bipolar depression). Mood and sleep disturbances can also respond to adjunct light therapy in a broader set of psychiatric, neurologic and medical illnesses. We specify criteria for choice of treatment devices: optimum dose (10,000 lux), spectrum (white light), exposure duration (30-60 minutes) and timing (early morning). Protocol adjustment requires continual monitoring with attention to rate of improvement and management of potential side effects.
Collapse
Affiliation(s)
- Anna Wirz-Justice
- Centre for Chronobiology, Transfaculty Research Platform, Molecular and Cognitive Neurosciences, Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - And Michael Terman
- Department of Psychiatry, Columbia University, and Center for Environmental Therapeutics, New York, USA
| |
Collapse
|
41
|
Ahmadpanah M, Pezeshki R, Soltanian AR, Jahangard L, Dürsteler KM, Keshavarzi A, Brand S. Influence of adjuvant clonidine on mania, sleep disturbances and cognitive performance - Results from a double-blind and placebo-controlled randomized study in individuals with bipolar I disorder during their manic phase. J Psychiatr Res 2022; 146:163-171. [PMID: 34990968 DOI: 10.1016/j.jpsychires.2021.12.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 12/10/2021] [Accepted: 12/17/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND While the favorable effect of adjuvant clonidine in the treatment of acute mania has been observed already about 40 years ago, this line of treatment has not been further investigated. Here, we resumed this topic, and we tested the effect of adjuvant clonidine, an antihypertensive stimulating the alpha-2 central adrenergic receptor, on symptoms of mania, cognitive performance, and subjective sleep. To this end, we performed a randomized, double-blind and placebo-controlled clinical trial among inpatients with bipolar disorder I during their acute phase of mania. METHODS A total of 70 inpatients (mean age: 37.40 years; 15.7% females) with diagnosed bipolar disorder I and during their acute manic phase were randomly assigned either to the adjuvant clonidine (0.2 mg/d to a maximum of 0.6 mg/d) or to the placebo condition. Standard medication was lithium at therapeutic dosages. At baseline, participants completed a series of self-rating questionnaires covering sociodemographic information and subjective sleep. Subjective sleep was re-assessed 24 days later at the end of the study. Experts rated participants' acute state of mania with the Young Mania Rating Scale at baseline and at day 12 and day 24. Participants' cognitive performance was assessed at baseline and at day 24 at the end of the study. RESULTS Over time, mania scores significantly decreased (large effect size), but more so in the clonidine condition, compared to the placebo condition (medium effect size). Likewise, over time, subjective sleep improved (large effect size), but more so in the clonidine, compared to the placebo condition (medium effect size). Over time, cognitive performance improved (medium effect size), irrespective from the study condition. CONCLUSIONS Compared to placebo, adjuvant clonidine to lithium improved symptoms of mania, as rated by experts', and subjective sleep quality. Adjuvant clonidine had no further favorable (or detrimental) impact on cognitive performance.
Collapse
Affiliation(s)
- Mohammad Ahmadpanah
- Research Center for Behavioral Disorders and Substances Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Rana Pezeshki
- Research Center for Behavioral Disorders and Substances Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Reza Soltanian
- Modeling of Non-Communicable Diseases Research Center, Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Leila Jahangard
- Research Center for Behavioral Disorders and Substances Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Kenneth M Dürsteler
- Psychiatric Clinics of the University of Basel, Division of Substance Use Disorders, University of Basel, Basel, Switzerland; Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Amir Keshavarzi
- Research Center for Behavioral Disorders and Substances Abuse, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Serge Brand
- Center for Affective, Stress and Sleep Disorders (ZASS), Psychiatric University Hospital Basel, 4002 Basel, Switzerland; Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran; Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran; Department of Sport, Exercise and Health, Division of Sport Science and Psychosocial Health, University of Basel, Basel, Switzerland; School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
42
|
Leger D, Andler R, Richard JB, Nguyen-Thanh V, Collin O, Chennaoui M, Metlaine A. Sleep, substance misuse and addictions: a nationwide observational survey on smoking, alcohol, cannabis and sleep in 12,637 adults. J Sleep Res 2022; 31:e13553. [PMID: 35088480 DOI: 10.1111/jsr.13553] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/30/2021] [Accepted: 01/12/2022] [Indexed: 11/29/2022]
Abstract
For a good night's sleep, we consensually recommend avoiding alcohol, smoking and drugs. However, these addictions are highly prevalent in the general population, and it is difficult to estimate their real impact on sleep. The aim of this study is to clarify the association between sleep habits and disorders, and addictions. The design was a telephone crossover national recurrent health poll survey (Santé publique France, Baromètre santé, 2017; Questionnaire, pp. 53; Saint Maurice) in a representative sample of French adults. There were 12,367 subjects (18-75 years old) who answered the survey. Sleep log items assessed sleep schedules (total sleep time) on work and leisure days: at night, while napping, and over 24 hr using a sleep log. Retained items include: (1) short sleep (≤ 6 hr/24 hr); (2) chronic insomnia (International Classification of Sleep Disorders, 3rd edition criteria); and (3) chronotype (evening-morning-neutral). Psychoactive substances retained included tobacco (current or former users), alcohol (daily consumption and weekly binge drinking), cannabis (Cannabis Abuse Screening Test), and other drugs (consumption during the past year). We found that: (1) daily smokers (lightly or heavily dependent) were more frequently short sleepers than occasional smokers and non-smokers; (2) heavily dependent daily smokers were more likely to suffer from insomnia than other smokers or non-smokers; (3) short sleep and insomnia were not significantly associated with the consumption of alcohol, cannabis or any other drug; (4) the evening chronotype was significantly associated with the consumption of tobacco, alcohol and cannabis. In conclusion, our study highlights significant relationships between the use of psychoactive substances and sleep characteristics among adults, emphasizing the need to take into account each subject individually.
