Vulnerability to bipolar disorder is linked to sleep and sleepiness

Moderating effect of shift work on sleep and depression in individuals at high risk of bipolar disorder

BACKGROUND

Social Zeitgeber Theory posits that disruptions in social rhythms can increase susceptibility to bipolar disorder (BD). Shift work (SW) is one of the external factors that cause instability in social rhythms and the sleep-wake cycle. This study evaluated the moderating influences of SW on the risks of BD and sleep-related parameters and depressive symptoms. Furthermore, we evaluated the specific work schedules including daytime, nighttime, and regular and irregular rotating SW.

METHODS

An online survey was administered to 6665 participants, with 3379 (50.7 %) classified as individuals with high scores of Mood Disorder Questionnaire (MDQ). The survey included the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Scale (ISI), Epworth Sleepiness Scale (ESS), and Center for Epidemiologic Studies Depression Scale (CES-D).

RESULTS

A multivariate regression model revealed significant interactive effects of MDQ positivity and SW on PSQI, ISI, and CES-D scores, but not ESS scores. In a secondary analysis of the high MDQ screen group, daytime workers had lower scores in sleep disturbances and depressive symptoms compared to those engaged in other forms of SW.

LIMITATIONS

Online surveys were accessible voluntarily, leading to potential selection bias. Cross-sectional data identified associations, not causal relationships. Only a self-reported questionnaire was used.

CONCLUSIONS

Our findings emphasize the advantages of a daytime work schedule for individuals at high risk of BD. In accordance with the principles of social rhythm interpersonal therapy, sleep interventions for individuals at high risk of BD should include the maintenance of a consistent daytime schedule.

The importance of sleep regularity: a consensus statement of the National Sleep Foundation sleep timing and variability panel

OBJECTIVE

To develop and present consensus findings of the National Sleep Foundation sleep timing and variability panel regarding the impact of sleep timing variability on health and performance.

METHODS

The National Sleep Foundation assembled a panel of sleep and circadian experts to evaluate the scientific evidence and conduct a formal consensus and voting procedure. A systematic literature review was conducted using the NIH National Library of Medicine PubMed database, and panelists voted on the appropriateness of 3 questions using a modified Delphi RAND/UCLA Appropriateness Method with 2 rounds of voting.

RESULTS

The literature search and panel review identified 63 full text publications to inform consensus voting. Panelists achieved consensus on each question: (1) is daily regularity in sleep timing important for (a) health or (b) performance? and (2) when sleep is of insufficient duration during the week (or work days), is catch-up sleep on weekends (or non-work days) important for health? Based on the evidence currently available, panelists agreed to an affirmative response to all 3 questions.

CONCLUSIONS

Consistency of sleep onset and offset timing is important for health, safety, and performance. Nonetheless, when insufficient sleep is obtained during the week/work days, weekend/non-work day catch-up sleep may be beneficial.

Neuroanatomical and functional substrates of the hypomanic personality trait and its prediction on aggression

Hypomanic personality manifests a close link with several psychiatric disorders and its abnormality is a risk indicator for developing bipolar disorders. We systematically investigated the potential neuroanatomical and functional substrates underlying hypomanic personality trait (HPT) and its sub-dimensions (i.e., Social Vitality, Mood Volatility, and Excitement) combined with structural and functional imaging data as well as their corresponding brain networks in a large non-clinical sample across two studies (n = 464). Behaviorally, HPT, specifically Mood Volatility and Excitement, was positively associated with aggressive behaviors in both studies. Structurally, sex-specific morphological characteristics were further observed in the motor and top-down control networks especially for Mood Volatility, although HPT was generally positively associated with grey matter volumes (GMVs) in the prefrontal, temporal, visual, and limbic systems. Functionally, brain activations related to immediate or delayed losses were found to predict individual variability in HPT, specifically Social Vitality and Excitement, on the motor and prefrontal-parietal cortices. Topologically, connectome-based prediction model analysis further revealed the predictive role of individual-level morphological and resting-state functional connectivity on HPT and its sub-dimensions, although it did not reveal any links with general brain topological properties. GMVs in the temporal, limbic (e.g., amygdala), and visual cortices mediated the effects of HPT on behavioral aggression. These findings suggest that the imbalance between motor and control circuits may be critical for HPT and provide novel insights into the neuroanatomical, functional, and topological mechanisms underlying the specific temperament and its impacts on aggression.

