|
Abstract
|
Symptoms of mental illness often become worse during the spring season. For patients with mood disorders, the phrase “spring fever” has a different meaning. Previous studies have reported that the incidence of mania peaks during the spring in both the Northern and Southern Hemispheres [1]. Many studies have indicated that suicide rates also peak during the spring season [2]. It has been suggested that the sudden increase in the duration and amount of sunlight is a possible cause of these phenomena. However, the mechanisms underlying the peak in incidence of mania and suicide during the spring season are unclear and remain to be elucidated.
All organisms on Earth must adapt to the 24-hour cycle of the Earth’s rotation and the yearly seasonal cycle of the Earth’s revolution. The daily light and dark cycle and the seasonal changes are a fundamental challenge to the necessary conditions for life; hence, all creatures have evolved a mechanism to adjust their physiology to these changes. The adjustment mechanism is the so-called circadian system. Circadian rhythms are physiological, mental, and behavioral changes that follow a roughly 24-hour cycle that regulates the approximate 24-hour cycle of biological processes, such as sleep or hormone production. The rhythms tent to be not exactly 24 hours, but slightly longer than 24-hours. Daily environmental cues, such as light, resets people’s circadian period back to the 24-hour day-night cycle. In mammals, circadian rhythms are generated by the suprachiasmatic nuclei (SCN) in a structure of the brain known as the hypothalamus with the day-night cycle as the primary environmental time cue that synchronizes the circadian system to the 24-hour day. Because the endogenous circadian system can also be sustained without external time cues, misalignment between the endogenous circadian system and an individual’s 24-hour environmental/behavioral cycles is possible, and it has been suggested that such misalignment can be related to health problems, especially mental illnesses [3]. The circadian system regulates monoaminergic activity in the brain that controls mood through the local expression of circadian genes. Recently, several studies have reported that the occurrence of mood disorders is related to shifts and misalignment in the circadian rhythm. Moon et al. [4] suggested that acute mood episodes are related to misalignment between the individual’s endogenous circadian rhythms and the individual’s physical environment. Acute manic episodes were associated with an average advance in the endogenous circadian rhythm over chronological time by 7 hours, although these could perhaps have resulted from an average of 17 hour clockwise delays. Individuals with mixed manias showed an average delay in their circadian cycle by more than 6 hours, whereas those with bipolar depression showed a 4 to 5 hour delay in their circadian cycle. It has been suggested that in patients with bipolar disorder, the circadian phase can be easily shifted by the disturbance of sleep-wake cycles and by unreliable zeitgebers (e.g., inappropriate artificial light). Cho et al. [5] observed that significant delays in the circadian pattern of salivary cortisol levels, when an individual is exposed to bright light before bedtime, is related to subthreshold bipolarity. These findings suggest that severe circadian shifting and misalignment may represent a pathophysiological mechanism underlying acute mood episodes and suicide attempts in susceptible individuals...
Copyright © 2018 Korean Neuropsychiatric Association
Language: en |