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Stress, Rhythms Dysregulation and Bipolar Spectrum
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Stress, Rhythms Dysregulation and Bipolar Spectrum

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Mental Health".

Deadline for manuscript submissions: 20 January 2025 | Viewed by 13510

Special Issue Editors

Prof. Dr. Mauro Giovanni Carta

E-Mail Website
Guest Editor
Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
Interests: psychiatric epidemiology; global mental health; human rights and mental health; quality of care; psychiatric epidemiology; mood disorders; translational medicine bedside to the community
Dr. Giulia Cossu

E-Mail Website
Guest Editor
Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
Interests: psychopathology; psychological assessment; psychotherapeutic processes; counseling; mental illness; clinical assessment; psychoeducation; personality assessment; behavioral psychology; psychological testing

Special Issue Information

Dear Colleagues,

We are delighted to announce a Special Issue of Journal of Clinical Medicine dedicated to exploring recent perspectives on “Stress, Rhythms Dysregulation and Bipolar Spectrum".

Recent evidence suggests that dysregulated social and biological rhythms may significantly contribute to mood disorder development, especially in stressful conditions like the COVID-19 pandemic. Moreover, contemporary socio-economic and cultural factors may both exacerbate bipolar disorder prevalence and lead to paradoxical adaptive conditions in certain cases. The term "Bipolar Spectrum", rooted in the neo-Kraepelinian tradition, encompasses a broad spectrum of mental health conditions beyond traditional bipolar disorder definitions, including depression, mood swings, impulse control disorders, anxiety disorders, personality disorders, substance abuse, and cognitive impairment. This dimensional approach enables us to examine elements across a spectrum, ranging from premorbid functioning systems characterized by traits such as hyperactivity, hyper-energy, and novelty-seeking, to more accurately characterizing prodromal symptoms and the onset of the disorder.

We invite relevant experts and colleagues to share their latest research findings to contribute their scientific and clinical insights on the topic. We encourage submissions of original research, comprehensive reviews, insightful case studies, new treatments and non-pharmacological interventions, and the implementation of strategies for managing medical comorbidities and risk factors. Our aim is to curate a collection of impactful works that hold clinical significance in tailoring care for individuals throughout their lifespan.

Prof. Dr. Mauro Giovanni Carta
Dr. Giulia Cossu
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

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Keywords

  • bipolar spectrum
  • neo-Kraepelinian tradition
  • dimensional approach
  • social rhythms
  • chronobiological rhythms

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Published Papers (13 papers)

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Editorial

Jump to: Research

5 pages, 193 KiB  
Editorial
Stress, Dysregulation of Rhythms, and Bipolar Disorder: A Challenging Field of Research
by Mauro Giovanni Carta, Elie Georges Karam and Giulia Cossu
J. Clin. Med. 2024, 13(10), 3014; https://doi.org/10.3390/jcm13103014 - 20 May 2024
Viewed by 1059
Abstract
Clarifying the mechanisms by which circadian rhythms regulate biology is a central issue in directing life choices in the immediate future and presents an interesting challenge for current scientific research [...] Full article
(This article belongs to the Special Issue Stress, Rhythms Dysregulation and Bipolar Spectrum)