Mania Following Traumatic Brain Injury: A Systematic Review

OBJECTIVE

Traumatic brain injury (TBI) is a leading cause of mortality and morbidity worldwide. Mania is an uncommon, but debilitating, psychiatric occurrence following TBI. The literature on mania following TBI is largely limited to case reports and case series. In the present review, the investigators describe the clinical, diagnostic, and treatment characteristics of mania following TBI.

METHODS

A systematic search of MEDLINE, EMBASE, and PsycINFO was conducted for English-language studies published from 1980 to July 15, 2021. The included studies provided the required individual primary data and sufficient information on clinical presentation or treatment of manic symptoms. Studies with patients who reported a history of mania or bipolar disorder prior to TBI and studies with patients who sustained TBI before adulthood were excluded.

RESULTS

Forty-one studies were included, which reported information for 50 patients (the mean±SD age at mania onset was 39.1±14.3 years). Patients were more frequently male, aged <50 years, and without a personal or family history of psychiatric disorders. Although 74% of patients reported mania developing within 1 year following TBI, latencies of up to 31 years were observed. Illness trajectory varied from a single manic episode to recurrent mood episodes. Rapid cycling was reported in six patients. Mood stabilizers and antipsychotics were most frequently used to improve symptoms.

CONCLUSIONS

Heterogeneity of lesion locations and coexisting vulnerabilities make causality difficult to establish. Valproate or a second-generation antipsychotic, such as olanzapine or quetiapine, may be considered first-line therapy in the absence of high-level evidence for a more preferred treatment. Early escalation to combined therapy (mood stabilizer and second-generation antipsychotic) is recommended to control symptoms and prevent recurrence. Larger prospective studies and randomized controlled trials are needed to refine diagnostic criteria and provide definitive treatment recommendations.

[Insomnia in the context of affective disorders]

The article analyzes the current literature on the relationship of insomnia with affective disorders, in particular with depression and anxiety. Research shows that there is a strong multi-channel relationship between insomnia, depression, and anxiety, with insomnia being considered a risk factor for mood disorders more often than vice versa. The so-called insomnia paradox of bipolar disorder is described, the essence of which is that in manic episodes the frequency of insomnia is higher than in depressive episodes. The data of a network meta-analysis, which found an evidence base for the use of a variety of drugs used for the pharmacological treatment of insomnia in adults, are presented. Efficiency and convenience in taking the drug Valocordin-Doxylamine are noted.

Relating parental stress with sleep disorders in parents and children

OBJECTIVE

To assess whether child sleep disorders positively correlate with parental insomnia, hypersomnia, and sleep apnea, and whether parental and child sleep disorders simultaneously positively associate with parental stress. Potential modifying influences of these associations by age, sex, and marital status will be considered.

METHODS

Analyses are based on 14,009 employees aged 18-64 with dependent children (n = 44,157) insured by Deseret Mutual Benefit Administrator (DMBA) in 2020. Rate ratios are adjusted for age, sex, and marital status.

RESULTS

The rate of parental stress is 3.00 (95% CI 2.33-4.85) times greater for those with insomnia and 1.88 (95% CI 1.59-2.22) times greater for those with sleep apnea. There is no increased risk of stress for those with hypersomnia. The number of dependent children filing one or more medical claims for a sleep disorder is 2.0%. Mean age is significantly older among those with a sleep disorder (17.1 vs. 14.4, t p < .0001). Child sex is not associated with the risk of having a sleep disorder. The rate of employee insomnia is 111% greater if their child has a sleep disorder, and employee sleep apnea is 115% greater if their child has a sleep disorder. The association between child sleep disorders and sleep apnea decreases with employee age (Wald chi-square p = 0.0410). The rate of employee stress is 90% greater if their child has a sleep disorder, 189% greater if they have insomnia, and 81% greater if they have sleep apnea. The strength of the association between insomnia and stress is greater for women (Wald Chi-square p = 0.0114), between sleep apnea and stress is greater for women (Wald chi-square p = 0.0010), and between sleep apnea and stress is greater for singles (Wald chi-square p = 0.0010).

