CHRONOBIOLOGICAL EVALUATION OF RAPID-CYCLING BIPOLAR DISORDER

快速循环型双相情感障碍(RCBD)患者至少经历过 四种情感性疾病(抑郁、轻躁狂和/或躁狂) 并且经常对常规治疗产生抗药性。 而双相情感障碍患者的性别比例是1：1， 双相情感障碍女性比双相情感障碍男性高三倍 快速自行车赛道。因此，这种疾病值得研究，因为 它的显著发病率，因为它可以提供关于 性别对双相情感障碍病程的影响。此外，由于 快速骑自行车的患者会经历频繁的情绪变化， 伴随着睡眠-觉醒周期的戏剧性变化，它们是 在有趣的人群中研究睡眠与睡眠、 昼夜节律和情绪紊乱。这个项目由三个部分组成 RCBD的时间生物学研究：(1)横断面研究 处于抑郁和低躁狂状态的患者；(2)强化治疗 少数患者的纵向研究；(3)收集 关于所有人的自然主义纵向数据(情绪评级和睡眠记录) 我们RCBD诊所的患者。 在横断面研究中，患者被送往医院接受治疗 一次简短、密集的时间生物学评估后不久 切换到轻躁狂症，并在他们切换到不久之后 抑郁症。每次住院时间为48小时， 由20个小时的“自然主义的一天”组成，在这一天中，患者睡眠和 随意进食，并坚持28小时不变的作息。不变的例程是 旨在将光线、睡眠、活动和卡路里的影响降至最低 增加了病人的昼夜节律。在住院期间， 患者佩戴直肠温度探头和活动监测器，睡眠 由脑电波监测，血液每30分钟通过 留置静脉导管。血液样本被用来测量 褪黑激素、促甲状腺激素、皮质醇、催乳素和生长激素。数据来自 最初的10名患者表示，有一种趋势，即 褪黑激素分泌和平稳皮质醇节律的最大值是 与低躁狂相比，低躁狂的相位提前(提前移位) 情绪低落，阶段。我们目前正在扩大这项研究的样本 看看这些发现是否达到了统计学意义。 除了这项横断面研究外，我们正在进行密集的 褪黑激素昼夜节律、温度、 并在几个RCBD患者中进行睡眠。这些研究使我们能够 更详细地理解这些节奏与 病人的情绪状态。最后，我们积累了大量的 自然主义的数据集，使我们能够展示昼夜节律 RCBD患者情绪转换方向的节律，并 探索以前的睡眠(睡眠持续时间、睡眠次数)之间的关系 睡眠和醒来)和情绪。

Patients with rapid-cycling bipolar disorder (RCBD) experience at least four episodes of affective illness (depression, hypomania, and/or mania) in a year and are frequently resistant to conventional treatments. Whereas the gender ratio among patients with bipolar illness is 1:1, bipolar women are three times more likely than bipolar men to develop a rapid-cycling course. Therefore, this illness warrants study because of its significant morbidity and because it can yield information about the effects of gender on the course of bipolar disorder. In addition, since rapid-cycling patients experience frequent mood shifts that are accompanied by dramatic changes in the sleep-wake cycle, they are an interesting population in which to study the relationships between sleep, circadian rhythms, and mood disorders. This project consists of three studies of the chronobiology of RCBD: (1) a cross-sectional study of patients in the depressed and hypomanic states; (2) an intensive longitudinal study of a small number of patients; and (3) the collection of naturalistic longitudinal data (mood ratings and sleep logs) on all patients in our RCBD clinic. In the cross-sectional study, patients are admitted to the hospital for brief, intensive chronobiological evaluations once shortly after they switch into hypomania, and once shortly after they switch into depression. The hospitalizations are each 48 hours in duration and consist of a 20-hour "naturalistic day", during which patients sleep and eat ad lib, 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, sleep is monitored by EEG, and blood is withdrawn every thirty minutes through an indwelling intravenous catheter. Blood samples are used to measure melatonin, TSH, cortisol, prolactin, and growth hormone. Data from the first ten patients indicate that there is a trend such that the onset of melatonin secretion and the maximum of the smoothed cortisol rhythm are phase-advanced (shifted earlier) in the hypomanic, compared to the depressed, phase. We are currently expanding the sample in this study to see if these findings reach statistical significance. In addition to this cross-sectional study, we are conducting intensive longitudinal studies of the circadian rhythms of melatonin, temperature, and sleep in several patients with RCBD. These studies allow us to understand in greater detail the relationship between these rhythms and the patients' mood states. Finally, we have accumulated a large naturalistic data set that has allowed us to demonstrate a circadian rhythm in the direction of mood switches in patients with RCBD, and to explore the relationship between prior sleep (sleep duration, times of sleep and wake onset) and mood.