Implementing interpersonal and social rhythm therapy for mood disorders across a continuum of care

Research progress in circadian rhythms in the application of psychological rehabilitation of cancer patients

The psychological distress of cancer patients seriously affects their therapeutic effects. Effective psychological rehabilitation of cancer patients significantly improves their survival chance and quality of life. Circadian rhythm results from adaptation to the environment during the organism's evolution. When the endogenous clock system is disrupted or the external environment is changed, the body and the environment are out of synchronization, and the circadian rhythm will be disrupted. Circadian rhythm disorder is a common phenomenon in cancer patients, and the changes of circadian rhythm are closely related to their psychological distress. Many studies believe that the circadian rhythm disorder of cancer patients may directly or indirectly affect their psychology through various mechanisms, and targeted intervention by regulating the circadian rhythm of patients may be an essential means to promote the psychological rehabilitation.

Toward a Digital Future in Bipolar Disorder Assessment: A Systematic Review of Disruptions in the Rest-Activity Cycle as Measured by Actigraphy

BACKGROUND

Disruptions in rest and activity patterns are core features of bipolar disorder (BD). However, previous methods have been limited in fully characterizing the patterns. There is still a need to capture dysfunction in daily activity as well as rest patterns in order to more holistically understand the nature of 24-h rhythms in BD. Recent developments in the standardization, processing, and analyses of wearable digital actigraphy devices are advancing longitudinal investigation of rest-activity patterns in real time. The current systematic review aimed to summarize the literature on actigraphy measures of rest-activity patterns in BD to inform the future use of this technology.

METHODS

A comprehensive systematic review using PRISMA guidelines was conducted through PubMed, MEDLINE, PsycINFO, and EMBASE databases, for papers published up to February 2021. Relevant articles utilizing actigraphy measures were extracted and summarized. These papers contributed to three research areas addressed, pertaining to the nature of rest-activity patterns in BD, and the effects of therapeutic interventions on these patterns.

RESULTS

Seventy articles were included. BD was associated with longer sleep onset latency and duration, particularly during depressive episodes and with predictive value for worsening of future manic symptoms. Lower overall daily activity was also associated with BD, especially during depressive episodes, while more variable activity patterns within a day were seen in mania. A small number of studies linked these disruptions with differential patterns of brain functioning and cognitive impairments, as well as more adverse outcomes including increased suicide risk. The stabilizing effect of therapeutic options, including pharmacotherapies and chronotherapies, on activity patterns was supported.

CONCLUSION

The use of actigraphy provides valuable information about rest-activity patterns in BD. Although results suggest that variability in rhythms over time may be a specific feature of BD, definitive conclusions are limited by the small number of studies assessing longitudinal changes over days. Thus, there is an urgent need to extend this work to examine patterns of rhythmicity and regularity in BD. Actigraphy research holds great promise to identify a much-needed specific phenotypic marker for BD that will aid in the development of improved detection, treatment, and prevention options.

Cytomegalovirus Antibody Elevation in Bipolar Disorder: Relation to Elevated Mood States

The neurobiology of mood states is complicated by exposure to everyday stressors (e.g., psychosocial, ubiquitous environmental infections like CMV), each fluctuating between latency and reactivation. CMV reactivation induces proinflammatory cytokines (e.g., TNF-α) associated with induction of neurotoxic metabolites and the presence of mood states in bipolar disorder (BD). Whether CMV reactivation is associated with bipolar diagnoses (trait) or specific mood states is unclear. We investigated 139 BD type I and 99 healthy controls to determine if concentrations of IgG antibodies to Herpesviridae (e.g., CMV, HSV-1, and HSV-2) were associated with BD-I diagnosis and specific mood states. We found higher CMV antibody concentration in BD-I than in healthy controls (T₂₃₄ = 3.1, P_uncorr = 0.002; P_corr = 0.006) but no difference in HSV-1 (P > 0.10) or HSV-2 (P > 0.10). Compared to euthymic BD-I volunteers, CMV IgG was higher in BD-I volunteers with elevated moods (P < 0.03) but not different in depressed moods (P > 0.10). While relationships presented between BD-I diagnosis, mood states, and CMV antibodies are encouraging, they are limited by the study's cross sectional nature. Nevertheless, further testing is warranted to replicate findings and determine whether reactivation of CMV infection exacerbates elevated mood states in BD-I.