CONCLUSIONS

Better understanding the connection between parent and child sleep problems and parent stress, and modifying influences, may improve treatment of these disorders.

Temporal relationships of ecological momentary mood and actigraphy-based sleep measures in bipolar disorder

Sleep disturbances are a key feature of bipolar disorder (BD), and poor sleep has been linked to mood symptoms. Recent use of ecological momentary assessment (EMA) has allowed for nuanced exploration of the sleep-mood link; though, the scale and directionality of this relationship is still unclear. Using EMA, actigraphy, and self-reported sleep measures, this study examines the concurrent and predictive relationships between sleep and mood. Participants with BD (n = 56) wore actigraphy devices for up to 14 days and completed validated scales and daily EMA surveys about mood and sleep quality. Linear mixed models were used to examine overall and time-lagged relationships between sleep and mood variables. EMA mood ratings were correlated with validated rating scales for depression, mania, anxiety, and impulsivity. Poor self-reported sleep quality was associated with worse overall ratings of sadness and anger. Worse self-reported sleep quality was associated with greater sadness the following day. Higher daytime impulsivity was associated with worse sleep quality the following night. Exploratory analyses found relationships between worse and more variable mood (sadness, anger, and impulsivity) with worse and more variable sleep that evening (efficiency, WASO, and sleep onset time). The sample size was modest, fairly homogenous, and included mainly euthymic persons with BD. EMA-based assessments of mood and sleep are correlated with validated scale scores and provide novel insight into intra-individual variability. Further work on the complex two-way interactions between sleep and mood is needed to better understand how to improve outcomes in BD.

A network analysis of rest-activity rhythms in young people with emerging bipolar disorders

AIMS

Actigraphy studies of individuals with bipolar disorders (BD) suggest that illness progression may be associated with a range of progressive disruptions in 24-hour rest-activity rhythms (RAR). However, those longitudinal studies were undertaken in older adults with extended histories or illness and treatment rather than young people with emerging BD. To our knowledge, this is the first study to use network modelling to examine the statistical associations between clinical phenotypes of BD and different subsets of RAR markers.

METHODS

This study of adolescents and young adults (mean age 22 years; 69% female) uses network modelling to examine which self-rated or actigraphic markers of RAR are more strongly associated with full threshold BD (referred to as Stage 2; N = 15) compared with BD-at risk syndromes (subthreshold presentations referred to as Stage 1; N = 25).

RESULTS

Network analysis demonstrated that some RAR are associated with both stage of BD and a family history of BD (such as longer sleep duration and higher levels of daytime impairment). Markers of circadian rhythmicity indicated that regulation of this system is weaker in Stage 2 compared with Stage 1 of BD.

LIMITATIONS

The small subgroup samples may have undermined the ability to detect some associations between phenotypes and RAR.

CONCLUSIONS

Network modelling may offer a useful strategy for visualizing and analysing patterns of association between RAR and clinical phenotypes defined by stage of illness, familial loading or symptom profile. This could prove useful in understanding the underlying pathophysiology of sleep-wake cycle and circadian rhythm disturbances in BD.

A critical examination of multidimensionality within the Hypomanic Personality Scale

BACKGROUND

The Hypomanic Personality Scale (HPS) assesses bipolar spectrum psychopathology and risk for bipolar disorders. Despite the developers' intent to create a scale that provides a unitary score, several studies have examined whether the HPS has a multidimensional structure. These models have been unable to identify a replicable multidimensional structure, with models varying from fairly similar to entirely dissimilar, and have suffered from theoretical and methodological concerns.

PROCEDURES

We therefore examined the multidimensional structure of the HPS in a large undergraduate and adult sample (n = 5002).

MAIN FINDINGS

We failed to reproduce factors with equal congruence to those of previously published models.

