초록 ▼

- 조울증의 증상에 따른 생체리듬을 변동을 평가하여 재발 예측 및 예방의 가능성을 탐색함.
- 조증으로 입원한 조울증 환자에서 입원초기와 입원후 2주, 4주 및 퇴원 직전에 2일에 거쳐서 4시간 간격으로 구강상피세포와 타액을 채취하였음.
- 또한 입원기간동안 신체활동과 수면각성주기를 측정하기 위하여 actigraphy를 착용하게 함.
- 총 31명의 조울증 환자가 모집이 되었으며 이에 대하여 타액내의 cortisol 농도와 생체시계유전자 Per1/Bmal1 mRNA ratio를 4시간 간격으로 측정함.
- 그

- 조울증의 증상에 따른 생체리듬을 변동을 평가하여 재발 예측 및 예방의 가능성을 탐색함.
- 조증으로 입원한 조울증 환자에서 입원초기와 입원후 2주, 4주 및 퇴원 직전에 2일에 거쳐서 4시간 간격으로 구강상피세포와 타액을 채취하였음.
- 또한 입원기간동안 신체활동과 수면각성주기를 측정하기 위하여 actigraphy를 착용하게 함.
- 총 31명의 조울증 환자가 모집이 되었으며 이에 대하여 타액내의 cortisol 농도와 생체시계유전자 Per1/Bmal1 mRNA ratio를 4시간 간격으로 측정함.
- 그 결과 조증의 경우에는 내적생체시계(endogenous circadian clock)가 실제시간에 비하여 8시간정도 앞당겨져있다는(phase advanced)것을 확인하였으며, 치료 후 퇴원을 앞둔 안정된 상태에서는 앞당겨졌던 내적생체시계가 정상화되는 것을 확인하였음.
- 이는 내적 생체시계의 앞당겨짐이 조증의 유력한 중요한 원인 또는 기전임을 확인 것이며, 향후 이를 바탕으로 조울증의 재발과 예방에 중요한 biomarker로 생체시계 변동을 사용할 수 있음을 제시함.

Abstract ▼

Ⅰ. Objectives
- There is few clinical evidence in circadian rhythm disturbance in pathophysiology of bipolar disorder, although circadian hypotheses of bipolar disorder have been suggested.
- By checking endogenous clock of hospitalized bipolar manic patients with regular schedule, we tried to

Ⅰ. Objectives
- There is few clinical evidence in circadian rhythm disturbance in pathophysiology of bipolar disorder, although circadian hypotheses of bipolar disorder have been suggested.
- By checking endogenous clock of hospitalized bipolar manic patients with regular schedule, we tried to evaluate the possibility of clinical application of endogenous circadian clock dysfunction for prediction and recurrence prevention of mood episodes in bipolar disorder.
Ⅱ. Study
- Scheduled sampling were done for bipolar manic patients from early hospital days to discharge with two weeks intervals. We had collected sample of saliva and buccal cells with every 4 hours interval for two consecutive days.
- All participants wore actigraphs in non-dominant hands for evaluating the physical activity rhythm and sleep wake cycles.
- Total Thirty one bipolar patients were recruited. Cortisol levels in saliva and Per1/Bmal1 mRNA ratio were checked for evaluating endogenous circadian clock.
- For control sample, normal healthy subjects with regular sleep wake cycles were recruited for same methods with bipolar disorders.
Ⅲ. Results
- As a results, we found out the endogenous circadian clock was about 8 hours phase advanced in manic states of bipolar disorders compared to normal control. After successful treatment, the phase advanced endogenous clock was normalized.
- We found out that the endogenous clock phase advancement is one of the possible mechanism of bipolar manic state and circadian dysregulation can be a susceptible factor for the bipolar disorders.
- Base on these findings, we suggested that the circadian instability can be a biomarker for recurrence and prognosis in bipolar disorders
Ⅳ. Future Plan
- These findings are very interesting and applicable to clinical situation for improving prognosis and disease recurrence.
- Intervention for circadian dysregulation can be a novel tool for overcoming the limitation of recurrence of prevention of bipolar disorders.
- Circadian clock state can be a biomarker for the treatment direction in unstable bipolar disorder patients.
- Clinical application of wearable activity tracker for biological and social rhythm and gene chip for determining endogenous circadian clock are new technology for diagnosis and treatment of bipolar disorders.