Clin Psychopharmacol Neurosci.  2012 Aug;10(2):110-116.

Circadian Rhythm Characteristics in Mood Disorders: Comparison among Bipolar I Disorder, Bipolar II Disorder and Recurrent Major Depressive Disorder

  • 1Department of Neuropsychiatry, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea.
  • 2Institute of Human Behavioral Medicine, Medical Research Institute, Seoul National University, Seoul, Korea.
  • 3Department of Neuropsychiatry, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea.
  • 4Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
  • 5Department of Psychiatry, Seoul Metropolitan EunPyeong Hospital, Seoul, Korea.
  • 6Department of Psychiatry, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
  • 7Department of Neuropsychiatry, Dongguk University International Hospital, Dongguk University Medical School, Goyang, Korea.


OBJECTIVE: Morningness/eveningness (M/E) is a stable characteristic of individuals. Circadian rhythms are altered in episodes of mood disorder. Mood disorder patients were more evening-type than normal population. In this study, we compared the characteristics of M/E among the 257 patients with bipolar I disorder (BPD1), bipolar II disorder (BPD2) and major depressive disorder, recurrent (MDDR).
M/E was evaluated using the Korean version of the composite scale of morningness (CS). Factor analysis was done to extract specific elements of circadian rhythm (morning preference, morning alertness, and evening tiredness). The total score and scores for factors and individual items of CS were compared in order to evaluate differences among the three different diagnostic groups. Factor scores of CS were different among the diagnostic groups.
BPD1 subjects had a higher score for evening tiredness than BPD2 subjects (p=0.060), and BPD1 subjects had a significantly higher score for morning alertness than subjects with MDDR (p=0.034). This difference was even more profound for the representative item scores of each factor; item 2 of CS for evening tiredness (BPD1>BPD2, p=0.007) and item 5 of CS for morning alertness (BPD1>MDDR, p=0.002). Total score of CS were not different among 3 diagnostic groups.
Circadian rhythm characteristics measured by CS were different among BPD1, BPD2, and MDDR. BPD2 showed more eveningness than BPD1. MDDR showed less morningness than BPD1. CS would be a reasonable endophenotype associated with mood disorders. More studies with large sample size of mood disorders on M/E are warranted.


Bipolar I disorder; Bipolar II disorder; Composite scale; Major depressive disorder; Chronotype
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