Moods, misattributions and mania: an interaction of biological and psychological factors in the pathogenesis of mania.

Circadian rhythm dysfunction has recently been suggested to have a causal role in major depressive disorders. Against this background, experiments on circadian rhythms are outlined that yield a state of sustained sleepless activity. Such states can be brought about it seems by manipulation of the external zeitgebers to which rhythms are synchronized rather than by any alteration of the circadian clock. This can be expected to yield a disorganized rhythmic state rather than any discrete phase shifting or desynchronization of rhythms. This state it is suggested should lead to a mild dysphoria, psychomotor activation and a subtle disordering of thought form. It is proposed that these changes lead to the typical clinical picture of mania when distorted cognitively by mechanisms similar to those found in depression. There are a number of implications of this hypothesis. Firstly, mania should commonly be precipitated by similar psychosocial factors to those which precipitate depression. Secondly, similar neuroendocrine findings should be found in both depression and mania. Thirdly, similar agents should be effective in the treatment of mania and depression. Fourthly, cognitive therapy may play a significant part in the management of acute episodes of mania and reduce liability to chronicity.