PRINCIPLE CONCLUSIONS

We concluded that the HPS lacks factorial validity in previous research as a multidimensional measure of bipolar spectrum psychopathology. We further recommend the creation of a novel multidimensional assessment of bipolar spectrum psychopathology developed from a theoretically driven, comprehensive model, rather than examining a multidimensional model of a pre-existing measure, such as the HPS.

A systematic review and meta-analysis of sleep and circadian rhythms disturbances in individuals at high-risk of developing or with early onset of bipolar disorders

Sleep and circadian rhythms disturbances (SCRD) in young people at high risk or with early onset of bipolar disorders (BD) are poorly understood. We systematically searched for studies of self, observer or objective estimates of SCRD in asymptomatic or symptomatic offspring of parents with BD (OSBD), individuals with presentations meeting recognized BD-at-risk criteria (BAR) and youth with recent onset of full-threshold BD (FT-BD). Of 76 studies eligible for systematic review, 35 (46%) were included in random effects meta-analyses. Pooled analyses of self-ratings related to circadian rhythms demonstrated greater preference for eveningness and more dysregulation of social rhythms in BAR and FT-BD groups; analyses of actigraphy provided some support for these findings. Meta-analysis of prospective studies showed that pre-existing SCRD were associated with a 40% increased risk of onset of BD, but heterogeneity in assessments was a significant concern. Overall, we identified longer total sleep time (Hedges g: 0.34; 95% confidence intervals:.1,.57), especially in OSBD and FT-BD and meta-regression analysis indicated the effect sizes was moderated by the proportion of any sample manifesting psychopathology or receiving psychotropic medications. This evolving field of research would benefit from greater attention to circadian rhythm as well as sleep quality measures.

Variability in Sleep Is Associated with Trait-Based and Daily Measures of Bipolar Spectrum Psychopathology

INTRODUCTION

Although sleep disturbances are well documented in bipolar spectrum disorders (BSDs), significantly less research has examined whether these disturbances are present in those at risk for developing BSDs or with subsyndromal symptoms. The present study examined associations between risk for BSDs, as measured by the Hypomanic Personality Scale (HPS), and sleep assessed using experience sampling. We assessed whether intraindividual variability in sleep was associated with affect, cognition, and behavior in daily life and potential directionality of these relationships.

METHODS

233 young adults oversampled for high scores on the HPS completed 14 days of experience sampling assessing total sleep time (TST), bed/rise time, sleep quality, affect (negative and positive affect), cognition (difficulty concentrating, racing thoughts), and behavior (impulsivity) in daily life. We used Dynamic Structural Equation Modeling (DSEM) to assess within-person links between sleep and bipolar spectrum psychopathology.

RESULTS

HPS scores were associated with less TST, later bedtime, and more variable TST and bedtime. Variability in TST was associated with negative affect, difficulty concentrating/racing thoughts, and impulsivity. Within-person decreases in sleep were associated with next day increases in negative affect, stress, difficulty concentrating, and racing thoughts.

LIMITATIONS

Measurement of sleep was limited. Future studies should examine both objective measures of sleep (e.g., actigraphy) and fragmentation in sleep.

CONCLUSIONS

Risk for BSD was associated with similar patterns of sleep disruptions as seen in BSDs. Important dynamic links between sleep and bipolar spectrum psychopathology emerged indicating that sleep is an important target for improving symptoms of BSDs in daily life.

Linking Brain Age Gap to Mental and Physical Health in the Berlin Aging Study II

From a biological perspective, humans differ in the speed they age, and this may manifest in both mental and physical health disparities. The discrepancy between an individual's biological and chronological age of the brain ("brain age gap") can be assessed by applying machine learning techniques to Magnetic Resonance Imaging (MRI) data. Here, we examined the links between brain age gap and a broad range of cognitive, affective, socioeconomic, lifestyle, and physical health variables in up to 335 adults of the Berlin Aging Study II. Brain age gap was assessed using a validated prediction model that we previously trained on MRI scans of 32,634 UK Biobank individuals. Our statistical analyses revealed overall stronger evidence for a link between higher brain age gap and less favorable health characteristics than expected under the null hypothesis of no effect, with 80% of the tested associations showing hypothesis-consistent effect directions and 23% reaching nominal significance. The most compelling support was observed for a cluster covering both cognitive performance variables (episodic memory, working memory, fluid intelligence, digit symbol substitution test) and socioeconomic variables (years of education and household income). Furthermore, we observed higher brain age gap to be associated with heavy episodic drinking, higher blood pressure, and higher blood glucose. In sum, our results point toward multifaceted links between brain age gap and human health. Understanding differences in biological brain aging may therefore have broad implications for future informed interventions to preserve mental and physical health in old age.