Research

Jump to: Editorial

14 pages, 291 KiB  
Article
Adaptive Hyperactivity and Biomarker Exploration: Insights from Elders in the Blue Zone of Sardinia
by Alessandra Scano, Germano Orrù, Goce Kalcev, Massimo Tusconi, Maura Spada, Laura Atzori, Caterina Ferreli, Flavio Cabitza, Diego Primavera and Federica Sancassiani
J. Clin. Med. 2024, 13(21), 6451; https://doi.org/10.3390/jcm13216451 - 28 Oct 2024
Viewed by 452
Abstract
Background/Objectives: Adaptive hyperactivity characterized by increased activity levels and novelty-seeking traits without mood disorders is prevalent among older adults in Sardinia’s “blue zone,” an area with high longevity. This study aims to evaluate the adaptive nature of hyperactivity concerning quality of life, social [...] Read more.
Background/Objectives: Adaptive hyperactivity characterized by increased activity levels and novelty-seeking traits without mood disorders is prevalent among older adults in Sardinia’s “blue zone,” an area with high longevity. This study aims to evaluate the adaptive nature of hyperactivity concerning quality of life, social rhythms, and mood symptoms in individuals from this region, particularly among elderly adults over 80. Methods: This observational cross-sectional study included adults and older adults over 80 from Sardinia’s blue zone. This study included a sample of patients followed at the Center for Consultation Psychiatry and Psychosomatics for Bipolar Disorder of the University Hospital of Cagliari and a homogeneous comparison sample of patients without psychiatric pathologies, referred to the Dermatology Clinic of the same hospital, for a period of 6 months, from February to August 2024. The general sample, divided into two parts—cases, represented by patients with psychiatric pathology, and controls, patients without psychiatric pathology—was divided in turn into three sub-groups: “adults” (18–64 years), young elders (65–79), and old elders (over 80 years). The participants underwent psychiatric interviews and completed the Mood Disorder Questionnaire (MDQ), Patient Health Questionnaire (PHQ-9), SF-12, and Brief Social Rhythm Scale (BSRS). Data were compared with national and regional normative data. Results: Older adults in the blue zone demonstrated higher MDQ positivity (22.58%) compared to the national averages (0.87%), without corresponding increases in dysregulated rhythms, depressive symptoms, or reduced quality of life. Younger old persons (65–79 years) showed increased rhythm dysregulation (BSRS score: 20.64 ± 7.02) compared to adults (17.40 ± 6.09, p = 0.040), but this trend was not observed in the oldest group (80+ years). No significant differences were found in the CH3SH and (CH3)2S levels between groups. Conclusions: The hyperactivity observed in older adults from Sardinia’s blue zone appears adaptive and not linked to social rhythm dysregulation, depressive symptoms, or a diminished quality of life, suggesting resilience factors which may contribute to longevity. These findings support the potential classification of such hyperactivity as beneficial rather than pathological, warranting further research into biomarkers and psychoeducational interventions to prevent the onset of bipolar disorders in predisposed individuals. Full article
(This article belongs to the Special Issue Stress, Rhythms Dysregulation and Bipolar Spectrum)
11 pages, 259 KiB  
Article
Alexithymia and Bipolar Disorder: Virtual Reality Could Be a Useful Tool for the Treatment and Prevention of These Conditions in People with a Physical Comorbidity
by Federica Sancassiani, Alessandra Perra, Alessia Galetti, Lorenzo Di Natale, Valerio De Lorenzo, Stefano Lorrai, Goce Kalcev, Elisa Pintus, Elisa Cantone, Marcello Nonnis, Antonio Egidio Nardi, Roberta Montisci and Diego Primavera
J. Clin. Med. 2024, 13(20), 6206; https://doi.org/10.3390/jcm13206206 - 18 Oct 2024
Cited by 1 | Viewed by 681
Abstract
Background: Alexithymia, a predictor in chronic illnesses, like cardiovascular and bipolar disorder (CD–BD), could be improved with a virtual reality (VR) cognitive remediation program. This secondary analysis of a previous randomized controlled trial (RCT) evaluates alexithymia improvement and its factors in an experimental [...] Read more.
