Impact of seasonal and lunar cycles on psychological symptoms in the ED: an empirical investigation of widely spread beliefs

A Systematic Review on the Impact of Seasonality on Severe Mental Illness Admissions: Does Seasonal Variation Affect Coercion?

Coercion in psychiatry is associated mainly with involuntary admissions. The purpose of this study was to investigate the associations between hospital admissions of patients suffering from affective and schizophrenic disorders and seasonality. A systematic literature search using PubMed, Scopus and Google Scholar was conducted, including studies with affective and schizophrenia disorder admissions, published from October 1992 to August 2020. A total of 31 studies were included in the review. Four broad severe mental illness admission categories were identified regarding seasonality: affective disorders, schizophrenia disorders, involuntary admission affective disorders and involuntary admission schizophrenia disorders. There was clear and strong evidence for spring and summer peaks for severe mental illness admissions; data provided for age, gender and involuntary admissions was limited. Seasonality may have a significant effect on the onset and exacerbation of psychopathology of severe mental illness and should be considered as a risk factor in psychiatric admissions, violence and the risk of mental health coercion. A better understanding of the impact of seasonality on severe mental illness will help professionals to provide the best practices in mental health services in order to reduce and prevent psychiatric hospitalizations (especially involuntary admissions) resulting in further coercive measures.

The effect of the lunar cycle on migraine: preliminary findings from a retrospective study

AIM

The purpose of this study was to evaluate the relationship between the lunar cycle and attacks observed in patients diagnosed with migraine and under follow-up in our pediatric neurology clinic.

METHODS

Cases diagnosed with migraine and under follow-up at the Balıkesir University Medical Faculty Pediatric Neurology Clinic, Turkey, undergoing attacks between 01.09.2019 and 01.09.2021, and whose attacks were recorded were included in the study. Patients' migraine attacks were investigated retrospectively, and the stage of the lunar cycle at which they occurred, based on the lunar calendar, was determined.

RESULTS

The mean age of the patients in the study was 13.39 ± 2.64 (8-17) years. Female gender was observed in the majority of attacks in all lunar cycles, and was most common in the first quarter. Headache was most common in the frontal region during the first quarter and full moon, and auras were also most frequent in the first quarter. Stress and exercise were the most frequent migraine-triggering factors in the first and third quarters, and in the full moon. Migraine attacks were shortest in duration in the full moon, and longest in the first quarter. The frequency of attacks (per week) was highest in the new moon and third quarter, and lowest in the full moon.

CONCLUSIONS

This study investigated the relationship between migraine attack characteristics in children and the lunar cycle. It represents the first such investigation of the association between the lunar cycle and pediatric migraine attacks.

Does lunar synodic cycle affect the rates of psychiatric hospitalizations and sentinel events?

The lunar synodic cycle is often believed to be associated with psychiatric emergencies and exacerbation in various countries, including India. However, the scientific literature regarding this matter is inconclusive. We aimed to evaluate the relationship between lunar cycle phase and admission rates plus occurrence of sentinel events in the psychiatric ward of a tertiary care general hospital in India. All admissions and transfer-ins (N = 780) to the Department of Psychiatry between August 1st, 2016 and July 31st, 2017 were evaluated from hospital records by a blinded author to obtain sentinel events, like requirement of physical restraint (PR) and chemical restraint (CR), occurring on full moon days (FM), new moon days (NM), and control days (CD). Statistical analysis was done by comparison of proportions. Significant positive differences were found when CR applied exclusively [p = .0008] on FM and NM days, and its frequency [p < .0001] in comparison to CD. Frequencies of parenteral [p = .0001] and per oral [p = .0064] modes of CR applied on FM and NM days showed significant positive results when compared with CD. Use of all restraints (PR plus CR) [p = .0017] and their frequencies [p < .0001] on FM and NM days were also positively significant. Sentinel events, such as use of restraints, especially chemical ones, in psychiatry in-patients are significantly more common during full moon and new moon phases.

Seasonality and symptoms of depression: A systematic review of the literature

AIMS

Lay opinions and published papers alike suggest mood varies with the seasons, commonly framed as higher rates of depression mood in winter. Memory and confirmation bias may have influenced previous studies. We therefore systematically searched for and reviewed studies on the topic, but excluded study designs where explicit referrals to seasonality were included in questions, interviews or data collection.

METHODS

Systematic literature search in Cochrane database, DARE, Medline, Embase, PsychINFO and CINAHL, reporting according to the PRISMA framework, and study quality assessment using the Newcastle-Ottawa scale. Two authors independently assessed each study for inclusion and quality assessment. Due to large heterogeneity, we used a descriptive review of the studies.

RESULTS

Among the 41 included studies, there was great heterogeneity in regards to included symptoms and disorder definitions, operationalisation and measurement. We also observed important heterogeneity in how definitions of 'seasons' as well as study design, reporting and quality. This heterogeneity precluded meta-analysis and publication bias analysis. Thirteen of the studies suggested more depression in winter. The remaining studies suggested no seasonal pattern, seasonality outside winter, or inconclusive results.

