Palagini Laura, Miniati Mario, Marazziti Donatella, Massa Lucia, Grassi Luigi, Geoffroy Pierre A
Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa; Azienda Ospedaliera Universitaria Pisana (AUOP), Pisa, Italy.
Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.
Clin Neuropsychiatry. 2022 Jun;19(3):174-186. doi: 10.36131/cnfioritieditore20220306.
The study aimed to investigate the possible impact of resilience and emotion dysregulation on the clinical manifestations of bipolar disorders (BDs) focusing on the possible role of circadian rhythm alterations.
A sample of 197 inpatients suffering from BD of type I (BDI) or II (BDII) were assessed during a major depressive episode using the Structural Clinical Interview for DSM-5 (SCID-5), the Beck Depression Inventory-II (BDI-II), the Young Mania Rating Scale (YMRS), Resilience Scale for Adults (RSA), Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN), Difficulties in Emotion Regulation Scale (DERS) and the Scale for Suicide Ideation (SSI). Participants with or without circadian rhythm disturbances as measured with Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN), were compared; regression and mediation analyses were computed.
Participants with circadian rhythms disturbances showed a greater severity of depressive symptoms, of suicidal risk, lower resilience and more disturbances in emotion regulation including impulsivity and regulatory strategies. The logistic regression revealed that circadian rhythm disturbances was related to depressive symptoms (O.R. 4.0), suicidal risk (OR 2.51), emotion dysregulation (OR 2.28) and low resilience (OR 2.72). At the mediation analyses, circadian rhythm alterations showed an indirect effect on depressive symptoms by impairing resilience (Z= 3.17, p=0.0014)/ emotional regulation (Z= 4.36, p<0.001) and on suicidal risk by affecting resilience (Z= 2.00, p=0.045) and favoring impulsivity (Z= 2.14, p=0.032).
The present findings may show that circadian rhythm alterations might play a key role in BD manifestations, as being correlated with more severe clinical presentations of depressive symptoms, suicidal risk, impaired resilience and emotional regulation. Addressing circadian rhythm alterations might potentially promote resilience and emotion regulation hence improving mood symptoms and suicidal risk in BDs.
本研究旨在探讨心理弹性和情绪调节障碍对双相情感障碍（BD）临床表现的可能影响，重点关注昼夜节律改变的可能作用。
使用《精神疾病诊断与统计手册》第5版结构性临床访谈（SCID - 5）、贝克抑郁量表第二版（BDI - II）、杨氏躁狂评定量表（YMRS）、成人心理弹性量表（RSA）、神经精神病学评估中的生物节律访谈（BRIAN）、情绪调节困难量表（DERS）和自杀意念量表（SSI），对197名患有I型双相情感障碍（BDI）或II型双相情感障碍（BDII）的住院患者在重度抑郁发作期间进行评估。比较经神经精神病学评估中的生物节律访谈（BRIAN）测量有或无昼夜节律紊乱的参与者；进行回归分析和中介分析。
有昼夜节律紊乱的参与者表现出更严重的抑郁症状、自杀风险、较低的心理弹性以及更多的情绪调节障碍，包括冲动性和调节策略。逻辑回归显示，昼夜节律紊乱与抑郁症状（优势比4.0）、自杀风险（优势比2.51）、情绪调节障碍（优势比2.28）和低心理弹性（优势比2.72）相关。在中介分析中，昼夜节律改变通过损害心理弹性（Z = 3.17，p = 0.0014）/情绪调节（Z = 4.36，p < 0.001）对抑郁症状产生间接影响，通过影响心理弹性（Z = 2.00，p = 0.045）和促进冲动性（Z = 2.14，p = 0.032）对自杀风险产生间接影响。
目前的研究结果可能表明，昼夜节律改变可能在双相情感障碍的表现中起关键作用，因为它与更严重的抑郁症状临床表现、自杀风险、受损的心理弹性和情绪调节相关。解决昼夜节律改变可能会潜在地促进心理弹性和情绪调节，从而改善双相情感障碍患者的情绪症状和自杀风险。