Circadian rhythm disruptions: A possible link of bipolar disorder and endocrine comorbidities

Epidemiological studies have demonstrated an association between bipolar disorder (BP) and endocrine diseases. Further, circadian rhythm disruptions may be a potential common pathophysiological mechanism of both disorders. This review provides a brief overview of the molecular mechanisms of circadian rhythms, as well as roles circadian rhythms play in BP and common endocrine comorbidities such as diabetes and thyroid disease. Treatments targeting the circadian system, both pharmacological and non-pharmacological, are also discussed. The hope is to elicit new interest to the importance of circadian system in BP and offer new entry points and impetus to the development of medicine.

Sleep markers in psychiatry: do insomnia and disturbed sleep play as markers of disrupted neuroplasticity in mood disorders? A proposed model

INTRODUCTION

Since insomnia and disturbed sleep may affect neuroplasticity, we aimed at reviewing their potential role as markers of disrupted neuroplasticity involved in mood disorders.

METHOD

We performed a systematic review, according to PRIMA, on PubMed, PsycINFO and Embase electronic databases for literature regarding mood disorders, insomnia, sleep loss/deprivation in relation to different pathways involved in the impairment of neuroplasticity in mood disorders such as 1] alterations in neurodevelopment 2] activation of the stress system 3] neuroinflammation 4] neurodegeneration/neuroprogression, 4] deficit in neuroprotection.

RESULTS

Sixty-five articles were analyzed and a narrative/ theoretical review was conducted. Studies showed that insomnia, sleep loss and sleep deprivation might impair brain plasticity of those areas involved in mood regulation throughout different pathways. Insomnia and disrupted sleep may act as neurobiological stressors that by over-activating the stress and inflammatory systems may affect neural plasticity causing neuronal damage. In addition, disturbed sleep may favor a deficit in neuroprotection hence contributing to impaired neuroplasticity.

CONCLUSIONS

Insomnia and disturbed sleep may play a role as markers of alteration in brain plasticity in mood disorders. Assessing and targeting insomnia in the clinical practice may potentially play a neuroprotective role, contributing to "repairing" alterations in neuroplasticity or to the functional recovery of those areas involved in mood and emotion regulation.

Is unemployment associated with inefficient sleep habits? A cohort study using objective sleep measurements

Unemployed people could be at risk of developing inefficient sleep habits by spending excessive time in bed, as they lack a structuring activity. This could impact their mental health and reintegration into labour. This study aims to analyse possible associations between employment status and sleep parameters using actigraphy. Subjects (148 employed and 50 unemployed) were drawn from a German population-based cohort. Sleep parameters were measured with the SenseWear Bodymedia Pro 3 armband. Comparison of means concerning sleep duration, sleep efficiency, time of sleep and sleep fragmentation was performed separately for week days and weekends. Multiple linear regression analysis was performed to analyse group differences controlling for covariates. Finally, we defined cut-off scores for each sleep variable, and analysed the distribution of subjects above and below these values. Unemployed people did not sleep significantly longer than employed people. However, on week days, they displayed night sleep efficiency reduced by on average > 5% points, they lay down for 28 min longer, had later mid sleep time (38 min) and sleep offset (55 min), as well as more frequent awakenings after sleep onset accounting for being awake 28 min longer (all p ≤ 0.005). Sleep in unemployed subjects compared with employed subjects aged 41-64 years was less efficient, more fragmented and shifted to a later point of the night. Results support prior findings that unemployment has a negative influence on sleep quality. Unemployed individuals could benefit from intervention programmes aiming at the adoption of healthier sleep habits.

