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ACTIGRAPHY IN AFFECTIVE DISORDERS

Krane-Gartiser, Karoline
Doctoral thesis
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URI
http://hdl.handle.net/11250/2391647
Date
2016
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  • Institutt for nevromedisin og bevegelsesvitenskap [1709]
Abstract
Norsk sammendrag -

Norsk tittel: Aktigrafi ved stemningslidelser

Det er i dag ingen objektive mål på symptomene ved psykiske lidelser. I dette

doktorgradsarbeidet er det vist at mennesker med ulike former for depresjoner og manier har

bevegelsesmønstre som skiller seg fra hverandre. Akuttinnlagte pasienter med

stemningslidelser (bipolar lidelse og depresjon) har gått med en bevegelsesmåler (aktigraf) i

24 timer under innleggelse ved avdeling Østmarka, St Olavs Hospital. Ved bruk av avanserte

matematiske metoder ble mengde bevegelse, grad av variasjon og stabilitet av aktivitet

beregnet. Ved alle depresjonstyper var det lav gjennomsnittsaktivitet og høy variasjon av

aktivitet sammenlignet med hos friske personer. Det var også objektive forskjeller i

aktivitetsmønstre mellom de pasientene med depresjon som etter legenes vurdering hadde

langsomme kroppsbevegelser (såkalt psykomotorisk retardasjon) og deprimerte som var

motorisk urolige. De deprimerte pasientene som var mer urolige, hadde et uorganisert

bevegelsesmønster som lignet mønsteret for pasienter med mani. I en annen studie av

pasienter som var i stabil fase av bipolar lidelse og som samtidig hadde søvnvansker, fant vi

at de som ikke hadde stabil døgnrytme, var yngre, og en større andel hadde forsinket søvnfase

og hyppige dag-til-dag-forandringer i stemningsleie. Det var også forskjeller i

bevegelsesmønstrene mellom gruppene.

Analyser av bevegelsesmønstre målt ved hjelp av instrumenter på størrelse med et

armbåndsur, kan trolig utvikles til å skille undergrupper med stemningslidelser fra hverandre

og få betydning for klassifisering og behandling av depresjoner og manier både ved

tilbakevendende depresjoner og ved bipolar lidelse.
 
Summary - Introduction and aims:

Affective disorders, characterized by recurrent episodes of low and/or elevated mood, are

among the most costly and burdensome chronic diseases. Diagnostic categories and episodespecific

symptoms overlap, and prevention of illness progression is hampered by an inability

to detect early signs of new episodes in due time. Psychiatry as a medical discipline is

uniquely dependent on clinical observation of signs and symptoms with few objective

markers of disease.

In all states of affective disorders, there are variations in mood symptoms, sleep, circadian

rhythms and motor activity. While mood is an ambiguous and subjective symptom, circadian

rhythms and motor activity patterns are objectively assessable via the use of actigraphy.

Actigraphs are convenient and non-invasive devices for monitoring wrist movement, and they

are increasingly employed in psychiatric settings to record sleep-wake and motor activity

rhythms. To date, analytical methods have focused on mean levels and simple variability

measures. This thesis aimed to analyze motor activity patterns in inpatients and outpatients

with affective disorders, using linear and non-linear mathematical methods, in order to

compare groups of patients defined by phenotypes.

Methods:

In two studies, 24-hour actigraphically recorded motor activity patterns in acutely admitted

inpatients with affective disorders and recordings from healthy controls were included. In the

first study, 52 patients with unipolar depression were divided into groups with and without

clinically assessed motor retardation. The second study included 30 patients with mania or

bipolar depression. In a third study, 1-week actigraphy recordings in 43 outpatients with

euthymic bipolar disorder and subjective sleep disturbance were compared between groups

with actigraphically determined stable and unstable rest-activity cycles. Actigraphy

recordings were compared to concurrent reports of mood and sleep. In all studies, motor

activity patterns were analyzed by measures of variability (standard deviation (SD), root mean

square successive difference (RMSSD), RMSSD/SD ratio). Studies I and II additionally

employed other measures of variability (autocorrelation lag 1, Fourier analysis) and

complexity (sample entropy, symbolic dynamics) and other non-linear methods for studying

the distribution of active and inactive periods.

Results:

Within the unipolar depression sample, patients with motor retardation had reduced activity

levels and higher intra-individual variability in activity compared to patients without motor

retardation. Motor retardation implied being active in shorter bursts with fewer long bursts of

activity. Patients without motor retardation displayed increased complexity in activity during

an active morning sequence of approximately one hour. Bipolar depression was characterized

by significantly lower mean activity and higher variability compared to healthy controls,

similar to all depression groups relative to controls. Patients with mania showed higher

minute-to-minute variability (higher RMSSD values) during 24 hours compared to healthy

controls, and increased complexity (higher sample entropy) during the active morning

sequence compared to patients with bipolar depression.

In euthymic bipolar disorder and sleep disturbance, a subgroup of patients demonstrated

unstable rest-activity cycles in combination with variability in mood and motor activity

patterns. The unstable subgroup was younger and showed delayed sleep phases compared to

the group with stable rest-activity cycles.

Discussion:

Patients with unipolar depression with and without motor retardation differed in 24-hour

activity patterns, and the two phenotypes could be distinguished by complementary methods.

Findings in unipolar depression without motor retardation resembled findings in the manic

state, which further resembled findings from previous studies of schizophrenia and glutamate

antagonism. Results from the euthymic bipolar group with unstable rest-activity cycles

resembled variability findings in activity during affective episodes. Here, the activity findings

could be associated to mood variability and/or circadian instability.

In conclusion, activity characteristics are potentially important clinical signatures of affective

disorders, and it may be possible to distinguish phenotypically different subgroups based on

activity levels and patterns. Actigraphy recordings combined with a set of advanced analytical

methods from linear and non-linear dynamics could provide a future diagnostic and

prognostic tool in affective disorders, of importance to the accuracy of diagnostics, treatment

response, prevention and classification of disease.
 
Has parts
Paper 1: Krane-Gartiser K, Henriksen TE, Vaaler AE, Fasmer OB, Morken G. Actigraphically Assessed Activity in Unipolar Depression – A Comparison of Inpatients with and without Motor Retardation. Journal of Clinical Psychiatry 2015 Sep; 76(9):118-7. Is not included due to copyright available at http://dx.doi.org/10.4088/JCP.14m09106

Paper 2: Krane-Gartiser K, Vaaler AE, Fasmer OB, Morken G. The Distribution and Characteristics of Active and Inactive Periods Distinguish Unipolar Depression with and without Motor Retardation. The Journal of Clinical Psychiatry 77(6):841-842 Is not included due to copyright available at http://dx.doi.org/10.4088/JCP.15l10408

Paper 3: Krane-Gartiser K, Henriksen TE, Morken G, Vaaler AE, Fasmer OB. Actigraphic Assessment of Motor Activity in Acutely Admitted Inpatients with Bipolar Disorder. PLoS One 2014 Feb 20;9(2):e89574 http://dx.doi.org/10.1371/journal.pone.0089574 Copyright: © 2014 Krane-Gartiser et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Paper 4: Krane-Gartiser K, Steinan MK, Langsrud K, Vestvik V, Sand T, Fasmer OB, Kallestad H, Morken G. Unstable Rest-Activity Cycles in Euthymic Bipolar Disorder and Clinical Implications for Sleep, Mood and Activity. Is not included - available at http://dx.doi.org/10.1016/j.jad.2016.05.012
Publisher
NTNU
Series
Doctoral thesis at NTNU;2016:154

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