Collapse
Affiliation(s)
- Damien Leger
- Université de Paris, EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Paris, France.,APHP, Hôtel-Dieu, Consultation de pathologie professionnelle Sommeil Vigilance et Travail, Centre du Sommeil et de la Vigilance, Paris, France
| | - Raphaël Andler
- Direction de la prévention et de la promotion de la santé, Santé publique France, Saint Maurice, France
| | - Jean-Baptiste Richard
- Direction Appui, Traitements et Analyses des données, Santé publique France, Saint Maurice, France
| | - Viêt Nguyen-Thanh
- Direction Appui, Traitements et Analyses des données, Santé publique France, Saint Maurice, France
| | - Olivier Collin
- Université de Paris, EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Paris, France.,APHP, Hôtel-Dieu, Consultation de pathologie professionnelle Sommeil Vigilance et Travail, Centre du Sommeil et de la Vigilance, Paris, France
| | - Mounir Chennaoui
- Université de Paris, EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Paris, France.,APHP, Hôtel-Dieu, Consultation de pathologie professionnelle Sommeil Vigilance et Travail, Centre du Sommeil et de la Vigilance, Paris, France.,Direction de la prévention et de la promotion de la santé, Santé publique France, Saint Maurice, France.,Direction Appui, Traitements et Analyses des données, Santé publique France, Saint Maurice, France.,Institut de Recherche Biomédical des Armées (IRBA), Brétigny, France
| | - Arnaud Metlaine
- Université de Paris, EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Paris, France.,APHP, Hôtel-Dieu, Consultation de pathologie professionnelle Sommeil Vigilance et Travail, Centre du Sommeil et de la Vigilance, Paris, France
| |
Collapse
|
43
|
Panchal P, de Queiroz Campos G, Goldman DA, Auerbach RP, Merikangas KR, Swartz HA, Sankar A, Blumberg HP. Toward a Digital Future in Bipolar Disorder Assessment: A Systematic Review of Disruptions in the Rest-Activity Cycle as Measured by Actigraphy. Front Psychiatry 2022; 13:780726. [PMID: 35677875 PMCID: PMC9167949 DOI: 10.3389/fpsyt.2022.780726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Disruptions in rest and activity patterns are core features of bipolar disorder (BD). However, previous methods have been limited in fully characterizing the patterns. There is still a need to capture dysfunction in daily activity as well as rest patterns in order to more holistically understand the nature of 24-h rhythms in BD. Recent developments in the standardization, processing, and analyses of wearable digital actigraphy devices are advancing longitudinal investigation of rest-activity patterns in real time. The current systematic review aimed to summarize the literature on actigraphy measures of rest-activity patterns in BD to inform the future use of this technology. METHODS A comprehensive systematic review using PRISMA guidelines was conducted through PubMed, MEDLINE, PsycINFO, and EMBASE databases, for papers published up to February 2021. Relevant articles utilizing actigraphy measures were extracted and summarized. These papers contributed to three research areas addressed, pertaining to the nature of rest-activity patterns in BD, and the effects of therapeutic interventions on these patterns. RESULTS Seventy articles were included. BD was associated with longer sleep onset latency and duration, particularly during depressive episodes and with predictive value for worsening of future manic symptoms. Lower overall daily activity was also associated with BD, especially during depressive episodes, while more variable activity patterns within a day were seen in mania. A small number of studies linked these disruptions with differential patterns of brain functioning and cognitive impairments, as well as more adverse outcomes including increased suicide risk. The stabilizing effect of therapeutic options, including pharmacotherapies and chronotherapies, on activity patterns was supported. CONCLUSION The use of actigraphy provides valuable information about rest-activity patterns in BD. Although results suggest that variability in rhythms over time may be a specific feature of BD, definitive conclusions are limited by the small number of studies assessing longitudinal changes over days. Thus, there is an urgent need to extend this work to examine patterns of rhythmicity and regularity in BD. Actigraphy research holds great promise to identify a much-needed specific phenotypic marker for BD that will aid in the development of improved detection, treatment, and prevention options.
