Role of biological rhythm dysfunction in the development and management of bipolar disorders: a review

Chen, Yiming; Wu, Hong; Fang, Yiru

doi:10.1136/gpsych-2019-100127

Cited by 10 publications

(6 citation statements)

References 93 publications

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“…Bipolar disorder (BD) is a recrudescent mood disorder with episodes of depression and mania [ 1 , 2 ]. It is often associated with significant impairment in cognitive functioning, circadian rhythm abnormalities, decreased quality of life, and reduced life expectancy [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…It is often associated with significant impairment in cognitive functioning, circadian rhythm abnormalities, decreased quality of life, and reduced life expectancy [ 3 , 4 ]. One of the central features in BD is sleep disturbance [ 1 , 5 ], with anxiety disorder being among the most highly prevalent comorbidities. Unfortunately, comorbid anxiety disorders are linked to more affective relapses, increased suicidality, sleep disturbances, and increased barriers to effective treatment [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Short- and Long-Term Influences of Benzodiazepine and Z-Drug Use in Patients with Bipolar Disorder Combined Sleep Disturbance during Affective Period: A Nine-Month Follow-Up Analysis

et al. 2022

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Background. Sleep disturbances and benzodiazepine (BZD)/Z-drug use are common in patients with bipolar disorder (BD). Objective. To investigate the short- and long-term effects of BZD/Z-drug use during acute affective episode. Methods. Participants diagnosed with BD as well as sleep disturbance chose BZDs/Z-drugs or not at will. Manic and depressive symptoms were assessed by Mental Disorders Questionnaire (MDQ) and Quick Inventory of Depressive Symptoms (QIDS) as self-reporting surveys. The participants were assessed by trained evaluators at baseline and months 1, 3, 6, and 9. Results. 61 patients with BD combined sleep disturbances were studied. At baseline, patients who used BZDs/Z-drugs had more amount of mood stabilizers ( p = 0.038 ), other psychotropic medications ( p = 0.040 ), and more risk of suicide attempt ( p = 0.019 ). The BZD/Z-drug group had a significantly higher QIDS reductive ratio as compared with the no BZD/Z-drug group at month 1; no significant differences in the variability of MDQ, QIDS reductive ratio, or recurrence rate were found between these two groups at baseline, month 1, month 3, month 6, or month 9. Conclusions. During acute affective episode, patients with BD combined sleep disturbance who took BZDs/Z-drugs tended to use more amount of mood stabilizers. Polytherapy of BZDs/Z-drugs or other psychiatric drugs could increase suicide attempt during an acute affective episode. BZD/Z-drug use, however, had a significant effect on helping depressive symptoms alleviate during affective period.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Short- and Long-Term Influences of Benzodiazepine and Z-Drug Use in Patients with Bipolar Disorder Combined Sleep Disturbance during Affective Period: A Nine-Month Follow-Up Analysis

et al. 2022

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“…In this sense, the available evidence on circadian rhythmicity in psychiatric conditions without SUD is limited and heterogeneous, indicating disruptions in prodromal phases in patients without medication [ 19 , 20 ] and in those with remission symptoms or in a sustained withdrawal phase [ 15 , 21 , 22 , 23 ]. All of this evidence suggests that circadian alterations could not only be symptoms but a significant clinical characteristic that affects the appearance and development of SMI [ 24 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

Circadian Characteristics in Patients under Treatment for Substance Use Disorders and Severe Mental Illness (Schizophrenia, Major Depression and Bipolar Disorder)

