Bipolar Bozuklukta Baskın Polarite ve Kronotipin Lityum Yanıtına Etkisi

Yıl 2025, Cilt: 35 Sayı: 1, 110 - 115, 28.02.2025

Rukiye Tekdemir

https://doi.org/10.54005/geneltip.1611659

Öz

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Amaç: Bu çalışma, bipolar bozukluk (BD) tip 1 hastalarında baskın polarite (BP) - depresif baskın polarite (DBP) ve manik baskın polarite (MBP) -nin prevalansını ve klinik korelasyonlarını, kronotip ve lityum yanıtıylaa ilişkisini araştırmıştır.

Yöntem: Bu kesitsel çalışmaya, BD tip 1, remisyonda, 18-65 yaş arası 80 hasta dahil edilmiştir. Sosyodemografik ve klinik verilerin yanı sıra, remisyon durumu, lityum yanıt düzeyleri ve kronotip tercihleri Young Mani Değerlendirme Ölçeği, Hamilton Depresyon Değerlendirme Ölçeği, Nöropsikiyatride Biyolojik Ritim Değerlendirme Görüşmesi, Sabahçıl-Akşamcıl Ölçeği ve Alda Ölçeği kullanılarak değerlendirilmiştir. DBP ve MBP, sırasıyla hipomanik/manik veya depresif atakların ömür boyu oranı ≥2:1 olarak tanımlanmıştır.

Bulgular: Katılımcıların ortalama yaşı 35,32 ± 11,39 yıl olup, %61,25'i kadın (n=49) idi. Baskın polariteler %46,25 (n=37) DBP ve %53,75 (n=43) MBP idi. İki grup arasında tedavi türleri, toplam hastalık süresi veya toplam atak sayısı açısından anlamlı bir fark bulunmamıştır (p>0,05). Bununla birlikte, bozukluğun başlangıç yaşı MBP grubunda anlamlı derecede daha erkendi (p=0,009). Bu grup ayrıca BRIAN, MEQ ve Alda Ölçeği'nde anlamlı derecede daha yüksek puanlara sahipti (sırasıyla t=-7,183, p=0,00; t=-3,968, p=0,00; t=-6,971, p=0,00). Manik ataklar ile BRIAN arasında zayıf pozitif bir korelasyon bulunurken, MEQ ile güçlü pozitif bir korelasyon gözlemlenmiştir (sırasıyla rs1=-0,355, rs2=-0,373). Alda Ölçeği ile hem BRIAN hem de MEQ arasında güçlü pozitif korelasyonlar, toplam depresif atak sayısıyla ise güçlü negatif korelasyonlar belirlenmiştir (sırasıyla rs1=-0,355, rs2=-0,373, rs3=-0,274).

Sonuç: Bu kesitsel çalışma, BP ve kronotipin BD-I'li bireylerde lityum yanıtını önemli ölçüde etkilediğini göstermektedir. MBP grubunun, hastalık başlangıç yaşının daha erken ve daha belirgin akşamcıl özellikler sergilediği bulunmuştur. Ayrıca, MBP grubu lityuma daha güçlü bir yanıt göstermiştir. Bu bulgular, lityumun MBP'li ve akşam tipi kronotipe sahip bireyler üzerinde daha etkili olabileceğini ve daha büyük örneklemlerde ve uzunlamasına çalışmalar yoluyla doğrulamanması gereklitiğini vurgulamaktadır.

Anahtar Kelimeler

Bipolar bozukluk, mani, depresyon, lityum, baskın polarite, kronotip

The Influence of Predominant Polarity and Chronotype on Lithium Response in Bipolar Disorder

