title: Effects of night shifts in bipolar disorders and extreme morningness.
abstract: BACKGROUND
  Night work and shift work scenarios are increasing in modern society. Instability in the sleep-wake rhythm is an important risk factor for triggering episodes of bipolar disorder. Extreme chronotype has negative effects on shift work ("shift-worker syndrome"). Effects of night or shift work on patients with bipolar disorder and extreme chronotype are not well understood.
  
  
  METHODS
  A patient with bipolar II disorder and extreme morning type followed a stable work schedule for a significant period of time, maintaining a stable mood. After changing to a night-shift schedule, depressive symptoms developed. When the night-shift schedule was stopped, her mental state normalised.
  
  
  CONCLUSIONS
  This case highlights the possibility of a sensitizing role of chronotype in triggering episodes of bipolar disorder after the sleep-wake rhythm has been disrupted by night work or shift work. The evaluation of a person's capability to perform night work or shift work should take into account psychiatric disorders and chronotype as well as physical conditions.
authors.affiliation: Department of Psychiatry and Psychotherapy, Centre for Sleep Medicine, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Meyrer
authors.forename: Joachim
authors.initials: J
authors.lastname: Demling
authors.forename: Johannes
authors.initials: J
authors.lastname: Kornhuber
authors.forename: Magdalena
authors.initials: M
authors.lastname: Nowak
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000503:physiopathology* / Q000628:therapy; D002940:Circadian Rhythm / Q000502:physiology*; D005260:Female; D006801:Humans; D011613:Psychotherapy / Q000379:methods; D012890:Sleep / Q000502:physiology*; D014851:Wakefulness / Q000502:physiology*