Serrano-Serrano

Marquez-Arrico

Navarro

et al. 2021

JCM

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Dual disorders (substance use and mental illness comorbidity) are a condition that has been strongly associated with severe symptomatology and clinical complications. The study of circadian characteristics in patients with Severe Mental Illness or Substance Use Disorder (SUD) has shown that such variables are related with mood symptoms and worse recovery. In absence of studies about circadian characteristics in patients with dual disorders we examined a sample of 114 male participants with SUD and comorbid Schizophrenia (SZ+; n = 38), Bipolar Disorder (BD+; n = 36) and Major Depressive Disorder (MDD+; n = 40). The possible differences in the sample of patients according to their psychiatric diagnosis, circadian functioning with recordings of distal skin temperature during 48 h (Thermochron iButton®), circadian typology and sleep-wake schedules were explored. MDD+ patients were more morning-type, while SZ+ and BD+ had an intermediate-type; the morning-type was more frequent among participants under inpatient SUD treatment. SZ+ patients had the highest amount of sleeping hours, lowest arousal and highest drowsiness followed by BD+ and MDD+, respectively. These observed differences suggest that treatment for patients with dual disorders could include chronobiological strategies to help them synchronize patterns with the day-light cycle, since morning-type is associated with better outcomes and recovery.

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“…Patients with bipolar disorder frequently experience hypersomnia ( 132 , 133 ), and disruption of circadian rhythms, which are thought to be fundamental contributors to bipolar disorder onset and progression ( 22 , 23 ). Sleep abnormalities in bipolar disorder vary between acute depressive and manic episodes ( 134 ). During depressive episodes, patients generally have increased total sleep time and time in bed but lower sleep efficiency, while manic episodes are characterized by reduced sleep time and increased rapid eye movement (REM) sleep, also with lower sleep efficiency ( 135 ).…”

Section: Sleep Disorders and Disruption Of Circadian Rhythms In Bipol...mentioning

confidence: 99%

Sleep, mood disorders, and the ketogenic diet: potential therapeutic targets for bipolar disorder and schizophrenia

Choi,

Kang,

Kim

et al. 2024

Front. Psychiatry

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Bipolar disorder and schizophrenia are serious psychiatric conditions that cause a significant reduction in quality of life and shortened life expectancy. Treatments including medications and psychosocial support exist, but many people with these disorders still struggle to participate in society and some are resistant to current therapies. Although the exact pathophysiology of bipolar disorder and schizophrenia remains unclear, increasing evidence supports the role of oxidative stress and redox dysregulation as underlying mechanisms. Oxidative stress is an imbalance between the production of reactive oxygen species generated by metabolic processes and antioxidant systems that can cause damage to lipids, proteins, and DNA. Sleep is a critical regulator of metabolic homeostasis and oxidative stress. Disruption of sleep and circadian rhythms contribute to the onset and progression of bipolar disorder and schizophrenia and these disorders often coexist with sleep disorders. Furthermore, sleep deprivation has been associated with increased oxidative stress and worsening mood symptoms. Dysfunctional brain metabolism can be improved by fatty acid derived ketones as the brain readily uses both ketones and glucose as fuel. Ketones have been helpful in many neurological disorders including epilepsy and Alzheimer’s disease. Recent clinical trials using the ketogenic diet suggest positive improvement in symptoms for bipolar disorder and schizophrenia as well. The improvement in psychiatric symptoms from the ketogenic diet is thought to be linked, in part, to restoration of mitochondrial function. These findings encourage further randomized controlled clinical trials, as well as biochemical and mechanistic investigation into the role of metabolism and sleep in psychiatric disorders. This narrative review seeks to clarify the intricate relationship between brain metabolism, sleep, and psychiatric disorders. The review will delve into the initial promising effects of the ketogenic diet on mood stability, examining evidence from both human and animal models of bipolar disorder and schizophrenia. The article concludes with a summary of the current state of affairs and encouragement for future research focused on the role of metabolism and sleep in mood disorders.

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Role of biological rhythm dysfunction in the development and management of bipolar disorders: a review

Cited by 10 publications

References 93 publications

Short- and Long-Term Influences of Benzodiazepine and Z-Drug Use in Patients with Bipolar Disorder Combined Sleep Disturbance during Affective Period: A Nine-Month Follow-Up Analysis

Short- and Long-Term Influences of Benzodiazepine and Z-Drug Use in Patients with Bipolar Disorder Combined Sleep Disturbance during Affective Period: A Nine-Month Follow-Up Analysis

Circadian Characteristics in Patients under Treatment for Substance Use Disorders and Severe Mental Illness (Schizophrenia, Major Depression and Bipolar Disorder)

Sleep, mood disorders, and the ketogenic diet: potential therapeutic targets for bipolar disorder and schizophrenia

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