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: 3845392
• 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/3845392
• 关键词: bipolar depression; body physical activity; body temperature; circadian rhythms; cortisol; female; human subject; human therapy evaluation; leuprolide; luteinizing hormone; melatonin; menstrual cycle; pathologic process; phototherapy; sleep; 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 During the hospitalizations, patients wear rectal temperature probes and activity monitors, and blood is withdrawn every twenty minutes through an indwelling intravenous catheter.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.

快速循环型双相情感障碍患者至少经历四次 情感性疾病（抑郁、轻躁狂和/或躁狂）的发作， 一年，并经常抵抗传统的治疗。 因此，我们认为， 这种精神疾病值得进一步研究，因为它 严重的发病率。 此外，由于快速循环患者 经历频繁的情绪变化，伴随着戏剧性的变化 在睡眠-觉醒周期中，它们提供了一个很有希望的研究机会， 睡眠活动和情绪障碍之间的关系。 这 该项目研究了快速循环患者的昼夜节律， 这是一系列计划研究中的第一项，旨在阐明 快速循环双相情感障碍的病因学，并测试几个 实验性治疗 在目前的研究中，快速循环患者记录他们的情绪和睡眠 在很长一段时间内每天都有。 此外，由于 大多数快速循环患者是绝经前妇女，我们 尤其是对月经周期和 和快速骑车女性的情感状态。 每个月，女性 受试者记录她们的月经周期并监测她们的尿液， 排卵LH峰 所有患者，男性和女性，间歇性 在门诊时佩戴体温和活动监测器。 病人被允许到医院进行短暂的，密集的 在研究过程中进行两次时间生物学评价：一次 在他们进入轻躁狂状态后不久， 在他们进入抑郁状态后 住院治疗是 每一个48小时的持续时间，包括20小时的“自然日”， 一天28小时不间断的例行公事 常数程序的设计是为了最小化 光线、睡眠、活动和热量负荷对 患者的昼夜节律。 在住院期间，患者佩戴 直肠温度探头和活动监测器， 每隔20分钟通过留置静脉导管。 通过 分析温度数据并通过测量褪黑激素的分泌， 皮质醇和其他激素，我们将有广泛的信息， 快速循环双相患者的昼夜节律，以及如何 这些节律在抑郁和轻躁狂状态下是不同的。 因为 项目尚处于早期阶段，目前尚未取得成果。 其他项目的病理生理学和治疗的快速循环是 目前正在规划中。 这些试验包括L-甲状腺素和光明 光在治疗快速循环，并使用亮丙瑞林的协议 醋酸，一种GnRH激动剂，探索性腺类固醇在快速生长中的作用 骑自行车的女人