Background: Alexithymia, a predictor in chronic illnesses, like cardiovascular and bipolar disorder (CD–BD), could be improved with a virtual reality (VR) cognitive remediation program. This secondary analysis of a previous randomized controlled trial (RCT) evaluates alexithymia improvement and its factors in an experimental group versus a control group, exploring extensions to individuals with comorbid non-psychiatric chronic conditions. Methods: A feasibility cross-over RCT (ClinicalTrials.gov NCT05070065) enrolled individuals aged 18–75 with mood disorders (BD, DSM-IV), excluding those with relapses, epilepsy, or severe eye conditions due to potential risks with VR. Alexithymia levels were measured using the Toronto Alexithymia Scale with 20 items (TAS-20). Results: The study included 39 individuals in the experimental group and 25 in the control group, with no significant age or sex differences observed. Significantly improved alexithymia scores were noted in the experimental group compared to controls (F = 111.9; p < 0.0001) and in subgroups with chronic non-psychiatric comorbidities (F = 4.293, p = 0.048). Scores were particularly improved for difficulty in identifying feelings (F = 92.42; p < 0.00001), communicating feelings (F = 61.34; p < 0.00001), and externally oriented thinking (F = 173.12; p < 0.00001). Conclusions: The findings highlight alexithymia enhancement in BD, even with comorbid non-psychiatric chronic diseases. Given its impact on BD progression and related conditions, like CD, developing and evaluating VR-based tools in this context is suggested by these findings. Full article
(This article belongs to the Special Issue Stress, Rhythms Dysregulation and Bipolar Spectrum)
13 pages, 269 KiB  
Article
Prevalence and Risk by Age and Sex of Sleep Dysregulation and Depressive Episodes in Bipolar and Depressive Disorders in a Community Survey in Sardinia, Italy
by Patrizia Congiu, Mauro Giovanni Carta, Alessandra Perra, Elisa Cantone, Stefano Lorrai, Elisa Pintus, Massimo Tusconi, Giulia Cossu, Stefania Redolfi and Federica Sancassiani
J. Clin. Med. 2024, 13(16), 4870; https://doi.org/10.3390/jcm13164870 - 18 Aug 2024
Cited by 1 | Viewed by 703
Abstract
Background/Objectives: Sleep disturbances often accompany mood disorders and persistent insomnia after mood symptoms have resolved may be a marker of poor outcome. The association between sleep symptoms and mood disorders seems to change with age and sex. This study aims to assess [...] Read more.
Background/Objectives: Sleep disturbances often accompany mood disorders and persistent insomnia after mood symptoms have resolved may be a marker of poor outcome. The association between sleep symptoms and mood disorders seems to change with age and sex. This study aims to assess the frequency of depressive episodes and sleep disorders in the general population through an agile screening questionnaire and to evaluate the association of depressive episodes and sleep symptoms by sex and age categories. Methods: 774 women and 728 men from Sardinia aged > 16 years old were enrolled. The Patient Health Questionnaire (PHQ-9) was administered through a computer-assisted telephonic interview. Results: The frequency of depressive episodes was double in women (10.6% vs. 4.4%; p < 0.0001), with the highest values in women > 75 yo (17.4%). The frequency of sleep dysregulation was double in women (18.7% vs. 9.6%; p < 0.0001), with the highest values in women > 75 yo (35.9%) and the lowest in the group of men > 75 yo. The group of young males showed the lowest frequency of depressive episodes (1.4%) and a frequency of sleep dysregulation (9.1%) similar to that of the other groups of age and sex. Sleep dysregulation without depressive episodes presented a higher distribution in the elderly, both in males (20.7%) and in females (18.5%). No significative differences were found across sex and age groups in the distribution of depressive episodes without sleep dysregulation. Conclusions: The use of an agile screener such as PHQ9 in the general population and/or in populations at risk can be a valuable tool in finding those individuals in whom sleep dysregulation may represent an early warning signal, one that may be thoroughly evaluated to identify and treat possible sleep disorders early. Full article
(This article belongs to the Special Issue Stress, Rhythms Dysregulation and Bipolar Spectrum)
11 pages, 642 KiB  
Article
Cognitive Function in Patients with Psychotic and Affective Disorders: Effects of Combining Pharmacotherapy with Cognitive Remediation
