Social rhythm disruption and stressful life events in the onset of bipolar and unipolar episodes

“Subsequent studies of rhythm-disrupting life events suggested that such events were indeed implicated in the onset of bipolar episodes.(27,28) We hypothesized that IPSRT would be associated with shorter time to remission and longer time to recurrence during a 2-year maintenance phase than an intensive clinical managem…”

“…bipolar I disorder; however, given extant theories about the relationship between circadian rhythms and bipolar episodes and subsequent data linking SRD events to mania (Malkoff-Schwartz et al 1998, 2000), we decided to augment IPT with behavioral strategies designed to stabilize daily routines.”

“Specific elements added to conventional IPT in this adaptation include scheduling activities and regularizing sleep schedules (Malkoff-Schwartz et al., 2000).”

“Two other studies have examined the association of life events and social rhythm regularity in a clinical sample (Malkoff-Schwartz et al., 2000, 1998).”

“These results were replicated in an expanded follow-up study (53) that included unipolar depressed and rapid-cycling bipolar patients and found that social rhythm disruptions occurred more frequently prior to mania than to other affective episodes.”

“In addition, although mood changes in BPD are usually reactions to environmental events [34,63], stressors are less clearly related to the onset of bipolar episodes [64].”

“In two retrospective studies using structured interview assessments and ratings of life events, Malkoff-Schwartz et al. (1998, 2000) reported that manic bipolar patients were significantly more likely to experience pre-onset events characterized by social rhythm disruptions than depressed bipolar…”

“Longitudinal studies have demonstrated that BD patients are likely to have experienced stressful life events prior to the onset of depressive(43) and manic episodes.(44,45)”

“When rates of life events pre-onset were compared to the rate of events among control participants, schedule-disrupting events were not more common before manic periods than they were in the general population (Malkoff-Schwartz et al., 2000).”

“Consistent with previous studies (Ellicott et al., 1990; Malkoff-Schwartz et al., 2000), higher levels of stress were also direct predictors of episode recurrence.”

“Creating and maintaining a continuous and stable sense of self across time requires not only the retrieval of specific past events but also the ability to create coherent links between the current self and past experiences (e.g., McAdams, 1993; McLean, 2008; McLean & Fournier, 2007).”

“They replicated these results in a second study (Malkoff-Schwartz et al. 2000).”

“Additionally, regularity in daily routine has long been indicated as a factor in depression [33] and BD [34], [35] where circadian2 rhythm disruption is considered by some to be a “core feature” [37].”

“This finding is supported by previous studies that have found an increase in manic episodes after social rhythm disruptions in a bipolar I sample (12, 13); however, this is the first study to examine this relationship in a sample with bipolar spectrum disorders.”

“We subsequently demonstrated that life events characterized by disruption in daily routines are, indeed, associated with the onset of depression and, particularly, of mania (Malkoff-Schwartz et al., 2000; MalkoffSchwartz et al., 1998).”

“Environmental novelty may disrupt a subject’s circadian rhythm, resulting in manic episodes in predisposed subjects (Ehlers et al., 1988; Malkoff-Schwartz et al., 1998; 2000), while events that disrupt social rhythm can predict episodes of hypomania (Sylvia et al., 2009).”

“Indeed, since first articulating this social zeitgeber hypothesis of mood disorders, we established that life events with the capacity to alter daily routines are in fact associated with the onset of both depressive and manic episodes, with particular emphasis on the latter.(9,10) It is still unclear how, and to what…”

“Malkoff-Schwartz et al. (1998, 2000) found that individuals with BD I were significantly more likely to experience schedule-disrupting events prior to manic episodes, but not before depressive episodes, as compared to an episode-free control period.”

“Further, it may also be that people with certain disorders, such as unipolar depression, are more prone that non-disordered people to social irregularity, and that this irregularity (and preceding disruptive events) is not necessarily the cause of disorder [4] as it appears to be with manic bipolar disorder [11].”

“We argued that, in vulnerable individuals, changes in social time cues could lead to disruptions in circadian rhythms and ultimately to affective episodes and subsequently demonstrated that life events that were characterized by a high degree of social rhythm disruption were significantly associated with the onset of…”

“In two retrospective studies, people with bipolar I disorder reported more schedule-disrupting life events (i.e., events that disrupt meals, daily routines, and sleep) before manic than depressive onsets (Malkoff-Schwartz et al., 1998, 2000).”

“However, when the severity of the stressful life events is considered, severe events are related to the onset of both manic and depressive episodes ~Malkoff-Schwartz et al., 1998, 2000!.”

“Alternatively, the association of (hypo)manic symptoms and life events has only been consistently documented in samples with severe forms of bipolar disorder (i.e., bipolar I disorder with full-blown mania; Malkoff-Schwartz et al., 1998, 2000).”

“This consists of 13 common somatic symptoms with 3 possible explanations for each which are either somatic internal (SIQ-S), normalising/environmental (SIQ-N) or psychological/emotional (SIQ-P), each of which are rated on the same type of Likert scale as described above for HIQ.”

“Two efficacious behavioral therapies for BD sufferers, bright light exposure (phototherapy) [19–22] and social rhythm therapy [23, 24], both seek to maintain a fixed photoperiod/activity lengths.”

“Mania is characterized by hyperactivity of movement and thought, and can be precipitated or exacerbated by stress (Ambelas, 1979; Malkoff-Schwartz et al., 2000).”

