Optimisation Thérapeutique en Neuropsychopharmacologie, INSERM U1144, Université Paris Cité, Paris, France; AP-HP Nord, GH Saint-Louis-Lariboisière-Fernand-Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, Paris, France; Université Paris Cité, Paris, France.
Optimisation Thérapeutique en Neuropsychopharmacologie, INSERM U1144, Université Paris Cité, Paris, France; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK.
Compr Psychiatry. 2024 Nov;135:152531. doi: 10.1016/j.comppsych.2024.152531. Epub 2024 Sep 20.
Bipolar Disorder (BD) is associated with alterations of circadian rhythms of activity (CRA). Experimental research suggests that lithium (Li) modifies CRA, but this has been rarely explored in BD using actigraphy.
The sample comprised 88 euthymic BD-I cases with 3 weeks of actigraphy. We used a Principal Component Analysis (PCA) to generate CRA dimensions. We then used linear regression analyses to compare these dimensions between groups of individuals defined according to prescribed mood stabilizers: Li monotherapy ("Li" group, n = 28), anticonvulsant or atypical antipsychotic monotherapy ("AC or AAP" group, n = 27) or combined treatments ("Li+AC or Li+AAP" group, n = 33). Analyses were adjusted for potential confounders (gender, age, body mass index, depressive symptoms, co-prescribed benzodiazepines and antidepressants, smoking status and past alcohol use disorder).
The PCA identified two dimensions: "robust CRA" (high amplitude and interdaily stability, with low intradaily variability) and "late chronotype". Univariate analyses showed higher scores for "robust CRA" in the "Li" versus the "AC or AAP" (p = 0.021) or "Li+AC or Li+AAP" groups (p = 0.047). These findings remained significant after adjustments (respectively p = 0.010 and p = 0.019). Post-hoc analyses suggested lower variability, higher stability and higher amplitude of CRA in the "Li" group. Medication groups were similar for the "late chronotype" dimension (p = 0.92).
This actigraphy study is the first to show more favorable CRA in BD-I individuals receiving a Li monotherapy when compared with those receiving other classes or combinations of mood stabilizers. Replications in larger samples are required. Prospective studies are also warranted to elucidate whether the introduction of Li or other mood stabilizers might influence CRA in BD-I.
双相情感障碍（BD）与活动的昼夜节律变化有关（CRA）。实验研究表明，锂（Li）可改变 CRA，但在使用活动记录仪的 BD 中很少对此进行探索。
样本包括 88 名处于缓解期的 BD-I 患者，进行了 3 周的活动记录仪监测。我们使用主成分分析（PCA）生成 CRA 维度。然后，我们使用线性回归分析比较了根据规定的心境稳定剂分组的个体之间的这些维度：Li 单药治疗（“Li”组，n=28）、抗惊厥药或非典型抗精神病药单药治疗（“AC 或 AAP”组，n=27）或联合治疗（“Li+AC 或 Li+AAP”组，n=33）。分析调整了潜在混杂因素（性别、年龄、体重指数、抑郁症状、同时处方的苯二氮䓬类药物和抗抑郁药、吸烟状况和过去的酒精使用障碍）。
PCA 确定了两个维度：“稳健的 CRA”（高振幅和日间稳定性，日内变异性低）和“晚型”。单变量分析显示，与“AC 或 AAP”（p=0.021）或“Li+AC 或 Li+AAP”组（p=0.047）相比，“Li”组的“稳健的 CRA”得分更高。调整后这些发现仍然具有统计学意义（分别为 p=0.010 和 p=0.019）。事后分析表明，“Li”组的 CRA 变异性更低、稳定性更高、振幅更高。药物组在“晚型”维度上相似（p=0.92）。
这项活动记录仪研究首次表明，与接受其他类别或联合心境稳定剂治疗的 BD-I 个体相比，接受 Li 单药治疗的 BD-I 个体的 CRA 更有利。需要在更大的样本中进行复制。前瞻性研究也需要阐明 Li 或其他心境稳定剂的引入是否会影响 BD-I 中的 CRA。