The Big Five Personality Traits and Brain Arousal in the Resting State

Based on Eysenck's biopsychological trait theory, brain arousal has long been considered to explain individual differences in human personality. Yet, results from empirical studies remained inconclusive. However, most published results have been derived from small samples and, despite inherent limitations, EEG alpha power has usually served as an exclusive indicator for brain arousal. To overcome these problems, we here selected N = 468 individuals of the LIFE-Adult cohort and investigated the associations between the Big Five personality traits and brain arousal by using the validated EEG- and EOG-based analysis tool VIGALL. Our analyses revealed that participants who reported higher levels of extraversion and openness to experience, respectively, exhibited lower levels of brain arousal in the resting state. Bayesian and frequentist analysis results were especially convincing for openness to experience. Among the lower-order personality traits, we obtained the strongest evidence for neuroticism facet 'impulsivity' and reduced brain arousal. In line with this, both impulsivity and openness have previously been conceptualized as aspects of extraversion. We regard our findings as well in line with the postulations of Eysenck and consistent with the recently proposed 'arousal regulation model'. Our results also agree with meta-analytically derived effect sizes in the field of individual differences research, highlighting the need for large (collaborative) studies.

The Big Five Personality Traits and Brain Arousal in the Resting State

Based on Eysenck's biopsychological trait theory, brain arousal has long been considered to explain individual differences in human personality. Yet, results from empirical studies remained inconclusive. However, most published results have been derived from small samples and, despite inherent limitations, EEG alpha power has usually served as an exclusive indicator for brain arousal. To overcome these problems, we here selected N = 468 individuals of the LIFE-Adult cohort and investigated the associations between the Big Five personality traits and brain arousal by using the validated EEG- and EOG-based analysis tool VIGALL. Our analyses revealed that participants who reported higher levels of extraversion and openness to experience, respectively, exhibited lower levels of brain arousal in the resting state. Bayesian and frequentist analysis results were especially convincing for openness to experience. Among the lower-order personality traits, we obtained the strongest evidence for neuroticism facet 'impulsivity' and reduced brain arousal. In line with this, both impulsivity and openness have previously been conceptualized as aspects of extraversion. We regard our findings as well in line with the postulations of Eysenck and consistent with the recently proposed 'arousal regulation model'. Our results also agree with meta-analytically derived effect sizes in the field of individual differences research, highlighting the need for large (collaborative) studies.

Neural Mechanism Underlying the Sleep Deprivation-Induced Abnormal Bistable Perception

Quality sleep is vital for physical and mental health. No matter whether sleep problems are a consequence of or contributory factor to mental disorders, people with psychosis often suffer from severe sleep disturbances. Previous research has shown that acute sleep deprivation (SD) can cause transient brain dysfunction and lead to various cognitive impairments in healthy individuals. However, the relationship between sleep disturbance and bistable perception remains unclear. Here, we investigated whether the bistable perception could be affected by SD and elucidated the functional brain changes accompanying SD effects on bistable perception using functional magnetic resonance imaging. We found that the 28-h SD resulted in slower perceptual transitions in healthy individuals. The reduced perceptual transition was accompanied by the decreased activations in rivalry-related frontoparietal areas, including the right superior parietal lobule, right frontal eye field, and right temporoparietal junction. We speculated that SD might disrupt the normal function of these regions crucial for bistable perception, which mediated the slower rivalry-related perceptual transitions in behavior. Our findings revealed the neural changes underlying the abnormal bistable perception following the SD. It also suggested that SD might offer a new window to understand the neural mechanisms underlying the bistable perception.

Rate of change in solar insolation is a hidden variable that influences seasonal alterations in bipolar disorder

The consensus in the literature is that bipolar disorder is seasonal. We argue that there is finer detail to seasonality and that changes in mood and energy in bipolar disorder are dictated by the rate of change of solar insolation.

Estimated model of psychotropic polypharmacy for bipolar disorder: Analysis using patients' and practitioners' parameters in the MUSUBI study

OBJECTIVE

This study aims to clarify the relevant factors influencing practitioners' methods of prescribing medications for bipolar disorder, in a nation-wide survey in Japan.