by Eva I. J. Maihofer, Gabriele Sachs and Andreas Erfurth
J. Clin. Med. 2024, 13(16), 4843; https://doi.org/10.3390/jcm13164843 - 16 Aug 2024
Viewed by 640
Abstract
Background: Cognitive impairment is a relevant problem in psychiatry and can be well assessed with a cross-diagnostic test such as the Screen for Cognitive Impairment in Psychiatry (SCIP). The aim of our pilot study is to assess cognitive impairment in acute psychiatric [...] Read more.
Background: Cognitive impairment is a relevant problem in psychiatry and can be well assessed with a cross-diagnostic test such as the Screen for Cognitive Impairment in Psychiatry (SCIP). The aim of our pilot study is to assess cognitive impairment in acute psychiatric inpatients diagnosed with psychotic disorders, bipolar disorder and depression using the German version of the SCIP (SCIP-G). We also investigate whether cognitive dysfunction improves over the course of the inpatient treatment, where patients are offered a combination of pharmacological treatment and cognitive remediation. Methods: A total of 143 adult inpatients were included in the study. Cognitive testing was performed using two different forms of the SCIP-G. All patients received state-of-the-art pharmacotherapy and cognitive remediation using the COGPACK® software package version 6.06. Results: Based on the ICD-10 Criteria for Research, 54 patients were given an F2 diagnosis (schizophrenia and schizotypal and delusional disorders). Thirty-nine patients met the criteria for bipolar disorder (F30 and F31) and fifty for depression (F32 and F33). At baseline, a significant difference was observed between the SCIP total scores of the F2 and F32/33 patients (p < 0.001) and between the F2 and F30/31 groups (p = 0.022). At the second measurement time point, the SCIP total score showed significant improvement in all three groups (p < 0.001), and there was no statistically significant interaction between SCIP total score and diagnostic groups (p = 0.860). Conclusions: Cognitive dysfunction is present in psychiatric disorders and can be easily assessed during an inpatient hospital stay. In our sample, patients with a psychotic disorder were more cognitively impaired at baseline than patients with an affective disorder. Inpatient treatment, consisting of pharmacotherapy and cognitive remediation, improved cognitive deficits. Patients with psychotic disorders, bipolar disorder and depression showed similar improvements in cognitive performance. Full article
(This article belongs to the Special Issue Stress, Rhythms Dysregulation and Bipolar Spectrum)
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14 pages, 540 KiB  
Article
Major Depressive Disorder with Catatonia: A Phenotype Related to Autistic Traits and High Suicidality
by Barbara Carpita, Giulia Amatori, Ivan Mirko Cremone, Chiara Bonelli, Benedetta Nardi, Gabriele Massimetti, Stefano Pini and Liliana Dell’Osso
J. Clin. Med. 2024, 13(16), 4796; https://doi.org/10.3390/jcm13164796 - 14 Aug 2024
Viewed by 997
Abstract
Background: Major Depressive Disorder (MDD) represents a significant global health concern, often complicated by comorbidities such as catatonia and autism spectrum disorder (ASD). Recognizing the interplay among these conditions and their impact on suicidal tendencies is crucial for effective clinical management. Methods [...] Read more.
Background: Major Depressive Disorder (MDD) represents a significant global health concern, often complicated by comorbidities such as catatonia and autism spectrum disorder (ASD). Recognizing the interplay among these conditions and their impact on suicidal tendencies is crucial for effective clinical management. Methods: A total sample of 147 subjects with MDD was divided into Significant Catatonia (SC) and Non-Significant Catatonia (NSC) groups based on Catatonia Spectrum (CS) scores. Participants were evaluated through the Structured Clinical Interview for DSM-5, Research Version (SCID-5-RV), the Adult Autism Subtreshold Spectrum (AdAS Spectrum), and the Mood Spectrum—Self Report questionnaires. Statistical analyses included Mann–Whitney U test, Chi-square test, logistic regression analyses, and a decision tree model. Results: The SC group exhibited higher CS, AdAS Spectrum, and MOODS-SR total and domain scores compared to the NSC group. Individuals with significant autistic traits