Öz

ABSTRACT
Aims: This study investigates the prevalence and clinical correlates of predominant polarity (PP)—depressive predominant polarity (DPP) and manic predominant polarity (MPP)—in patients with bipolar disorder (BD) type 1, as well as their association with chronotype and lithium response.
Method: Eighty patients aged 18-65, in remission from BD type 1, participated in this cross-sectional study. In addition to sociodemographic and clinical data, remission status, lithium response levels, and chronotype were evaluated using the Young Mania Rating Scale, Hamilton Depression Rating Scale, Biological Rhythms Interview of Assessment in Neuropsychiatry, Morningness-Eveningness Questionnaire, and Alda Scale. DPP and MPP were defined as a lifetime ratio of ≥2:1 of either hypomanic/manic episodes or depressive episodes, respectively. Results: The mean age of participants was 35.32 ± 11.39 years, with 61.25% being female (n=49). The dominant polarities were 46.25% (n=37) DPP and 53.75% (n=43) MPP. No significant differences were found between the two groups in terms of treatment types, total duration of illness, or total episode number (p>0.05). However, the onset age of the disorder was significantly earlier in the MPP group (p=0.009). This group also had significantly higher scores on the BRIAN, MEQ, and Alda Scale (t=-7.183, p=0.00; t=-3.968, p=0.00; t=-6.971, p=0.00, respectively). A weak positive correlation was found between manic episodes and BRIAN, while a strong positive correlation was observed with MEQ (respectively rs1=-0.355, rs2=-0.373). Strong positive correlations were noted between the Alda Scale and both BRIAN and MEQ, alongside strong negative correlations with the total number of depressive episodes (respectively rs1=-0.355, rs2=-0.373, rs3=-0.274).
Conclusion: This cross-sectional study demonstrates that PP and chronotype significantly influence lithium response in individuals with BD-I. The MPP group was found to have an earlier onset of the disorder and exhibit more pronounced evening characteristics. Additionally, the MPP group showed a stronger response to lithium. These findings suggest that lithium may have a greater effect on individuals with MPP and evening chronotype and highlight the need for validation through larger sample sizes and longitudinal studies

