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Circadian alterations in bipolar disorder


The sleep-wake cycle is important for affect regulation. Alterations in sleep timing or duration are observed in depressed and manic patients and may precipitate episodes of bipolar disorder. Bipolar patients often complain of longer time in bed, fragmented sleep, unstable and irregular sleep-wake cycles. The exact mechanism of interaction between affect and sleep is still unknown, but it has been hypothesized that interventions toward good sleep habits might prevent relapse.


The objective of this research is to detect relations of alterations in sleep-wake cycle and affective symptoms and functionality in patients with bipolar disorder.


Outpatients attending a psychiatric service specialized in bipolar disorder (DSM-5 criteria) were recruited to participate in a larger study that is investigating response predictors to the disease. As part of the screening, in the initial interviews, individuals completed the Hamilton Depression Scale (HAM-D), Young Mania Rating Scale (YMRS), Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN), and Functional Assessment Staging (FAST). Response of the scales had a maximum time-lapse of 30 days, and interviews were held between March 2017 and January 2018. Ethics Committee approved the study.


After excluding those individuals with unstable clinical status and current substance use, 32 patients (17 women) were recruited, with mean age of 44.7 years (27 - 62). Spearman´s correlations were significant for BRIAN and HAM-D (rs=0.40, p=0.04) and for BRIAN and FAST (rs=0.56, p=0.002). HAM-D was related to YMRS (rs=0.41, p=0.02) and to FAST (rs=0.42, p=0.03). After controlling for the other variables, only BRIAN and FAST remained significant (r=0.53, p=0.02).


Circadian alterations related to depressive symptoms and not to manic symptoms. After controlling for other variables, only the alterations in biological rhythms predicted the functionality of bipolar patients. However, the neuropsychological profiles of the patients were not evaluated. Regularity and rhythmicity in behavior in bipolar patients are important in maintaining their functionality.


Bipolar disorder, sleep-wake cycle, BRIAN, functionality


Área Clínica


Universidade Federal do Paraná - Parana - Brasil


Fernanda Thays Mukae Iqueuti, Marina Lumi Higa, André Hideki Braga, Pedro Henrique Pereira Alvim, Mariana Richartz Schwind, Eduardo Alves Guilherme, Dirceu Zorzetto Filho, João Guilherme Fiorani Borgio