were over-represented in the SC group, as well as participants with higher suicidality, suicidal ideation, and a history of suicide attempts. The total AdAS Spectrum and MOOD-SR score, the AdAS domain “Hyper-hypo reactivity to sensory input”, and the “Cognitive depressive” MOOD-SR domain were predictive of belonging to the SC group. Suicidality levels appeared to be higher in clinically significant ASD, intermediate in subjects with autistic traits (AT), and low in the absence of AT. Conclusions: the study suggests the existence of a specific phenotype of MDD associated with catatonia, characterized by elevated autistic traits and suicide risk. Full article
(This article belongs to the Special Issue Stress, Rhythms Dysregulation and Bipolar Spectrum)
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11 pages, 257 KiB  
Article
A Virtual Reality Cognitive Stimulation Program as an Effective Tool Against Residual/Prodromal Depressive Symptoms in Bipolar Disorders
by Mauro Giovanni Carta, Peter K. Kurotschka, Sergio Machado, Andreas Erfurth, Federica Sancassiani, Alessandra Perra, Massimo Tusconi, Giulia Cossu, Cesar Ivan Aviles Gonzalez and Diego Primavera
J. Clin. Med. 2024, 13(16), 4714; https://doi.org/10.3390/jcm13164714 - 11 Aug 2024
Cited by 1 | Viewed by 1126
Abstract
Background: Bipolar disorder (BD) is a severe psychiatric illness characterized by a chronic course and recurrent episodes, including residual depressive symptoms even during euthymic phases. These symptoms, although not meeting criteria for a depressive episode, are linked to relapse risk and impaired social [...] Read more.
Background: Bipolar disorder (BD) is a severe psychiatric illness characterized by a chronic course and recurrent episodes, including residual depressive symptoms even during euthymic phases. These symptoms, although not meeting criteria for a depressive episode, are linked to relapse risk and impaired social functioning. This study aims to assess whether Virtual Reality Cognitive Remediation Training reduces depressive symptoms below the clinical threshold in individuals with BD. Methods: This post hoc analysis focuses on the secondary outcome (PHQ9) of a randomized–controlled trial. Participants were recruited from the Center of Liaison Psychiatry and Psychosomatics in Italy. The experimental group received Virtual Reality Cognitive Remediation, while the control group received standard treatment Results: Data from 39 individuals in the experimental group and 25 in the control group were analyzed. A greater reduction in PHQ-9 scores (>9) was observed in the experimental group (71.8% to 48.7%) compared to the control group. Significant improvements in total PHQ-9 scores and specific symptoms were noted in the experimental group compared to the control group. Conclusions: The study highlights the significant impact of virtual reality intervention on reducing depressive symptoms in bipolar disorder. This promising outcome underscores the potential preventive role of cognitive stimulation in relapse prevention. The intervention could offer valuable benefits for both treatment and prevention strategies in bipolar disorder. Full article
(This article belongs to the Special Issue Stress, Rhythms Dysregulation and Bipolar Spectrum)
14 pages, 3772 KiB  
Article
Hyperactivity and Risk for Dysregulation of Mood, Energy, and Social Rhythms Syndrome (DYMERS): Standardization of a Simple One-Item Screener versus the Mood Disorder Questionnaire (MDQ)
by Uta Ouali, Amina Aissa, Salsabil Rejaibi, Nada Zoghlami, Amine Larnaout, Yosra Zgueb, Mejdi Zid, Hajer Aounallah Skhiri, Goce Kalcev, Massimo Tusconi, Cesar Ivan Aviles Gonzales, Antonio Preti and Diego Primavera
J. Clin. Med. 2024, 13(15), 4433; https://doi.org/10.3390/jcm13154433 - 29 Jul 2024
Cited by 1 | Viewed by 1032
Abstract
Background: This study aims to verify the accuracy of item 10 on the energy level of the Short-Form Health Survey (SF-12) in an item screening according to Mood Disorder Questionnaire (MDQ) results, providing a measure of hyper-energy. Methods: Regression techniques were employed in [...] Read more.
