title: Seasonal changes, sleep length and circadian preference among twins with bipolar disorder.
abstract: BACKGROUND
  We aimed at studying the seasonal changes in mood and behaviour, the distribution of hospital admissions by season, and the persistence of the circadian type in twins with bipolar disorder and their healthy co-twins.
  
  
  METHODS
  All Finnish like-sex twins born from 1940 to 1969 were screened for a diagnosis of bipolar type I disorder. The diagnosis was assessed with a structured research interview, and the study subjects (n = 67) filled in the Seasonal Pattern Assessment Questionnaire (SPAQ) and the Morningness-Eveningness Questionnaire (MEQ). For studying the persistence of the habitual sleep length and circadian type, we used data derived from the Finnish Twin Cohort Questionnaire (FTCQ). Bipolar twins were compared with their healthy co-twins.
  
  
  RESULTS
  Bipolar twins had greater seasonal changes in sleep length (p = 0.01) and mood (p = 0.01), and higher global seasonality scores (p = 0.03) as compared with their co-twins with no mental disorder. Sunny days (p = 0.03) had a greater positive effect on wellbeing in the bipolar than healthy co-twins.
  
  
  CONCLUSIONS
  Our results support the view that bipolar disorder is sensitive to the environmental influence in general and to the seasonal effect in specific. Exposure to natural light appears to have a substantial effect on wellbeing in twins with bipolar disorder.
authors.affiliation: Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland. reeta.hakkarainen@ktl.fi
authors.forename: Reeta
authors.initials: R
authors.lastname: Hakkarainen
authors.forename: Carolina
authors.initials: C
authors.lastname: Johansson
authors.forename: Tuula
authors.initials: T
authors.lastname: Kieseppä
authors.forename: Timo
authors.initials: T
authors.lastname: Partonen
authors.forename: Markku
authors.initials: M
authors.lastname: Koskenvuo
authors.forename: Jaakko
authors.initials: J
authors.lastname: Kaprio
authors.forename: Jouko
authors.initials: J
authors.lastname: Lönnqvist
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis / Q000235:genetics* / Q000523:psychology*; D002940:Circadian Rhythm / Q000502:physiology*; D004200:Diseases in Twins / Q000235:genetics*; D005260:Female; D006801:Humans; D008027:Light; D008297:Male; D017440:Photoperiod; D012621:Seasons; D012890:Sleep / Q000502:physiology*; D014429:Twins, Dizygotic / Q000235:genetics; D014430:Twins, Monozygotic / Q000235:genetics; D014887:Weather