Collapse
Affiliation(s)
- Priyanka Panchal
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | | | - Danielle A Goldman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.,Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, CT, United States
| | - Randy P Auerbach
- Department of Psychiatry, Columbia University, New York, NY, United States
| | - Kathleen R Merikangas
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, United States
| | - Holly A Swartz
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Anjali Sankar
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.,Neurobiology Research Unit, Rigshospitalet, Copenhagen, Denmark
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.,Department of Radiology and Biomedical Imaging, and the Child Study Center, Yale School of Medicine, New Haven, CT, United States
| |
Collapse
|
44
|
Mukherjee D, Weissenkampen JD, Wasserman E, Krishnamurthy VB, Millett C, Conway S, Saunders EF. Dysregulated Diurnal Cortisol Pattern and Heightened Night-Time Cortisol in Individuals with Bipolar Disorder. Neuropsychobiology 2022; 81:51-59. [PMID: 34320487 PMCID: PMC8795243 DOI: 10.1159/000517343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 05/17/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Hypothalamic-pituitary-adrenal (HPA) axis dysregulation may contribute to the symptom burden in bipolar disorder (BD). Further characterization of cortisol secretion is needed to improve understanding of the connection between mood, sleep, and the HPA axis. Here, we observe diurnal cortisol patterns in individuals with BD and healthy controls (HCs) to determine time points where differences may occur. METHODS Salivary cortisol was measured at 6 time points (wake, 15, 30, and 45 min after wake, between 2:00 and 4:00 p.m. and 10:00 p.m.) for 3 consecutive days in individuals with symptomatic BD (N = 27) and HC participants (N = 31). A general linear model with correlated errors was utilized to determine if salivary cortisol changed differently throughout the day between the 2 study groups. RESULTS A significant interaction (F = 2.74, df = 5, and p = 0.02) was observed between the time of day and the study group (BD vs. HC) when modeling salivary cortisol over time, indicating that salivary cortisol levels throughout the day significantly differed between the study groups. Specifically, salivary cortisol in BD was elevated compared to HCs at the 10:00 p.m. time point (p = 0.01). CONCLUSION Significantly higher levels of cortisol in participants with BD in the night-time suggest that the attenuation of cortisol observed in healthy individuals may be impaired in those with BD. Reregulation of cortisol levels may be a target of further study and treatment intervention for individuals with BD.
Collapse
Affiliation(s)
- Dahlia Mukherjee
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA, United States of America
| | - J. Dylan Weissenkampen
- Neural and Behavioral Sciences, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA, United States of America,Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States of America
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States of America
| | - Venkatesh Basappa Krishnamurthy
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA, United States of America
| | - Caitlin Millett
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA, United States of America,Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA, United States of America
| | - Stephen Conway
- Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA, United States of America
| | - Erika F.H. Saunders
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA, United States of America
| |
Collapse
|
45
|
Bisdounis L, Saunders KEA, Farley HJ, Lee CK, McGowan NM, Espie CA, Kyle SD. Psychological and behavioural interventions in bipolar disorder that target sleep and circadian rhythms: A systematic review of randomised controlled trials. Neurosci Biobehav Rev 2022; 132:378-390. [PMID: 34871635 DOI: 10.1016/j.neubiorev.2021.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/18/2021] [Accepted: 12/01/2021] [Indexed: 01/10/2023]
Abstract
Sleep and circadian disruptions are prominent symptoms of bipolar disorder (BD) and potential targets for adjunctive interventions. The aim of this review was to appraise the effectiveness of psychological and behavioural interventions in BD that target sleep and circadian rhythms, as reported by randomised controlled trials. Nineteen studies met the inclusion/exclusion criteria. They were summarised via narrative synthesis and meta-analysis wherever appropriate. Six studies delivered bright light therapy, five interpersonal and social rhythm therapy, two blue-light blocking glasses, one cognitive behavioural therapy for insomnia, one total sleep deprivation, and four combination treatments. More than half of the studies (N = 10, 52 %) did not measure sleep or circadian rhythms despite being the principal target of the intervention. Overall, the evidence base for the effectiveness of these interventions was limited. There was a small number of studies for each intervention, and a lack of consistency in protocols and outcomes. Meta-analysis was possible for the effect of bright light therapy on depression, revealing a medium-to-large post-treatment effect (Nc = 6; g=-0.74 [95 % CI=-1.05 to -0.42], p < 0.001).
