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Studies find stable sleep patterns and regular routines may improve outcomes in bipolar disorder
December 10, 2007Bipolar disorder, commonly known as manic-depressive disorder, is highly influenced by the circadian system - the body's internal clock - and a specific kind of psychotherapy may help decrease irregularities in the circadian system that can trigger key symptoms of bipolar disorder, according to a study presented today at the American College of Neuropsychopharmacology (ACNP) annual meeting. The results are important because they show for the first time that psychotherapy which focuses on practical lifestyle changes can ease the symptoms of bipolar disorder. Every year nearly six million American adults suffer from bipolar disorder, a brain disorder which causes severe shifts in mood, energy, and ability to function, according to the National Institute of Mental Health.
Maintaining a consistent sleep schedule and wake time can help balance the circadian system, which in turn can help people avoid nighttime sleeplessness or daytime exhaustion, which can increase the risk of new episodes of mania or depression. "Having already found that disruption in daily routines can make individuals with bipolar disorder vulnerable to new episodes of illness, we have now learned that working with patients to achieve and maintain regular social rhythms - including regular sleep patterns and adequate physical activity - will help to protect them against episodes of mania or depression," says Ellen Frank, Ph.D., clinical psychologist and professor of psychiatry and psychology at the University of Pittsburgh School of Medicine.
People with bipolar disorder tend to have extremely sensitive circadian systems, which makes it much more difficult for them to recover from disruptions in sleep and routine. In contrast, people without bipolar disorder generally recover fairly quickly if their systems are thrown off by a change in routine or loss of sleep and might even be temporarily energized by these alterations.
Frank studied 175 adult patients with bipolar disorder and compared the effects of two approaches when combined with a common medical treatment for bipolar disorder, usually lithium carbonate: the first was interpersonal and social rhythm therapy, in which patients use a self-monitoring instrument to record and monitor the regularity of their daily routines-for example, their sleep patterns, meal times and physical activity. The second approach involved an intensive clinical management paradigm focusing just on patients' mood symptoms and management of medication side effects.
The study found that patients who participated in interpersonal and social rhythm therapy in the earlier phases of the trial were able to go longer without a new episode of mania or depression than those who received clinical management.
Frank notes that many study participants had other medical and psychiatric conditions that also had important effects on their treatment outcomes. She adds that her study was conducted in an academic environment using highly trained therapists, so results from other settings might be different.
In a related study presented at the meeting, researchers studying circadian rhythms in mice found that the genes that regulate these rhythms also control the activity of neurons in the brain that utilize dopamine, a neurotransmitter implicated in motivation and emotion. Mice that are lacking some of the key circadian genes closely resemble bipolar patients in the manic state.
Lead researcher Colleen McClung, Ph.D., assistant professor of psychiatry at the University of Texas Southwest Medical Center, says these mice are the most well characterized animal models of human mania that have been described. Symptoms of mania include increased energy, activity, and restlessness; excessively good, euphoric mood; and poor judgment.
While there has long been an association between circadian rhythms and bipolar disorder, no studies have examined whether these rhythmic disruptions contribute to the symptoms associated with bipolar disorder. McClung says the findings of this study bring researchers one small step closer to discovering why bipolar disorder occurs at all, even though the study was done in mice, not humans, and that many more studies will be needed to discover a cure.
American College of Neuropsychopharmacology
Frank studied 175 adult patients with bipolar disorder and compared the effects of two approaches when combined with a common medical treatment for bipolar disorder, usually lithium carbonate: the first was interpersonal and social rhythm therapy, in which patients use a self-monitoring instrument to record and monitor the regularity of their daily routines-for example, their sleep patterns, meal times and physical activity. The second approach involved an intensive clinical management paradigm focusing just on patients' mood symptoms and management of medication side effects.
The study found that patients who participated in interpersonal and social rhythm therapy in the earlier phases of the trial were able to go longer without a new episode of mania or depression than those who received clinical management.
Frank notes that many study participants had other medical and psychiatric conditions that also had important effects on their treatment outcomes. She adds that her study was conducted in an academic environment using highly trained therapists, so results from other settings might be different.
In a related study presented at the meeting, researchers studying circadian rhythms in mice found that the genes that regulate these rhythms also control the activity of neurons in the brain that utilize dopamine, a neurotransmitter implicated in motivation and emotion. Mice that are lacking some of the key circadian genes closely resemble bipolar patients in the manic state.
Lead researcher Colleen McClung, Ph.D., assistant professor of psychiatry at the University of Texas Southwest Medical Center, says these mice are the most well characterized animal models of human mania that have been described. Symptoms of mania include increased energy, activity, and restlessness; excessively good, euphoric mood; and poor judgment.
While there has long been an association between circadian rhythms and bipolar disorder, no studies have examined whether these rhythmic disruptions contribute to the symptoms associated with bipolar disorder. McClung says the findings of this study bring researchers one small step closer to discovering why bipolar disorder occurs at all, even though the study was done in mice, not humans, and that many more studies will be needed to discover a cure.
American College of Neuropsychopharmacology
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Faulty body clock may make kids bipolar
Malfunctioning circadian clock genes may be responsible for bipolar disorder in children. Researchers writing in the open access journal BMC Psychiatry found four versions of the regulatory gene RORB that were associated with pediatric bipolar disorder.
Autism Speaks' genetic resource exchange, tissue program support findings published in Nature
Autism Speaks' Autism Genetic Resource Exchange (AGRE) and the Autism Tissue Program (ATP) continue to play an integral role in continuing genetic research and new findings in the complex autism inheritance and causation puzzle.
UNC study pinpoints gene controlling number of brain cells
In populating the growing brain, neural stem cells must strike a delicate balance between two key processes - proliferation, in which the cells multiply to provide plenty of starting materials - and differentiation, in which those materials evolve into functioning neurons.
Young Adults May Outgrow Bipolar Disorder
Bipolar disorder, or manic-depression, causes severe and unusual shifts in mood and energy, affecting a person's ability to perform everyday tasks. With symptoms often starting in early adulthood, bipolar disorder has been thought of traditionally as a lifelong disorder.
Mad Genius: Study Suggests Link Between Psychosis and Creativity
Vincent van Gogh cut off his ear. Sylvia Plath stuck her head in the oven. History teems with examples of great artists acting in very peculiar ways. Were these artists simply mad or brilliant? According to new research reported in Psychological Science, a journal of the Association for Psychological Science, maybe both.
Sleep patterns in children and teenagers could indicate risk for depression, researcher finds
Sleep patterns can help predict which adolescents might be at greatest risk for developing depression, a researcher at UT Southwestern Medical Center has found in a five-year study.
Sleep patterns in children and teenagers could indicate risk for depression, researcher finds
Sleep patterns can help predict which adolescents might be at greatest risk for developing depression, a researcher at UT Southwestern Medical Center has found in a five-year study.
Invisible Ink? What Rorschach Tests Really Tell Us
One of the most well-known psychological tools is the Rorschach Inkblot Test. A viewer looks at ten inkblots, one at a time, and describes what they see.
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