EVALUATION AND TREATMENT OF RAPID-CYCLING BIPOLAR DISORDER

快循环双相情感障碍的评估和治疗

• 批准号: 3781488
• 负责人: E LEIBENLUFT
• 金额: --
• 依托单位: NATIONAL INSTITUTE OF MENTAL HEALTH
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/3781488
• 关键词: bipolar depression; bipolar depression manic phase; blood chemistry; body temperature; circadian rhythms; cortisol; electroencephalography; female; gender difference; hormone metabolism; human subject; human therapy evaluation; leuprolide; luteinizing hormone; male; melatonin; menopause; mood disorders; patient monitoring device; phototherapy; sleep; thyrotropin; thyroxine

Patients with rapid cycling bipolar disorder experience at least four episodes of affective illness (depression, hypomania, and/or mania) in a year and are frequently resistant to conventional treatments. Therefore, this psychiatric illness warrants further study because of its significant morbidity. In addition, since rapid cycling patients experience frequent mood shifts that are accompanied by dramatic changes in the sleep-wake cycle, they present a promising opportunity to study the relationships between sleep activity, and mood disorders. This project studies the circadian rhythms of rapid cycling patients and is the first in a series of planned studies designed to elucidate the etiology of rapid cycling bipolar disorder and to test several experimental treatments. In the current study, rapid cycling patients record their mood and sleep on a daily basis over an extended period of time. In addition, since the majority of rapid cycling patients are premenopausal women, we are particularly interested in the relationship between the menstrual cycle and the affective state of rapid cycling women. Each month, female subjects record their menstrual cycles and monitor their urine for the ovulatory LH surge. All patients, both male and female, intermittently wear temperature and activity monitors on an outpatient basis. Patients are admitted to the hospital for brief, intensive chronobiological evaluations twice in the course of the study: once shortly after they switch into the hypomanic state, and once shortly after they switch into the depressive state. The hospitalizations are each 48 hours in duration and consist of a 20-hour "naturalistic day" and a 28-hour constant routine. The constant routine is designed to minimize the effects of light, sleep, activity, and caloric loading on the patient's circadian rhythms. During the hospitalizations, patients wear rectal temperature probes and activity monitors, and blood is withdrawn every twenty minutes through an indwelling intravenous catheter. By analyzing temperature data and by measuring the secretion of melatonin, cortisol, and other hormones, we will have extensive information about the circadian rhythms of rapid cycling bipolar patients, and about how those rhythms differ in the depressed and hypomanic states. Because the project is in its early stages, results are not available at this time. Other projects on the pathophysiology and treatment of rapid cycling are currently being planned. These include trials of L-thyroxine and bright light in the treatment of rapid cycling, and a protocol using Leuprolide acetate, a GnRH agonist, to explore the role of gonadal steroids in rapid cycling in women.

患有快速循环双相情感障碍的患者至少经历了四次 情感性疾病(抑郁、轻躁狂和/或躁狂)的发作 而且经常对常规治疗有抵抗力。因此， 这种精神疾病值得进一步研究，因为它 严重的发病率。此外，由于快速骑自行车的患者 体验伴随着戏剧性变化的频繁情绪变化 在睡眠-觉醒循环中，它们提供了一个很有希望的机会来研究 睡眠活动与情绪障碍之间的关系。这 项目研究快速循环患者和IS的昼夜节律 这是一系列计划研究中的第一项，旨在阐明 快速循环型双相情感障碍的病因学及检测 实验性治疗。 在目前的研究中，快速骑自行车的患者记录他们的情绪和睡眠 在一段较长的时间内每天都是如此。此外，由于 大多数快速自行车患者是绝经前妇女，我们是 对月经周期之间的关系特别感兴趣 以及快速骑自行车的女性的情感状态。每个月，女性 受试者记录他们的月经周期，并监测他们的尿液中 排卵期黄体生成素激增。所有患者，包括男性和女性，间歇性地 门诊时佩戴体温和活动监测器。 病人被送进医院进行简短的、密集的治疗 在研究过程中进行两次时间生物学评估：一次 在他们转换到低躁狂状态后不久，有一次很快 在他们转换到抑郁状态之后。住院治疗是 每个48小时的持续时间，由20个小时的“自然主义日”和 28小时不变的例行公事。常量例程旨在最小化 光照、睡眠、运动和卡路里负荷对 病人的昼夜节律。在住院期间，病人穿着 直肠温度探头和活动监测器，抽血 每隔20分钟通过静脉留置导管。通过 通过分析温度数据和测量褪黑激素的分泌， 皮质醇和其他激素，我们将有关于 快速循环双相情感障碍患者的昼夜节律，以及如何 这些节奏在抑郁和轻度躁狂状态下是不同的。因为 该项目还处于早期阶段，目前还没有结果。 关于快速自行车的病理生理学和治疗的其他项目有 目前正在计划中。这些试验包括L-甲状腺素和光明 光在治疗快速循环中的作用，以及使用亮丙瑞林的方案 促性腺激素释放激素激动剂乙酸酯探讨性腺类固醇在快速反应中的作用 骑自行车的是女人。