Background: This study aims to verify the accuracy of item 10 on the energy level of the Short-Form Health Survey (SF-12) in an item screening according to Mood Disorder Questionnaire (MDQ) results, providing a measure of hyper-energy. Methods: Regression techniques were employed in a dataset comprising 4093 records of respondents to test both linear and nonlinear relationships between predictor and outcome variables (energy level and symptoms considered in the MDQ). We examined the relationship of energy level with cases identified using MDQ with a cut-off of 7. Results: Levels of energy, as rated on item 10 of the SF-12, were related to the MDQ score with sensitivity = 0.72 and specificity = 0.70. In linear regression, the associations were stronger with MDQ items on excessive energy or activity, showing a medium effect size and an explained variance of 10% or higher. A greater association was observed for items on excessive energy and activity, as expected, as well as for items concerning self-confidence, sociability, and talkativeness. Conclusions: This result may have implications for the research on risk factors and the pathogenesis of the dysregulation of mood, energy, and social rhythms syndrome (DYMERS), a syndrome that is hypothesized to occur in stressful conditions like those shown under the COVID-19 pandemic. Full article
(This article belongs to the Special Issue Stress, Rhythms Dysregulation and Bipolar Spectrum)
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12 pages, 249 KiB  
Article
Are Depressive Symptoms in Obstructive Sleep Apnea Attributable to a Syndrome of Dysregulation of Rhythms and Hyperactivity (DYMERS)?
by Diego Primavera, Elisa Cantone, Gregorio Marco Cannizzaro, Chiara Sanna and Stefania Redolfi
J. Clin. Med. 2024, 13(15), 4396; https://doi.org/10.3390/jcm13154396 - 27 Jul 2024
Viewed by 851
Abstract
Background: Obstructive sleep apnea (OSA) is characterized by repeated airway obstructions during sleep, causing hypopnea, apnea, intermittent hypoxia, and sleep fragmentation. The severity of OSA is measured using the apnea–hypopnea index (AHI), with AHI ≥ 5 indicating OSA. This study aims to assess [...] Read more.
Background: Obstructive sleep apnea (OSA) is characterized by repeated airway obstructions during sleep, causing hypopnea, apnea, intermittent hypoxia, and sleep fragmentation. The severity of OSA is measured using the apnea–hypopnea index (AHI), with AHI ≥ 5 indicating OSA. This study aims to assess the frequency and type of depressive disorder characteristics of OSA patients and to evaluate the impact on quality of life, also considering the presence of hyperactivity. Methods: A case-control study using OSA patients referred to Cagliari’s sleep disorder center. Controls were matched by age and sex from community databases. OSA diagnoses were made with AHI > 15. Depressive episodes were identified using BDI-SF, and H-QoL (Health related Quality of Life) was measured with the SF-12, focusing on item 10 for hyper-energy. Results: The clinical sample (n = 25) had a higher frequency of depressive episodes (36%) compared to controls (7% and 4%). Depressed OSA patients had worse H-QoL and higher hyper-energy scores, but the additional burden from depression was relatively low. Conclusions: The OSA sample has a higher frequency of depressive episodes compared to the general population. Depressive episodes in OSA patients are linked to higher scores on item 10 of the SF-12, indicating hyper-energy despite lower overall quality of life scores. While OSA significantly impacts quality of life, the additional burden from depression is less severe than in other chronic diseases. These findings suggest that depressive episodes in OSA may be related to rhythm dysregulation and hyperactivity (DYMERS). Full article
(This article belongs to the Special Issue Stress, Rhythms Dysregulation and Bipolar Spectrum)
14 pages, 282 KiB  
Article
The Impact on Anxiety Symptoms of an Immersive Virtual Reality Remediation Program in Bipolar Disorders: A Randomized Clinical Trial
by Diego Primavera, Antonio Urban, Elisa Cantone, Marcello Nonnis, Cesar Ivan Aviles Gonzalez, Alessandra Perra, Massimo Tusconi and Federica Sancassiani
J. Clin. Med. 2024, 13(14), 4203; https://doi.org/10.3390/jcm13144203 - 18 Jul 2024
Viewed by 1090
Abstract
Background: The objective of this work is to investigate the effectiveness of a cognitive remediation intervention on anxiety symptoms in people with bipolar disorder and the therapeutic effect on people whose anxiety symptoms were above the threshold for a screener and whose [...] Read more.
