Desynchronization of diurnal rhythms in bipolar disorder and borderline personality disorder

Oliver Carr,Maarten De Vos,Guy M Goodwin,Athanasios Tsanas,Russell Foster,Kate E A Saunders,John R Geddes,Niclas Palmius,Amy C Bilderbeck

doi:10.1038/s41398-018-0125-7

Abstract

It has long been proposed that diurnal rhythms are disturbed in bipolar disorder (BD). Such changes are obvious in episodes of mania or depression. However, detailed study of patients between episodes has been rare and comparison with other psychiatric disorders rarer still. Our hypothesis was that evidence for desynchronization of diurnal rhythms would be evident in BD and that we could test the specificity of any effect by studying borderline personality disorder (BPD). Individuals with BD (n = 36), BPD (n = 22) and healthy volunteers (HC, n = 25) wore a portable heart rate and actigraphy device and used a smart-phone to record self-assessed mood scores 10 times per day for 1 week. Average diurnal patterns of heart rate (HR), activity and sleep were compared within and across groups. Desynchronization in the phase of diurnal rhythms of HR compared with activity were found in BPD (+3 h) and BD (+1 h), but not in HC. A clear diurnal pattern for positive mood was found in all subject groups. The coherence between negative and irritable mood and HR showed a four-cycle per day component in BD and BPD, which was not present in HC. The findings highlight marked de-synchronisation of measured diurnal function in both BD but particularly BPD and suggest an increased association with negative and irritable mood at ultradian frequencies. These findings enhance our understanding of the underlying physiological changes associated with BPD and BD, and suggest objective markers for monitoring and potential treatment targets. Improved mood stabilisation is a translational objective for management of both patient groups.

Highlights

Introduction Human biology is circadianThe central oscillator or clock in the suprachiasmatic nucleus of the brain has a harmonic cycle of about 24 h and a sleep homeostat overlays the clock
Participants diagnosed with bipolar disorder (BD) or borderline personality disorder (BPD) and healthy controls were recruited for the study through previous studies, local advertising and word-of-mouth
The phase of diurnal variation in heart rate (HR) is delayed relative to peak activity in BPD and BD (1 h), and for sleep 2 h in BPD and not in BD

Summary

Introduction

Introduction Human biology is circadianThe central oscillator or clock in the suprachiasmatic nucleus of the brain has a harmonic cycle of about 24 h and a sleep homeostat overlays the clock. The relationship between mood and diurnal function is of particular interest when patients are apparently well, because abnormal sensitivity to different aspects of sleep or the circadian cycle might explain why patients with BD show persistent mood instability in euthymia or have the potential to decompensate into mania or depression[5]. It is when patients are well and between episodes that interventions to stabilise mood must be developed and deployed

Methods

Results

Discussion

Conclusion