Collapse
Affiliation(s)
- Lampros Bisdounis
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Department of Psychiatry, Warneford Hospital, University of Oxford, United Kingdom.
| | - Kate E A Saunders
- Department of Psychiatry, Warneford Hospital, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Hannah J Farley
- Clinical Medical School, Medical Sciences Division, Academic Centre, John Radcliffe Hospital, University of Oxford, United Kingdom
| | - Charlotte K Lee
- Clinical Medical School, Medical Sciences Division, Academic Centre, John Radcliffe Hospital, University of Oxford, United Kingdom
| | - Niall M McGowan
- Department of Psychiatry, Warneford Hospital, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| |
Collapse
|
46
|
Yan X, Xu P, Sun X. Circadian rhythm disruptions: A possible link of bipolar disorder and endocrine comorbidities. Front Psychiatry 2022; 13:1065754. [PMID: 36683994 PMCID: PMC9849950 DOI: 10.3389/fpsyt.2022.1065754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023] Open
Abstract
Epidemiological studies have demonstrated an association between bipolar disorder (BP) and endocrine diseases. Further, circadian rhythm disruptions may be a potential common pathophysiological mechanism of both disorders. This review provides a brief overview of the molecular mechanisms of circadian rhythms, as well as roles circadian rhythms play in BP and common endocrine comorbidities such as diabetes and thyroid disease. Treatments targeting the circadian system, both pharmacological and non-pharmacological, are also discussed. The hope is to elicit new interest to the importance of circadian system in BP and offer new entry points and impetus to the development of medicine.
Collapse
Affiliation(s)
- Xiu Yan
- Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, China
| | - Peiwei Xu
- Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, China
| | - Xueli Sun
- Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, China
| |
Collapse
|
47
|
Swartz HA, Rollman BL, Mohr DC, Sadow S, Frank E. A randomized pilot study of Rhythms And You (RAY): An internet-based program for bipolar disorder administered with and without clinical helper support in primary care. J Affect Disord 2021; 295:183-191. [PMID: 34469857 PMCID: PMC8551063 DOI: 10.1016/j.jad.2021.08.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/12/2021] [Accepted: 08/18/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Rhythms And You (RAY) is an online intervention for bipolar disorders (BD) based on Interpersonal and Social Rhythm Therapy. We examined RAY's feasibility and acceptability for individuals with BD recruited from primary care. Because online interventions may be more effective when paired with human support, we evaluated RAY with and without weekly brief (∼5 min) calls from clinical helpers (CH). METHODS Participants (n = 47) meeting criteria for BD I, II or other specified BD, presenting for primary care, were randomly assigned to RAY, RAY-CH, or Adjunctive Reading Material (ARM) control. RAY consisted of 12 weekly online modules. ARM consisted of 12 weekly emails. Participants were assessed at baseline, 4, 8, and 12 weeks. RESULTS RAY showed high completion rates and Client Satisfaction Questionnaire scores (36/47, 77% and 25.1 ± 5.5, respectively; no group differences). Effect sizes for RAY- CH ranged from small [Internal State Scale-Activation Subscale (ISS-ACT); d = 0.3] to large [SF-12 Mental Health Composite Score (SF-12 MHC); d = 1.3]. ARM also showed moderate effects (ISS-ACT d = 0.7; Quick Inventory of Depressive Symptoms, d = 0.8). SF-12 MHC scores showed a time*group interaction (F = 2.38, df = 6,32, p = 0.05) favoring RAY-CH. Number of logins trended toward significant association with improved social rhythm regularity (F = 4.09, df = 1, 17, p = 0.06). LIMITATIONS Sample size is small, limiting conclusions that can be drawn. CONCLUSIONS Remote delivery of RAY for individuals with BD is feasible and acceptable. More time spent engaged in RAY was associated with greater improvement in social rhythm regularity. Preliminary evidence suggests adding brief human support to RAY may yield better outcomes.
