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Acta Psychiatr Scand. 2016 Feb;133(2):102-108. doi: 10.1111/acps.12442. Epub 2015 May 22.

The association between biological rhythms, depression, and functioning in bipolar disorder: a large multi-center study.

Author information

1
Laboratory of Molecular Psychiatry, INCT for Translational Medicine - CNPq, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
2
Post Graduate Program in Medicine, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
3
MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada.
4
Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
5
Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, Catalonia, Spain.
6
Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
7
Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
8
Department of Pharmacology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

Abstract

OBJECTIVE:

We examined the relationship between biological rhythms and severity of depressive symptoms in subjects with bipolar disorder and the effects of biological rhythms alterations on functional impairment.

METHOD:

Bipolar patients (n = 260) and healthy controls (n = 191) were recruited from mood disorders programs in three sites (Spain, Brazil, and Canada). Parameters of biological rhythms were measured using the Biological Rhythms Assessment in Neuropsychiatry (BRIAN), an interviewer administered questionnaire that assesses disruptions in sleep, eating patterns, social rhythms, and general activity.

RESULTS:

Multivariate analyses of covariance showed significant intergroup differences after controlling for potential confounders (Pillai's F = 49.367; df = 2, P < 0.001). Depressed patients had the greatest biological rhythms disturbance, followed by patients with subsyndromal symptoms, euthymic patients, and healthy controls. Biological rhythms and HAMD scores were independent predictors of poor functioning (F = 12.841, df = 6, P < 0.001, R2  = 0.443).

CONCLUSION:

Our study shows a dose-dependent association between the severity of depressive symptoms and degree of biological rhythms disturbance. Biological rhythms disturbance was also an independent predictor of functional impairment. Although the directionality of this relationship remains unknown, our results suggest that stability of biological rhythms should be an important target of acute and long-term management of bipolar disorder and may aid in the improvement of functioning.

KEYWORDS:

biological rhythm; bipolar disorder; circadian rhythm; depression; functioning

PMID:
26010130
DOI:
10.1111/acps.12442

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