精神医学59巻6号

2017年06月発行

特集 精神医学と睡眠学の接点

双極性障害における睡眠・覚醒リズム障害の意義

著者： 高江洲義和¹

所属機関： ¹東京医科大学精神医学分野

ページ範囲：P.535 - P.540

文献概要

はじめに
　近年，双極性障害の病態に概日リズム障害が密接な関連を持っていることが示唆されている。双極性障害における睡眠・覚醒リズムの乱れは症状の寛解期にも存在しており，躁症状やうつ症状に独立した重要な特性と考えられている。また概日リズム障害は気分障害の中でも特に双極性障害に特異性が高く，うつ病と双極性障害の早期の鑑別の糸口となることが示されつつある。双極性障害の非薬物療法として，高照度光療法や断眠療法などの時間生物学的治療介入による双極性障害の再発予防治効果が期待されている。本稿では双極性障害と概日リズム障害の関連についてのこれまでの研究知見を概説し，今後の双極性障害の臨床における概日リズム障害に着目した診断や治療への応用の可能性についても言及したい。

参考文献

1) Benedetti F, Serretti A, Colombo C, et al：Influence of CLOCK gene polymorphism on circadian mood fluctuation and illness recurrence in bipolar depression. Am J Med Genet B Neuropsychiatr Genet 123B：23-26, 2003

2) Benedetti F, Barbini B, Fulgosi MC, et al：Combined total sleep deprivation and light therapy in the treatment of drug-resistant bipolar depression：acute response and long-term remission rates. J Clin Psychiatry 66：1535-1540, 2005

3) Benedetti F, Riccaboni R, Locatelli C, et al：Rapid treatment response of suicidal symptoms to lithium, sleep deprivation, and light therapy(chronotherapeutics)in drug-resistant bipolar depression. J Clin Psychiatry 75：133-140, 2014

4) Duarte Faria A, Cardoso Tde A, Campos Mondin T, et al：Biological rhythms in bipolar and depressive disorders：A community study with drug-naive young adults. J Affect Disord 186：145-148, 2015

5) Frank E, Kupfer DJ, Thase ME, et al：Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. Arch Gen Psychiatry 62：996-1004, 2005

6) Harvey AG：Sleep and circadian rhythms in bipolar disorder：seeking synchrony, harmony, and regulation. Am J Psychiatry 165：820-829, 2008

7) Harvey AG, Soehner AM, Kaplan KA, et al：Treating insomnia improves mood state, sleep, and functioning in bipolar disorder：a pilot randomized controlled trial. J Consult Clin Psychol 83：564-577, 2015

8) Lee HJ, Son GH, Geum D：Circadian rhythm hypotheses of mixed features, antidepressant treatment resistance, and manic switching in bipolar disorder. Psychiatry Investig 10：225-232, 2013

9) Melo MC, Abreu RL, Linhares Neto VB, et al：Chronotype and circadian rhythm in bipolar disorder：a systematic review. Sleep Med Rev 2016. doi：10.1016/j.smrv.2016.06.007［Epub ahead of print］

10) Moon JH, Cho CH, Son GH, et al：Advanced Circadian Phase in Mania and Delayed Circadian Phase in Mixed Mania and Depression Returned to Normal after Treatment of Bipolar Disorder. EBioMedicine 11：285-295, 2016

11) Murray G, Harvey A：Circadian rhythms and sleep in bipolar disorder. Bipolar Disord 12：459-472, 2010

12) Ng TH, Chung KF, Ho FY, et al：Sleep-wake disturbance in interepisode bipolar disorder and high-risk individuals：a systematic review and meta-analysis. Sleep Med Rev 20：46-58, 2015

13) Nurnberger JI Jr, Adkins S, Lahiri DK, et al：Melatonin suppression by light in euthymic bipolar and unipolar patients. Arch Gen Psychiatry 57：572-579, 2000

14) Robillard R, Naismith SL, Rogers NL, et al：Sleep-wake cycle and melatonin rhythms in adolescents and young adults with mood disorders：comparison of unipolar and bipolar phenotypes. Eur Psychiatry 28：412-416, 2013

15) Scotti MA, Lee G, Stevenson SA, et al：Behavioral and pharmacological assessment of a potential new mouse model for mania. Physiol Behav 103：376-383, 2011

16) Seleem MA, Merranko JA, Goldstein TR, et al：The longitudinal course of sleep timing and circadian preferences in adults with bipolar disorder. Bipolar Disord 17：392-402, 2015

17) Shen GH, Alloy LB, Abramson LY, et al：Social rhythm regularity and the onset of affective episodes in bipolar spectrum individuals. Bipolar Disord 10：520-529, 2008

18) Sylvia LG, Dupuy JM, Ostacher MJ, et al：Sleep disturbance in euthymic bipolar patients. J Psychopharmacol 26：1108-1112, 2012

19) Takaesu Y, Inoue Y, Murakoshi A, et al：Prevalence of Circadian Rhythm Sleep-Wake Disorders and Associated Factors in Euthymic Patients with Bipolar Disorder. PLoS One 11：e0159578, 2016

20) Wever RA：The circadian system of man：results of experiments under temporal isolation. Springer-Verlag, New York, 1979