“Since social rhythm disruptions are associated with manic and depressive symptoms (Gruber et al., 2011; Malkoff-Schwartz et al., 2000), this might be an additional explanation for the association we found between negative life events and mania.”

“In addition, life events characterized by social rhythm disruptions ~e.g., transmeridian air travel, birth of a child! have been found to precipitate manic episodes in individuals with bipolar I disorder ~Malkoff-Schwartz et al., 1998, 2000!.”

“The kindling model is supported by multiple studies that found major SLEs occurring particularly in the year before the first episode of mood disturbance [114, 115, 121] or early on in the course of illness [122].”

“In a retrospective study, Malkoff-Schwartz et al. (2000) found that life events associated with disrupted sleep patterns were associated with a greater number of manic rather than depressive episodes in individuals with bipolar I disorder.”

“In two retrospective studies with structured interview assessments of life events in bipolar I patients, Malkoff-Schwartz et al. (1998, 2000) found that manic episodes were significantly more likely to be preceded by social rhythm disruption (SRD) events than depressive episodes.”

“[90] Malkoff-Schwartz S, Frank E, Anderson B, Hlastala S, Luther J, Sherrill J, et al.”

“Sleep deprivation-induced changes in mood supports the social rhythm disruption (SRD) (social zeitgeber) theory of affective disorders (Grandin et al., 2006; Malkoff-Schwartz et al., 2000).”

“In patients with bipolar disorders life events which cause a social rhythm disruption were more frequently observed prior to (hypo-)manic episodes than prior to control periods without affective symptoms (e.g. Malkoff-Schwartz et al., 1998, 2000).”

“…as prior studies demonstrating that low social rhythm regularity predicts recurrences of bipolar mood episodes in individuals with BSDs (Shen et al., 2008) and that life events that disrupt social rhythms precipitate bipolar mood episodes (Malkoff-Schwartz et al., 1998; 2000; Sylvia et al., 2009).”

“Furthermore, stressful life events, particularly those that disrupt social rhythms (which is likely if people are confined to home), are often implicated in the onset and reoccurrence of mood disorders (30, 31).”

“More specifically, Malkoff–Schwartz et al. (2000) found that manic episodes, more so than depressive episodes, are associated with social rhythm disruption brought about by negative life events.”

“Further, Malkoff-Schwartz et al. (1998, 2000) found that manic patients had significantly more preonset stressors characterized by social rhythm disruption (e.g., change in sleep–wake cycle) than did depressed patients with bipolar disorder.”

“In fact, the etiology of depression has been tied to social zeitgebers since major life events are hypothesized to disrupt zeitgebers, which can dysregulate the circadian system and precipitate depressive episodes in vulnerable individuals (Ehlers et al., 1988; Haynes et al., 2006; Malkoff-Schwartz et al., 2000).”

“It has long been known that manic episodes are often preceded by life events that interfere with sleep (eg, transatlantic flights, childbearing) [27–29].”

“, 1988) and mania (Malkoff-Schwartz et al., 2000) in vulnerable individuals.”

“Social rhythms Disrupted social rhythms([182-184]) Lower daily regularity in anxiety”

“What is more, evidence suggests that disruptions to daily routin e, i cluding social interactions, caused by external events may trigger an onset of an episode in bipolar patients [5,10].”

“…are similar to emerging evidence from the adult bipolar literature, which has indicated that sleep duration and variability are prospectively associated with severity of mania and depression symptoms, constituting candidate targets for treatment (Malkoff-Schwartz et al., 2000; Gruber et al., 2010).”

“More in general, previous studies reported that life events characterized by disruption of daily routines are associated with the onset of depression and mania in adults.(28,29) An explanation for this discrepancy between younger patients and our results in older adults can be found in the maturation‐hypothesis, stati…”

“, 1986), social circadian rhythms have only recently become a focus of interest in MDD (Ehlers et al., 1988; Malkoff-Schwartz et al., 2000).”

“For example, disruptions in daily routines associated with life events have been associated with mania ( Malkoff-Schwartz et al, 2000 ) and children with anxiety disorders have later bedtimes than their peers ( Hudson, Gradisar, Gamble, Schniering, & Rebelo, 2009 ).”

“[9], in their seminal study, found that the onset of manic episodes was preceded”

“Such studies might be even more valuable, though, in providing information about potentially modifiable environmental triggers of episode recurrence (Malkoff-Schwartz et al., 2000; Monroe et al., 2006).”

“It has been suggested that affected circadian rhythm generation (sleep–wake cycles) and the development of certain mental illnesses, such as depression, bipolar disorders, and seasonal affective disorders are somehow correlated (Ehlers et al., 1988; Malkoff-Schwartz et al., 2000; Grandin et al., 2006; Lader, 2007; McC…”

“(i) Its appearance in BPD is related to stimuli by the environment [25, 26], which is uncommon in BD [27].”

“(2003) found that individuals with BD were exposed to significantly more independent SLEs 3 months prior to a BD depressive but not a manic episode compared to a euthymic phase; although other studies fail to detect this association (Malkoff-Schwartz et al., 2000).”

“The impact of life events and stressors on the onset and relapse of bipolar disorder (Johnson & Miller, 1997; Johnson & Roberts, 1995; Malkoff-Schwartz et al., 2000) suggests a potential role for psychosocial intervention in its management (Jones, 2004; Kahn et al.”

“Stressors like family or romantic conflicts and legal or disciplinary problems can trigger suicidal behaviors [17] and manic episodes [18,19].”