liothyronine sodium First are there characteristic sequentia

First, are there characteristic sequential changes in liothyronine sodium related to the exacerbation of BD symptoms? So far, studies about the disturbances of circadian rhythms related to BD have been almost entirely cross-sectional (Nurnberger et al., 2000; Wood et al., 2009). If we identify sequential changes of circadian rhythms with the clinical transitions from severe mood states (such as mania or depression or mixed states) to euthymic states, it will provide a deeper understanding of circadian rhythms associated with BD. Second, how should we interpret the variations of circadian rhythm shifts within studies of BD (Nurnberger et al., 2000; Salvatore et al., 2008)? As highlighted by the subphenotypes in genetic studies of BD (Craddock and Sklar, 2009), we speculate that there could be several subphenotypes correlated with distinctive changes of circadian rhythms within BD. Third, are there inconsistencies in disorders when measuring circadian rhythm variables of different body systems at the same time, so-called internal desynchronization? Most of the studies have been analyses of independent variables such as hormonal, genetic, or physical activity (Nurnberger et al., 2000; Salvatore et al., 2008). However, these variables may differ in sensitivity to reflect aspects of human circadian rhythm systems. If we compare several circadian rhythm variables of different systems at the same time, it might distinguish dysregulation of circadian coordination in these systems.
Materials & Methods
Results
Discussion This study suggests that acute mood episodes are related to circadian misalignment between the individual\'s endogenous circadian rhythms and the individual\'s physical environment. Acute manic episodes were usually associated with biochemical circadian rhythm acrophases averaging 7hour more advanced (earlier) than those of controls, though these acrophases could perhaps have resulted from an average of 17hour clockwise delays. Mixed manias were >6hour delayed, whereas bipolar depression was associated with 4–5hour phase delays compared to the controls. Interestingly, findings of advanced phase in mania and delayed phase in depression are parallel to studies of jetlag effects on BD that traveling east precipitate manic episode while traveling west induces depressive episode (Inder et al., 2016). Previous studies suggested that disturbance of circadian rhythms is a possible mechanism of BD (Duarte Faria et al., 2015; Gonzalez, 2014; Kripke et al., 2015; McClung, 2007; Wirz-Justice, 2006). However, there has been no monitoring of circadian rhythms at the biochemical level tracking the healing from an acute mood episode to euthymia. This study provides novel observations of resolution of circadian phase abnormalities accompanying resolution of mood disturbances. Three of 26 manic episodes arose in mixed states and showed a pattern of circadian shifts distinct from other manic episodes. During the acute mixed states, patients showed about 6–7hour delayed phases compared to those in recovered states. Interestingly, when biochemical circadian rhythms were observed in depressive episodes, the result showed about 4–5h delayed circadian phases in acute depressive states compared to recovered states. Thus, the phase orientation of the biochemical rhythms of the mixed manic-depressives during the acute episodes were intermediate between the phases of pure manic and the depressive episodes, seemingly corresponding to the intermediate phenotype of mixed mania and depression. Both mixed manics and depressives corrected the phase delay during the acute mood episode by phase advance during recovery. Mixed mania, also known as dysphoric mania or mixed features, is a condition during which features of mania and depression occur almost simultaneously. However, the pathophysiology of mixed mania was not well established. Transitions between manic or depressive states are common as demonstrated in a longitudinal study (Kotin and Goodwin, 1972). Polyphasic episodes, in which state changes occur without a euthymic mood period, resemble mixed states (Turvey et al., 1999). Furthermore, Sit et al. reported that the mixed states were induced by morning bright light treatment in women with bipolar depression and midday light therapy did not (Sit et al., 2007), which suggest that abrupt phase shifts by light may be a cause of mixed states. It is possible that morning light therapy for bipolar depressive patients induce further circadian delays because morning times may lie in the delay zone in the phase response curve for light during bipolar depression (Khalsa et al., 2003). Furthermore, hypersensitivity of circadian rhythm shifts to bright light has been suggested to be a possible biological marker for sub-threshold bipolarity and BD (Cho et al., 2016; Lewy et al., 1985).