Background: The objective of this work is to investigate the effectiveness of a cognitive remediation intervention on anxiety symptoms in people with bipolar disorder and the therapeutic effect on people whose anxiety symptoms were above the threshold for a screener and whose comorbidity could be identified as an anxiety disorder. Methods: The experimental intervention included 24 sessions (around 45 min each), two for each week over three months. The entire program was inspired by user-centered rehabilitation principles in a recovery-oriented perspective and an approach to bipolar disorder in an evolutionary and non-discriminating vision. The primary outcomes measure the score of the Zung Self-Rating Anxiety Scale (SAS), hypothesizing a higher decrease in the experimental group than in the control group. The survey has been conducted per the CONSORT guidelines for feasibility studies. Results: We evaluate a decrease in the overall SAS score from T0 to T1 to be higher in the experimental group compared to the control group, indicating an improvement in anxiety symptoms (p < 0.0001). Conclusions: The study suggests that virtual reality could have a role in treating anxiety symptoms and disorders in young adults with bipolar disorders or anxiety symptoms in people with hyperactivity and novelty-seeking behaviorsunder stress and high risk for bipolar disorder. Full article
(This article belongs to the Special Issue Stress, Rhythms Dysregulation and Bipolar Spectrum)
10 pages, 247 KiB  
Article
Heart Rate Variability Biofeedback Efficacy on Fatigue and Energy Levels in Fibromyalgia: A Secondary Analysis of RCT NCT0412183
by Mauro Giovanni Carta, Giulia Cossu, Diego Primavera, Cesar Ivan Aviles Gonzalez, Giorgia Testa, Serena Stocchino, Gabriele Finco, Maria Teresa Littera, Maria Cristina Deidda, Stefano Lorrai, Clelia Madeddu, Antonio Egidio Nardi and Federica Sancassiani
J. Clin. Med. 2024, 13(14), 4008; https://doi.org/10.3390/jcm13144008 - 9 Jul 2024
Viewed by 1161
Abstract
Background: Fibromyalgia syndrome (FMs) is a chronic condition characterized by widespread musculoskeletal pain and a range of complex symptoms, with chronic fatigue being a central feature significantly impacting daily life. The aim of this study was to analyze the secondary outcomes, specifically [...] Read more.
Background: Fibromyalgia syndrome (FMs) is a chronic condition characterized by widespread musculoskeletal pain and a range of complex symptoms, with chronic fatigue being a central feature significantly impacting daily life. The aim of this study was to analyze the secondary outcomes, specifically those related to perceived energy and fatigue symptoms in a randomized controlled trial (RCT) assessing the efficacy of heart rate variability biofeedback (HRV-BF) as an adjunctive treatment for FMs. Methods: Sixty-four FMs patients were randomly assigned to either receive 10 HRV-BF training sessions alongside standard pharmacological therapy (experimental group) or standard therapy alone for 10 weeks (control group). For this secondary analysis, potential improvements in specific items were evaluated regarding perceived energy (Item 10 of the Short-Form Health Survey), the ability to walk and climb stairs (Item 7 and Item 11 of the Fibromyalgia Impact Questionnaire, respectively), and the impact of pain on movement ability (Item 17 of the Bodily and Emotional Perception of Pain). Results: The experimental group demonstrated an improvement in the perception of energy, the ability to walk, and the impact of pain on movement ability. However, the same improvement was not observed in the ability to climb stairs. Conclusions: Fatigue assessment has emerged as a crucial factor for evaluating treatment efficacy in FMs and related conditions linked to altered energy levels, such as bipolar depression, and can offer valuable insights for precisely guiding HRV-BF treatments. ClinicalTrials.gov with code: NCT04121832. Full article
(This article belongs to the Special Issue Stress, Rhythms Dysregulation and Bipolar Spectrum)
11 pages, 269 KiB  
Article
Improving Quality of Life in Bipolar Disorders with an Immersive Virtual Reality Remediation Training Randomized Controlled Trial (RCT)
by Diego Primavera, Gian Mario Migliaccio, Valentino Garau, Germano Orrù, Alessandra Scano, Alessandra Perra, Samantha Pinna, Massimo Tusconi, Mauro Giovanni Carta and Federica Sancassiani
J. Clin. Med. 2024, 13(13), 3886; https://doi.org/10.3390/jcm13133886 - 2 Jul 2024
