Palagini Laura, Miniati Mario, Caruso Danila, Massa Lucia, Novi Martina, Pardini Francesco, Salarpi Gianluca, Pini Stefano, Marazziti Donatella, Etain Bruno, Riemann Dieter
Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa, Azienda Ospedaliera Universitaria Pisana (AUOP), Via Roma 67, 56100 Pisa, Italy.
Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa, Azienda Ospedaliera Universitaria Pisana (AUOP), Via Roma 67, 56100 Pisa, Italy.
J Affect Disord. 2020 Apr 1;266:263-272. doi: 10.1016/j.jad.2020.01.134. Epub 2020 Jan 22.
Bipolar disorders are complex disorders involving the interaction of multiple factors. Affective temperaments, insomnia, and chronobiological rhythms desynchronization may all contribute to bipolar disorder. Since there is a paucity of research examining this topic we aimed to study how they are interrelated and collectively associated with clinical features of bipolar disorder.
One-hundred patients with Bipolar Disorder type II depressive episode with and without mixed features were recruited and compared. Subjects were evaluated with SCID -5, the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN), the Insomnia Severity Index (ISI), and the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A) while evaluating depressive (Beck Depression Inventory-BDI-II) and manic (Young Mania Rating Scale-YMRS) symptoms. Logistic regression and mediation analyses were conducted.
Subjects with mixed features showed a higher scores in both insomnia and chronobiological rhythms scores. When considering affective temperaments not only depressive, cyclothymic and irritable temperaments predicted mood symptoms but also insomnia (depressive symptoms O.R. 4.17, p = 0.043) and chronobiological sleep de-synchronization (manic symptoms O.R. 8.69, p = 0.001). Insomnia symptoms and chronobiological alterations mediated the association between affective temperaments and mood symptoms.
the cross-sectional design limited any causal interpretation.
Subjects with mixed features showed a greater severity of insomnia and chronobiological rhythm de-synchronization compared to subjects without. Insomnia and chronobiological alterations may contribute to mood disorders together with affective temperaments in a complex interplay also mediating their effect on mood. Preventive strategies for bipolars should also act on the dysregulation of sleep and circadian rhythms.
双相情感障碍是涉及多种因素相互作用的复杂疾病。情感气质、失眠和生物钟节律失调都可能导致双相情感障碍。由于对该主题的研究较少，我们旨在研究它们之间的相互关系以及与双相情感障碍临床特征的共同关联。
招募了100例伴有或不伴有混合特征的II型双相情感障碍抑郁发作患者并进行比较。在评估抑郁（贝克抑郁量表-II，BDI-II）和躁狂（杨氏躁狂评定量表，YMRS）症状时，使用精神疾病诊断与统计手册第5版（SCID-5）、神经精神病学评估中的生物节律访谈（BRIAN）、失眠严重程度指数（ISI）以及孟菲斯、比萨、巴黎和圣地亚哥气质自评问卷（TEMPS-A）对受试者进行评估。进行了逻辑回归和中介分析。
具有混合特征的受试者在失眠和生物钟节律评分方面得分更高。在考虑情感气质时，不仅抑郁、环性心境和易怒气质可预测情绪症状，失眠（抑郁症状，比值比4.17，p = 0.043）和生物钟睡眠失调（躁狂症状，比值比8.69，p = 0.001）也可预测。失眠症状和生物钟改变介导了情感气质与情绪症状之间的关联。
横断面设计限制了任何因果解释。
与无混合特征的受试者相比，具有混合特征的受试者失眠和生物钟节律失调更为严重。失眠和生物钟改变可能与情感气质一起在复杂的相互作用中导致情绪障碍，也介导了它们对情绪的影响。双相情感障碍的预防策略也应针对睡眠和昼夜节律的失调。