Interpersonal and social rhythm group therapy for patients with bipolar disorder

This article describes Interpersonal and Social Rhythm Therapy (IPSRT) adapted for use in a group setting for patients with bipolar disorder. In a preliminary efficacy study, we studied the pre-post group treatment effect on affective symptoms. One-year pre-post findings in the IPSRT group indicated that this modality was effective in reducing depressive symptoms and might reduce the number of hospital admissions. Also, group IPSRT increased stability of the social rhythm, which is thought to be important in reducing recurrence of manic and depressive episodes. These findings suggest that group IPSRT could be an additional treatment option for patients with bipolar disorder who continue to have mood episodes despite adequate pharmacotherapy and psychoeducation.

Social support and social rhythm regularity in elderly patients with major depressive disorder

OBJECTIVE

According to the social zeitgeber theory, the lack of social support (SS) may decrease circadian rhythm regularity. However, the effect of SS on social rhythms in major depression has never been investigated. The objective of this study was to investigate the relation between SS and social rhythms in elderly patients with major depression.

METHODS

Case-control study on the relation of SS with social rhythm regularity in 213 elderly patients with major depressive disorder (MDD) and 183 elderly healthy comparison subjects (HCs). Social rhythm regularity was studied using the social rhythm metric (SRM-5), in which a lower score represents less regularity. SS was assessed with the social support list (SSL).

RESULTS

Patients with MDD displayed lower SRM-5 scores than HCs (4.94 ± 0.94 versus 5.38 ± 1.12; p = 0.003), as well as lower SSL-interactions (60.0 ± 13.7 versus 70.5 ± 11.6; p <0.001), higher SSL-discrepancies (56.3 ± 15.5 versus 39.4 ± 7.2; p <0.001), and higher SSL-negative interactions (11.0 ± 4.5 versus 8.9 ± 1.9; p <0.001). In HCs, social support was negatively correlated with SRM-5 (SSL-interactions, r = -0.30; SSL-discrepancies, r = -0.23; SSL-negative interactions, r = -0.44). In MDD, SS was not correlated with SRM-5 (all r ≤ 0.03; all p >0.05).

CONCLUSIONS

Patients with MDD showed lower social rhythm regularity as well as lower measures of SS than HCs. In HCs, high SS was correlated with low social rhythm regularity, suggesting that increases in SS in combination with a healthy organization of circadian rhythms allow the social rhythms to become less rigid. Interestingly, in MDD, no correlation was found, suggesting that patients have a blunted response to social stimuli and may, therefore, benefit from treatment that increases the susceptibility to SS.

Group interpersonal and social rhythm therapy for bipolar depression

PURPOSE

To evaluate the feasibility of 2-week interpersonal and social rhythm therapy group (IPSRT-G) for bipolar depression.

DESIGN AND METHODS

Participants with bipolar depression received two individual sessions, six IPSRT-G sessions, and a 12-week telephone call. The Inventory of Depressive Symptomatology-Clinician Rated (IDS-C), Young Mania Rating Scale (YMRS), Sheehan Disability Scale (SDS), and Clinical Global Impressions-Bipolar Version (CGI-BP) were used.

FINDINGS

IDS-C and SDS scores improved significantly at 12 weeks. YMRS and CGI-BP scores improved but did not reach statistical significance.

PRACTICE IMPLICATIONS

The promising antidepressive response supports further study of IPSRT-G for bipolar depression.