Abstract
BackgroundBiological rhythm disturbance is common in bipolar patients and seems to affect the course and prognosis of the illness negatively. The main aim of the current study was to assess biological rhythms in remitted bipolar patients. We also assessed whether there was an association between clinical variables or functioning and biological rhythms in remitted bipolar participants.MethodsThe Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) was used to assess biological rhythm disturbance. It is an 18-item interviewer-administered instrument which allows us to investigate the main areas related to circadian rhythm disturbance (sleep/social, activities, and eating pattern) in bipolar disorder.Results and discussionBipolar patients (n = 107) experienced greater biological rhythm alterations than the control group (n = 100) (BRIAN total scores 35.36 ± 7.11 vs. 32.48 ± 6.10, t = 6.912, p = 0.002, Cohen's d = 0.43, r = 0.21). In particular, patients were more impaired than the control group with regard to sleep/social (14.67 ± 4.14 vs. 13.49 ± 2.91, t = 10.61, p = 0.018, Cohen's d = 0.33, r = 0.16) and activity (8.49 ± 2.51 vs. 7.07 ± 2.13, t = 3.90, p = 0.001, Cohen's d = 0.61, r = 0.29) domains. Furthermore, a significant correlation was found between biological rhythms with residual depressive symptoms (r = 0.459, p < 0.001) and functioning (r = 0.432, p < 0.001). These findings suggest a potential link between biological rhythms and the pathophysiology of bipolar disorder. It highlights the importance of novel instruments (e.g., BRIAN) which allow us to assess biological rhythm disturbance in psychiatry. Finally, specific psychosocial interventions focused on lifestyle regularity may be considered as a supplemental treatment of bipolar illness episodes.Electronic supplementary materialThe online version of this article (doi:10.1186/2194-7511-1-6) contains supplementary material, which is available to authorized users.
Highlights
Biological rhythm disturbance is common in bipolar patients and seems to affect the course and prognosis of the illness negatively
Instruments Biological rhythms interview of assessment in neuropsychiatry The Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) was developed by the Bipolar Disorder Program at the Hospital de Clínicas de Porto Alegre, Brazil, taking into account the main difficulties associated with rhythm disturbance in psychiatric patients, especially patients with bipolar disorder
The patients were more impaired than the control group with regard to sleep/ social (14.67 ± 4.14 vs. 13.49 ± 2.91, t = 10.61, p = 0.018, Cohen's d = 0.33, r = 0.16) and activity domains of the BRIAN (8.49 ± 2.51 vs. 7.07 ± 2.13, t = 3.90, p < 0.001, Cohen's d = 0.61, r = 0.29)
Summary
Biological rhythm disturbance is common in bipolar patients and seems to affect the course and prognosis of the illness negatively. There is a decreased need for sleep during manic episodes, whereas insomnia and hypersomnia are presumably found in depression (American Psychiatric Association 1994) Other biological rhythms, such as the daily profiles of body temperature, cortisol, thyrotropin, prolactin, growth. The social zeitgeber theory suggests that irregular circadian rhythms lead to mood episodes in vulnerable individuals (Grandin et al 2006). Consistent with this concept, biological rhythm alterations have been associated with mood symptoms and, with increased risk of relapses in bipolar disorder (Frank et al 2006; Gruber et al 2011). Treatments based on biological rhythm stability as well as control exposure to environmental stimuli (e.g., light) may have therapeutic effects on illness episodes (Dallaspezia and Benedetti 2011; Heiler et al 2011)
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