Anahtar Kelimeler

Bipolar disorder, mania, depression, lithium, predominant polarity, chronotype

Kaynakça

• 1. McIntyre RS, Berk M, Brietzke E, Goldstein BI, López-Jaramillo C, Kessing LV, et al. Bipolar disorders. The Lancet. 2020;396(10265):1841-56.
• 2. Grande I, Goikolea J, De Dios C, González‐Pinto A, Montes J, Saiz‐Ruiz J, et al. Occupational disability in bipolar disorder: analysis of predictors of being on severe disablement benefit (PREBIS study data). Acta Psychiatrica Scandinavica. 2013;127(5):403-11.
• 3. Calabrese JR, Hirschfeld RM, Frye MA, Reed ML. Impact of depressive symptoms compared with manic symptoms in bipolar disorder: results of a US community-based sample. Journal of Clinical Psychiatry. 2004;65(11):1499-504.
• 4. Kupka RW, Altshuler LL, Nolen WA, Suppes T, Luckenbaugh DA, Leverich GS, et al. Three times more days depressed than manic or hypomanic in both bipolar I and bipolar II disorder 1. Bipolar disorders. 2007;9(5):531-5.
• 5. Angst J. The course of affective disorders. Psychopathology. 1986;19(Suppl 2):47-52.
• 6. Colom F, Vieta E, Suppes T. Predominant polarity in bipolar disorders: refining or redefining diagnosis? : Wiley Online Library; 2015. p. 324-6.
• 7. Atay E, Ermiş Ç, Gökbayrak Atay İN, Aydemir Ö, Özmen E. The role of predominant polarity on cognitive dysfunctions in patients with bipolar disorder. International Journal of Bipolar Disorders. 2024;12(1):41.
• 8. Sentissi O, Popovic D, Moeglin C, Stukalin YB, Mosheva M, Vieta E, et al. Predominant polarity in bipolar disorder patients: the COPE bipolar sample. Journal of affective dAffective Disorders. 2019;250:43-50.
• 9. Azorin J, Adida M, Belzeaux R. Predominant polarity in bipolar disorders: Further evidence for the role of affective temperaments. Journal of Affective Disorders. 2015;182:57-63.
• 10. Bartoli F, Bassetti C, Gazzola M, Gianfelice L, Cavaleri D, Crocamo C, Carrà G. Prevalence and correlates of manic/hypomanic and depressive predominant polarity in bipolar disorder: systematic review and meta-analysis. BJPsych Open. 2024;10(3):e100.
• 11. Popovic D, Reinares M, Goikolea JM, Bonnin CM, Gonzalez-Pinto A, Vieta E. Polarity index of pharmacological agents used for maintenance treatment of bipolar disorder. European Neuropsychopharmacology. 2012;22(5):339-46.
• 12. Bailey SL, Heitkemper MM. Circadian rhythmicity of cortisol and body temperature: morningness-eveningness effects. Chronobiology international. 2001;18(2):249-61.
• 13. Boudebesse C, Lajnef M, Geoffroy P, Bellivier F, Nieto I, Gard S, et al. Chronotypes of bipolar patients in remission: validation of the French version of the circadian type inventory in the FACE-BD sample. Chronobiology international. 2013;30(8):1042-9.
• 14. Karadağ F, Oral ET, Aran Yalçın F, Erten E. Young mani derecelendirme ölçeğinin Türkiye’de geçerlik ve güvenilirliği. Türk Psikiyatri Dergisi. 2001;13(2):107-14.
• 15. Akdemir A, Türkçapar M, Örsel S, Demirergi N, Dag I, Özbay M. Reliability and validity of the Turkish version of the Hamilton Depression Rating Scale. Comprehensive psychiatry. 2001;42(2):161-5.
• 16. Colom F, Vieta E, Daban C, Pacchiarotti I, Sanchez-Moreno J. Clinical and therapeutic implications of predominant polarity in bipolar disorder. Journal of affective dAffective Disorders. 2006;93(1-3):13-7.
• 17. Aydemir O, Akkaya C, Altinbas K, Kora K, Suculluoglu Dikici D, Akdeniz F, et al. Reliability and validity of Turkish version of biological rhythms interview of assessment in neuropsychiatry. ANADOLU PSIKIYATRI DERGISI-ANATOLIAN JOURNAL OF PSYCHIATRY. 2012;13(4).
• 18. Agargun MY, Cilli AS, Boysan M, Selvi Y. Turkish version of the morningness-eveningness questionnaire (MEQ). Sleep and Hypnosis. 2007;9(1):16.
• 19. Grof P, Duffy A, Cavazzoni P, Grof E, Garnham J, MacDougall M, et al. Is response to prophylactic lithium a familial trait? Journal of Clinical Psychiatry. 2002;63(10):942-7.
• 20. Nivoli AM, Pacchiarotti I, Rosa AR, Popovic D, Murru A, Valenti M, et al. Gender differences in a cohort study of 604 bipolar patients: the role of predominant polarity. Journal of affective dAffective Disorders. 2011;133(3):443-9.
• 21. Carvalho AF, McIntyre RS, Dimelis D, Gonda X, Berk M, Nunes-Neto PR, et al. Predominant polarity as a course specifier for bipolar disorder: a systematic review. Journal of affective dAffective Disorders. 2014;163:56-64.
• 22. Fico G, Anmella G, Sague-Villavella M, Gomez-Ramiro M, Hidalgo-Mazzei D, Vieta E, Murru A. Undetermined predominant polarity in a cohort of bipolar disorder patients: prevalent, severe, and overlooked. Journal of Affective Disorders. 2022;303:223-9.
• 23. McCarthy MJ, Wei H, Nievergelt CM, Stautland A, Maihofer AX, Welsh DK, et al. Chronotype and cellular circadian rhythms predict the clinical response to lithium maintenance treatment in patients with bipolar disorder. Neuropsychopharmacology. 2019;44(3):620-8.
• 24. Kanagarajan K, Gou K, Antinora C, Buyukkurt A, Crescenzi O, Beaulieu S, et al. Morningness-Eveningness questionnaire in bipolar disorder. Psychiatry research. 2018;262:102-7.
• 25. Takaesu Y. Circadian rhythm in bipolar disorder: a review of the literature. Psychiatry and clinical neurosciences. 2018;72(9):673-82.
• 26. Taillard J, Sagaspe P, Philip P, Bioulac S. Sleep timing, chronotype and social jetlag: impact on cognitive abilities and psychiatric disorders. Biochemical pharmacology. 2021;191:114438.
• 27. Hsu C-W, Tsai S-Y, Tseng P-T, Liang C-S, Vieta E, Carvalho AF, et al. Differences in the prophylactic effect of serum lithium levels on depression and mania in bipolar disorder: a dose-response meta-analysis. European Neuropsychopharmacology. 2022;58:20-9.
• 28. Scott J, Bellivier F, Manchia M, Schulze T, Alda M, Etain B, et al. Can network analysis shed light on predictors of lithium response in bipolar I disorder? Acta Psychiatrica Scandinavica. 2020;141(6):522-33.
• 29. Rohr KE, McCarthy MJ. The impact of lithium on circadian rhythms and implications for bipolar disorder pharmacotherapy. Neuroscience letters. 2022;786:136772.
• 30. Hui T, Kandola A, Shen L, Lewis G, Osborn D, Geddes J, Hayes J. A systematic review and meta‐analysis of clinical predictors of lithium response in bipolar disorder. Acta Psychiatrica Scandinavica. 2019;140(2):94-115.
• 31. Tekdemir R, Selvi Y, Altınbaş K, Koçak N. Decreased miR-15b-5p/miR-155-5p levels and increased miR-134-5p/miR-652-3p levels among BD patients under lithium treatment. Journal of Affective Disorders. 2022;317:6-14.