Cited by 1 | Viewed by 1003
Abstract
Background: Health-related quality of life (H-QoL) is a critical measure in bipolar disorder (BD). Recent trials using virtual reality (VR) have shown potential in improving H-QoL. However, VR’s effect on the H-QoL of people with BD needs to be further explored. Methods: This [...] Read more.
Background: Health-related quality of life (H-QoL) is a critical measure in bipolar disorder (BD). Recent trials using virtual reality (VR) have shown potential in improving H-QoL. However, VR’s effect on the H-QoL of people with BD needs to be further explored. Methods: This study involved a secondary analysis of a feasibility randomized controlled trial, focusing on “quality of life”. Participants (aged 18–75) diagnosed with bipolar disorder were randomized into two groups. The experimental group used the CEREBRUM VR app, while the control group received the usual care. Quality of life was assessed using the Short-Form Health Survey (SF-12). Results: A total of 39 individuals in the experimental group and 25 in the control group represent the final samples. The results showed a greater improvement in the SF-12 total score in the experimental group (8.7%) compared to the control group (F = 66.851 p < 0.0001), specifically in the dimension of physical activity limitation, emotional impact, concentration, pain, calmness, energy levels, discouragement, and social activities. Conclusions: This study demonstrated an improvement in QoL for individuals with BD following a VR intervention. As a feasibility study, this secondary outcome needs to be confirmed by further phase III studies. If confirmed, VR could offer valuable rehabilitation tools and insights into the pathogenesis and treatment of BD. Full article
(This article belongs to the Special Issue Stress, Rhythms Dysregulation and Bipolar Spectrum)
11 pages, 1007 KiB  
Article
Improving Social and Personal Rhythm Dysregulation in Young and Old Adults with Bipolar Disorder: Post-Hoc Analysis of a Feasibility Randomized Controlled Trial Using Virtual Reality-Based Intervention
by Federica Sancassiani, Alessandra Perra, Peter K. Kurotschka, Goce Kalcev, Alessia Galetti, Rosanna Zaccheddu, Aurora Locci, Federica Piludu, Lorenzo Di Natale, Valerio De Lorenzo, Michele Fornaro, Antonio Egidio Nardi and Diego Primavera
J. Clin. Med. 2024, 13(13), 3786; https://doi.org/10.3390/jcm13133786 - 27 Jun 2024
Cited by 3 | Viewed by 1824
Abstract
Introduction: Rehabilitative interventions employing technology play a crucial role in bipolar disorder (BD) treatment. The study aims to appraise the virtual reality (VR)-based cognitive remediation (CR) and the interpersonal rhythm approaches to treatment outcomes of BD across different age groups. Methods: Post-hoc analysis [...] Read more.
Introduction: Rehabilitative interventions employing technology play a crucial role in bipolar disorder (BD) treatment. The study aims to appraise the virtual reality (VR)-based cognitive remediation (CR) and the interpersonal rhythm approaches to treatment outcomes of BD across different age groups. Methods: Post-hoc analysis of a 12-week randomizedcontrolled cross-over feasibility trial involving people with mood disorders (BD, DSM-IV) aged 18–75 years old: thirty-nine exposed to the experimental VR-based CR vs 25 waiting list controls. People with BD relapse, epilepsy or severe eye diseases (due to the potential VR risks exposure) were excluded. Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) was used to measure the outcome. Results: Cases and controls did not statistically significantly differ in age and sex distributions. Personal rhythm scores improved over the study follow-up in the experimental vs the control group (APC = 8.7%; F = 111.9; p < 0.0001), both in young (18–45 years) (APC = 5.5%; F = 70.46; p < 0.0001) and, to a lesser extent, older (>46 years) adults (APC = 10.5%; F = 12.110; p = 0.002). Conclusions: This study observed improved synchronization of personal and social rhythms in individuals with BD after a virtual reality cognitive remediation intervention, particularly in social activity, daily activities, and chronotype, with greater benefits in the younger population. Full article
(This article belongs to the Special Issue Stress, Rhythms Dysregulation and Bipolar Spectrum)
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