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The Relationship Between Affective State and the Rhythmicity of Activity in Bipolar Disorder

Robert Gonzalez, MD; Carol A. Tamminga, MD; Mauricio Tohen, MD; and Trisha Suppes, MD, PhD

Published: January 21, 2014

Article Abstract

Objective: The aim of this study was to test the relationships between mood state and rhythm disturbances as measured via actigraphy in bipolar disorder by assessing the correlations between manic and depressive symptoms as measured via Young Mania Rating Scale (YMRS) and 30-item Inventory for Depressive Symptomatology, Clinician-Rated (IDS-C-30) scores and the actigraphic measurements of rhythm, the 24-hour autocorrelation coefficient and circadian quotient.

Method: The research was conducted at the University of Texas Southwestern Medical Center at Dallas from February 2, 2009, to March 30, 2010. 42 patients with a DSM-IV-TR diagnosis of bipolar I disorder were included in the study. YMRS and the IDS-C-30 were used to determine symptom severity. Subjects wore the actigraph continuously for 7 days. The 24-hour autocorrelation coefficient was used as an indicator of overall rhythmicity. The circadian quotient was used to characterize the strength of a circadian rhythm.

Results: A greater severity of manic symptoms correlated with a lower degree of rhythmicity and less robust rhythms of locomotor activity as indicated by lower 24-hour autocorrelation (r = −0.3406, P = .03) and circadian quotient (r = −0.5485, P = .0002) variables, respectively. No relationship was noted between the degree of depression and 24-hour autocorrelation scores (r = −0.1190, P = .45) or circadian quotient (r = 0.0083, P = .96). Correlation was noted between the 24-hour autocorrelation and circadian quotient scores (r = 0.6347, P < .0001).

Conclusions: These results support the notion that circadian rhythm disturbances are associated with bipolar disorder and that these disturbances may be associated with clinical signatures of the disorder. Further assessment of rhythm disturbances in bipolar disorder is warranted.

J Clin Psychiatry

Submitted: March 31, 2013; accepted August 29, 2013.

Published online: January 21, 2014 (doi:10.4088/JCP.13m08506).

Corresponding author: Robert Gonzalez, MD, Department of Psychiatry, Texas Tech University Health Sciences Center at El Paso, El Paso, TX 79905 (

Volume: 75

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