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EBioMedicine. 2016 Sep;11:285-295. doi: 10.1016/j.ebiom.2016.08.019. Epub 2016 Aug 13.

Advanced Circadian Phase in Mania and Delayed Circadian Phase in Mixed Mania and Depression Returned to Normal after Treatment of Bipolar Disorder.

Author information

1
Dept. of Psychiatry, Korea Univ. College of Medicine, Seoul, South Korea; Dept. of Biomedical Sciences, Korea Univ. College of Medicine, Seoul, South Korea.
2
Dept. of Psychiatry, Korea Univ. College of Medicine, Seoul, South Korea.
3
Dept. of Legal Medicine, Korea Univ. College of Medicine, South Korea.
4
Dept. of Biomedical Sciences, Korea Univ. College of Medicine, Seoul, South Korea.
5
Dept. of Brain and Cognitive Science, Ewha Womans Univ., Seoul, South Korea.
6
Dept. of Anatomy, Korea Univ. College of Medicine, Seoul, South Korea.
7
Dept. of Psychiatry, School of Medicine, Gachon Univ., Incheon, South Korea.
8
Dept. of Psychiatry, Inje Univ. College of Medicine, Ilsan, South Korea.
9
Dept. of Biostatistics, Korea Univ. College of Medicine, Seoul, South Korea.
10
Dept. of Psychiatry, University of California, San Diego, CA, USA.
11
Dept. of Psychiatry, Korea Univ. College of Medicine, Seoul, South Korea; Dept. of Biomedical Sciences, Korea Univ. College of Medicine, Seoul, South Korea. Electronic address: leehjeong@korea.ac.kr.

Abstract

Disturbances in circadian rhythms have been suggested as a possible cause of bipolar disorder (BD). Included in this study were 31 mood episodes of 26 BD patients, and 18 controls. Circadian rhythms of BD were evaluated at admission, at 2-week intervals during hospitalization, and at discharge. All participants wore wrist actigraphs during the studies. Saliva and buccal cells were obtained at 8:00, 11:00, 15:00, 19:00, and 23:00 for two consecutive days. Collected saliva and buccal cells were used for analysis of the cortisol and gene circadian rhythm, respectively. Circadian rhythms had different phases during acute mood episodes of BD compared to recovered states. In 23 acute manic episodes, circadian phases were ~7hour advanced (equivalent to ~17hour delayed). Phases of 21 out of these 23 cases returned to normal by ~7hour delay along with treatment, but two out of 23 cases returned to normal by ~17hour advance. In three cases of mixed manic episodes, the phases were ~6-7hour delayed. For five cases of depressive episodes, circadian rhythms phases were ~4-5hour delayed. After treatment, circadian phases resembled those of healthy controls. Circadian misalignment due to circadian rhythm phase shifts might be a pathophysiological mechanism of BD.

KEYWORDS:

Bipolar disorders; Circadian dysregulation; Circadian rhythm; Phase shift

PMID:
27543154
PMCID:
PMC5049992
DOI:
10.1016/j.ebiom.2016.08.019
[Indexed for MEDLINE]
Free PMC Article

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