METHODS

The clinical records of 3130 outpatients with bipolar disorder were consecutively reviewed from 176 psychiatric outpatient clinics. Fifteen parameters, that is, five patients' including five general characteristics (sex, age, education, occupation, and social adjustment), five patients' aspects of mental functioning (onset age, comorbid mental illness, rapid-cycling, psychopathologic severity, and followed-up years), and five practitioners' characteristics (sex, age, specialist experience, clinic standing years, and location), were evaluated. The number of psychotropic drugs (mood stabilizers, antidepressants, antipsychotic drugs, anxiolytics, and hypnotics) was used as an index of pharmacotherapy. Converted data from each practitioner-unit were analyzed.

RESULTS

Seven factors (patient's social adjustment, patient's psychopathology, patient's comorbid mental disorders, patient's followed-up years, doctor's age, clinic running years, and patient's education years) were correlated to the number of psychotropic drugs. Multiple regression analysis showed that the severity of illness (poor social adjustment, and comorbid mental illness) and an intractable disease course (long followed-up years), were significantly associated with the number of psychotropic drugs.

CONCLUSION

Our findings indicated that patient-related conditions affected psychotropic polypharmacy more strongly than did practitioner-related conditions.

Real-time mobile monitoring of bipolar disorder: a review of evidence and future directions

Rapidly accumulating data from mobile assessments are facilitating our ability to track patterns of emotions, behaviors, biologic rhythms, and their contextual influences in real time. These approaches have been widely applied to study the core features, traits, changes in states, and the impact of treatments in bipolar disorder (BD). This paper reviews recent evidence on the application of both passive and active mobile technologies to gain insight into the role of the circadian system and patterns of sleep and motor activity in people with BD. Findings of more than two dozen studies converge in demonstrating a broad range of sleep disturbances, particularly longer duration and variability of sleep patterns, lower average and greater variability of motor activity, and a shift to later peak activity and sleep midpoint, indicative of greater evening orientation among people with BD. The strong associations across the domains tapped by real-time monitoring suggest that future research should shift focus on sleep, physical/motor activity, or circadian patterns to identify common biologic pathways that influence their interrelations. The development of novel data-driven functional analytic tools has enabled the derivation of individualized multilevel dynamic representations of rhythms of multiple homeostatic regulatory systems. These multimodal tools can inform clinical research through identifying heterogeneity of the manifestations of BD and provide more objective indices of treatment response in real-world settings. Collaborative efforts with common protocols for the application of multimodal sensor technology will facilitate our ability to gain deeper insight into mechanisms and multisystem dynamics, as well as environmental, physiologic, and genetic correlates of BD.

Comprehensive review of the current literature on impact of ambient air pollution and sleep quality

Air pollution is associated with increasing morbidity, mortality and decreasing health and life span. Accumulating epidemiological and experimental evidence has shown that exposure to ambient air pollutants such as particulate matters (PM) and gaseous components [eg, nitrogen dioxide (NO₂), ozone (O₃)] has detrimental effects on sleep quality. We conducted this comprehensive review to explore the association between ambient air pollution and sleep quality. A systematic search was conducted with the databases of PubMed and Web of Science from inception to November 2019. Overall, 15 studies with 133,695 subjects that evaluated the association between ambient air pollution and sleep quality were conducted in 10 different countries (ie, USA, Brazil, Canada, Chile, China, Egypt, Germany, Iran, Mexico, and Turkey). Most included studies in the current review have shown that one or more air pollutants have negative influences on sleep quality. Air pollutants might be one of the triggers for poor sleep quality via disparate mechanisms including but not limited to the central ventilator control centers, central nervous system, allergic and non-allergic mechanisms. The possible association between air pollution and select chronic diseases (eg, mental illnesses, cardiovascular diseases) and behaviors (eg, impulsivity) may also play important roles in explaining the association between ambient air pollution and sleep quality. The associations and underlying mechanisms between ambient air pollutants and sleep quality need to be clarified with long-term, multi-centered cohort studies.