Collapse
Affiliation(s)
- Holly A Swartz
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, United States.
| | - Bruce L Rollman
- University of Pittsburgh School of Medicine, Center for Behavioral Health, Media, and Technology, Department of Medicine, Pittsburgh, PA, United States
| | - David C Mohr
- Northwestern University Feinberg School of Medicine, Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Chicago, IL, United States
| | - Samuel Sadow
- University of Pittsburgh, Department of Statistics, Pittsburgh, PA, United States; now located at AstraZeneca, Gaithersburg, MD
| | - Ellen Frank
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, United States
| |
Collapse
|
48
|
Gillett G, Watson G, Saunders KE, McGowan NM. Sleep and circadian rhythm actigraphy measures, mood instability and impulsivity: A systematic review. J Psychiatr Res 2021; 144:66-79. [PMID: 34601378 DOI: 10.1016/j.jpsychires.2021.09.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/24/2021] [Accepted: 09/22/2021] [Indexed: 01/04/2023]
Abstract
The normal spectrum trait measures of mood instability and impulsivity are implicated in and comprise core symptoms of several psychiatric disorders. A bidirectional relationship between these traits and sleep disturbance and circadian rhythm dysfunction has been hypothesised, although has not been systematically assessed using objective measures in naturalistic settings. We systematically reviewed the literature following PRISMA guidelines, according to a pre-registered protocol (PROSPERO: CRD 42018108213). Peer-reviewed quantitative studies assessing an association between actigraphic variables and any measure of mood instability or impulsivity in participants aged 12-65 years old were included. Studies were critically appraised using the AXIS tool. Twenty-three articles were retained for inclusion. There was significant heterogeneity in the selection and reporting of actigraphic variables and metrics of mood instability and impulsivity. We identified emerging evidence of a positive association between circadian rest-activity pattern disturbance and delayed sleep timing with both mood instability and impulsivity. Evidence for an association with sleep duration, sleep efficiency or sleep quality was inconsistent. Future research should focus on longitudinal intra-individual associations to establish the directionality between these measures and may lead to the development of chronotherapeutic interventions for a number of psychiatric disorders.
Collapse
Affiliation(s)
- George Gillett
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AB, United Kingdom; Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Gareth Watson
- Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
| | - Kate Ea Saunders
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, United Kingdom; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, United Kingdom
| | - Niall M McGowan
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, United Kingdom; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, United Kingdom
| |
Collapse
|
49
|
Guerriero G, Wartenberg C, Bernhardsson S, Gunnarsson S, Ioannou M, Liljedahl SI, Magnusson K, Svanberg T, Steingrimsson S. Efficacy of transcutaneous vagus nerve stimulation as treatment for depression: A systematic review. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
50
|
Out-patient triple chronotherapy for the rapid treatment and maintenance of response in depression: feasibility and pilot randomised controlled trial. BJPsych Open 2021. [PMCID: PMC8693902 DOI: 10.1192/bjo.2021.1044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Triple chronotherapy (sleep deprivation for 36 h, followed by 4 days of advancing the time of sleep and daily morning bright-light therapy for 6 months) has demonstrated benefits for the rapid treatment of depressive symptoms in four small controlled trials of in-patients. Aims To test the feasibility of recruitment and delivery of triple chronotherapy for out-patients with depression (ISRCTN17706836; NCT03405493). Method In a single-blind trial, 82 participants were randomised to triple chronotherapy or a control intervention. The primary outcome was the number of participants recruited per month and adherence to the protocol. Secondary outcomes included the 6-item Hamilton Rating Scale for Depression (HRSD-6) at 1 week. Timings of observer ratings were baseline and 1, 2, 4, 8 and 26 weeks after randomisation. Results The triple chronotherapy group stayed awake for the planned 36 h and 89.9% adhered to the plan of phase advance of their sleep over the following 4 days. We achieved our recruitment target (60 participants completed the trial within 13 months). There were no reported adverse side-effects. We found a significant difference between the groups by intention-to-treat analysis for the HRSD-6 at weeks 1, 8 and 26. There was a large effect size of Cohen's d = 0.8 on HRSD-6 score at week 1, increasing to d = 1.30 at week 26. A response (≥50% reduction in symptoms) was achieved by 33.3% in the triple chronotherapy group and 16.2% in the control group. This stayed relatively steady until week 26 (35.9 v. 13.9%). Conclusions Triple chronotherapy produced a significant and rapid benefit after 1 week in out-patients with depression that was sustained at 26 weeks. Cost-effectiveness trials with a larger clinical sample are required.
Collapse
|