Juliana Castro1, Marcio Zanini2, Bruno da Silva Brandão Gonçalves3, Fernando Morgadinho Santos Coelho4, Rodrigo Bressan2, Lia Bittencourt5, Ary Gadelha2, Elisa Brietzke2, Sergio Tufik5. 1. Departamento de Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil. Electronic address: juvilela.castro@gmail.com. 2. PRISMA/PROESQ - Departamento de Psiquiatria, Universidade Federal de Sao Paulo, Sao Paulo, Brazil. 3. Instituto Federal Sudeste de Minas Gerais, Campus Barbacena, Barbacena, Brazil. 4. Departamento de Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil; Departamento de Neurologia e Neurocirurgia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil. 5. Departamento de Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
Abstract
BACKGROUND: At-risk mental states (ARMS) are clinical syndromes that are associated with higher risk, compared with the general population, for developing psychosis and bipolar disorder. Circadian rhythm misalignments have been proposed to be part of this early phase of the clinical course. OBJECTIVE: To compare circadian rhythm of activity and rest changes between ARMS individuals and a healthy control group. METHODS: Forty volunteers of both genders, aged between 13 and 27years old, participated in this study (n=20 ARMS group, and n=20 healthy controls). The ARMS individuals were classified as ultra-high risk for psychosis according to the CAARMS (Comprehensive Assessment of At-risk Mental State) or at high risk for bipolar disorder according to criteria proposed by Bechdolf and colleagues. Participants used an actigraph for fifteen days, kept a sleep diary, and completed the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index, and a Morningness-Eveningness Questionnaire. RESULTS: Compared with healthy volunteers, the ARMS group presented worse sleep quality (P=0.010); longer nap durations (P=0.038), shorter wake times (P=0.001), higher total sleep times (P=0.011), and shorter activity duration (P=0.021), sleep rhythms were more fragmented, the circadian rest-activity rhythms were less synchronized with the dark-light cycle and had lower amplitudes of motor activity. CONCLUSION: The results suggest alterations in the circadian rest-activity rhythms (and likely in sleep-wake cycle patterns) in ARMS individuals compared with healthy controls. It is possible that circadian rhythms of activity and rest changes are one of the prodromal clinical and behavioral expressions of the brain changes that underlie ARMS individuals.
BACKGROUND: At-risk mental states (ARMS) are clinical syndromes that are associated with higher risk, compared with the general population, for developing psychosis and bipolar disorder. Circadian rhythm misalignments have been proposed to be part of this early phase of the clinical course. OBJECTIVE: To compare circadian rhythm of activity and rest changes between ARMS individuals and a healthy control group. METHODS: Forty volunteers of both genders, aged between 13 and 27years old, participated in this study (n=20 ARMS group, and n=20 healthy controls). The ARMS individuals were classified as ultra-high risk for psychosis according to the CAARMS (Comprehensive Assessment of At-risk Mental State) or at high risk for bipolar disorder according to criteria proposed by Bechdolf and colleagues. Participants used an actigraph for fifteen days, kept a sleep diary, and completed the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index, and a Morningness-Eveningness Questionnaire. RESULTS: Compared with healthy volunteers, the ARMS group presented worse sleep quality (P=0.010); longer nap durations (P=0.038), shorter wake times (P=0.001), higher total sleep times (P=0.011), and shorter activity duration (P=0.021), sleep rhythms were more fragmented, the circadian rest-activity rhythms were less synchronized with the dark-light cycle and had lower amplitudes of motor activity. CONCLUSION: The results suggest alterations in the circadian rest-activity rhythms (and likely in sleep-wake cycle patterns) in ARMS individuals compared with healthy controls. It is possible that circadian rhythms of activity and rest changes are one of the prodromal clinical and behavioral expressions of the brain changes that underlie ARMS individuals.
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