Association between affective temperaments and mood features in bipolar disorder II: the role of insomnia and chronobiological rhythms desynchronization
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Background Bipolar disorders are complex disorders involving the interaction of multiple factors. Affective temperaments, insomnia, and chronobiological rhythms desynchronization may all contribute to bipolar disorder. Since there is a paucity of research examining this topic we aimed to study how they are interrelated and collectively associated with clinical features of bipolar disorder.Method One-hundred patients with Bipolar Disorder type II depressive episode with and without mixed features were recruited and compared. Subjects were evaluated with SCID -5, the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN), the Insomnia Severity Index (ISI), and the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A) while evaluating depressive (Beck Depression Inventory-BDI-II) and manic (Young Mania Rating Scale-YMRS) symptoms. Logistic regression and mediation analyses were conducted.Results Subjects with mixed features showed a higher scores in both insomnia and chronobiological rhythms scores. When considering affective temperaments not only depressive, cyclothymic and irritable temperaments predicted mood symptoms but also insomnia (depressive symptoms O.R. 4.17, p = 0.043) and chronobiological sleep de-synchronization (manic symptoms O.R. 8.69, p = 0.001). Insomnia symptoms and chronobiological alterations mediated the association between affective temperaments and mood symptoms.Limitations the cross-sectional design limited any causal interpretation.Conclusion Subjects with mixed features showed a greater severity of insomnia and chronobiological rhythm de-synchronization compared to subjects without. Insomnia and chronobiological alterations may contribute to mood disorders together with affective temperaments in a complex interplay also mediating their effect on mood. Preventive strategies for bipolars should also act on the dysregulation of sleep and circadian rhythms.
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ISI has been shown to be a valid and sensitive tool to detect changes in perceived sleep difficulties with treatment and eligible for use in patients with affective disorders.
“Moreover, ISI has been shown to be a valid and sensitive tool to detect changes in perceived sleep difficulties with treatment (30) and eligible for use in patients with affective disorders (67, 68).”
From Total Sleep Deprivation Followed by Bright Light Therapy as Rapid Relief for Depression: A Pragmatic Randomized Controlled Trial (2021) · cites this paper as [68]
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Self-citation
- Authors
- Palagini, L., Miniati, M., Caruso, D., Massa, L., Novi, M., Pardini, F., Salarpi, G., Pini, S., Marazziti, D., Etain, B., & Riemann, D.
- Affiliations
- University of Pisa (IT)
- University of Freiburg (DE)
- Corresponding author
- Palagini, Laura
- ORCID
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2020-04
- Volume
- 266
- Pages
- 263-272
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W3002676149
- Cited by
- 20
- References
- 70
- Citations by year
- 2026: 2 · 2025: 2 · 2023: 4 · 2022: 1 · 2021: 7 · 2020: 4
- FWCI
- 2.93
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion, cc-by-nc-nd)
- Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion, cc-by-nc-nd)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Keywords
- bipolar II disorder, affective temperament, insomnia, circadian rhythm desynchronization, mixed features, depressive episodes, manic symptoms, cyclothymic temperament, irritable temperament, sleep-wake cycle
- MeSH terms
- Affect, Bipolar Disorder, Cross-Sectional Studies, Humans, Sleep Initiation and Maintenance Disorders, Temperament
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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