CONCLUSIONS

The results of this review suggest that the research field of seasonal variations in mood disorders is fragmented, and important questions remain unanswered. There is some support for seasonal variation in clinical depression, but our results contest a general population shift towards lower mood and more sub-threshold symptoms at regular intervals throughout the year. We suggest future research on this issue should be aware of potential bias by design and take into account other biological and behavioural seasonal changes that may nullify or exacerbate any impact on mood.

Weather conditions influence the number of psychiatric emergency room patients

The specific impact of weather factors on psychiatric disorders has been investigated only in few studies with inconsistent results. We hypothesized that meteorological conditions influence the number of cases presenting in a psychiatric emergency room as a measure of mental health conditions. We analyzed the number of patients consulting the emergency room (ER) of a psychiatric hospital in Berlin, Germany, between January 1, 2008, and December 31, 2014. A total of N = 22,672 cases were treated in the ER over the study period. Meteorological data were obtained from a publicly available data base. Due to collinearity among the meteorological variables, we performed a principal component (PC) analysis. Association of PCs with the daily number of patients was analyzed with autoregressive integrated moving average model. Delayed effects were investigated using Granger causal modeling. Daily number of patients in the ER was significantly higher in spring and summer compared to fall and winter (p < 0.001). Three PCs explained 76.8% percent of the variance with PC1 loading mostly on temperature, PC2 on cloudiness and low pressure, and PC3 on windiness. PC1 and PC2 showed strong association with number of patients in the emergency room (p < 0.010) indicating higher patient numbers on warmer and on cloudy days. Further, PC1, PC2, and PC3 predicted the number of patients presenting in the emergency room for up to 7 days (p < 0.050). A secondary analysis revealed that the effect of temperature on number of patients was mostly due to lower patient numbers on cold days. Although replication of our findings is required, our results suggest that weather influences the number of psychiatric patients consulting the emergency room. In particular, our data indicate lower patient numbers during very cold temperatures.

Relationship between lunar cycle and haemorrhagic complication rate in surgery

BACKGROUND

The aim of this study was to evaluate a possible relationship between lunar cycles and haemorrhagic complication rate in surgery.

MATERIALS AND METHODS

The possible relationship between moon phases and surgical outcome was tested by evaluating the haemorrhagic complication rate for 18,760 patients who underwent surgery between January 2001 and December 2008 at the National Institute for Cancer Research in Genoa. A total of 103 lunar phases were considered using Chi-square (χ²) test analysis, and patients were allocated a surgery date.

RESULTS

One hundred and sixty-seven haemorrhagic complications were observed. Three hundred and nine new moon phase days were analysed and 12 incidences of complications detected, with a 3.9% complication rate per day. In the waxing moon phase, 1184.5 d were analysed with 68 incidences of complications at a daily rate of 5.7%. In the full moon phase there was a 4.9% complication rate per day (15 incidences in 309 d), whereas in the waning moon phase, the 6% percentage rate per day resulted from 72 incidences in 1184.5 d.

CONCLUSIONS

No statistically significant correlations were found between moon cycles and postoperative haemorrhagic complications (p = .50).

Evaluation of the safety of conventional lighting replacement by artificial daylight

Background

Short morning exposure to high illuminance visible electromagnetic radiations termed as artificial daylight is beneficial for the mental health of people living in geographical areas with important seasonal changes in daylight illuminance. However, the commercial success of high illuminance light sources has raised the question of the safety of long hour exposure.

Methods

We have investigated the effect of the replacement of natural daylight by artificial daylight in Swiss mice raised under natural lighting conditions. Mice were monitored for neurotoxicity and general health changes. They were submitted to a battery of conventional tests for mood, motor and cognitive functions' assessment on exposure day (ED) 14 and ED20. Following sacrifice on ED21 due to marked signs of neurotoxicity, the expression of markers of inflammation and apoptosis was assessed in the entorhinal cortex and neurons were estimated in the hippocampal formation.

Results

Signs of severe cognitive and motor impairments, mood disorders, and hepatotoxicity were observed in animals exposed to artificial daylight on ED20, unlike on ED14 and unlike groups exposed to natural daylight or conventional lighting. Activated microglia and astrocytes were observed in the entorhinal cortex, as well as dead and dying neurons. Neuronal counts revealed massive neuronal loss in the hippocampal formation.

Conclusions

These results suggest that long hour exposure to high illuminance visible electromagnetic radiations induced severe alterations in brain function and general health in mice partly mediated by damages to the neocortex-entorhinal cortex-hippocampus axis. These findings raise caution over long hour use of high illuminance artificial light.

Effect of lunar phase on frequency of psychogenic nonepileptic events in the EMU

INTRODUCTION

Studies of the effect of a full moon on seizures have yielded mixed results, despite a continuing prevailing belief regarding the association of lunar phase with human behavior. The potential effect of a full moon on psychogenic nonepileptic events has not been as well studied, despite what anecdotal accounts from most epilepsy monitoring unit (EMU) staff would suggest.

METHODS

We obtained the dates and times of all events from patients diagnosed with psychogenic nonepileptic events discharged from our EMU over a two-year period. The events were then plotted on a 29.5-day lunar calendar. Events were also broken down into lunar quarters for statistical analysis.

RESULTS

We found a statistically significant increase in psychogenic nonepileptic events during the new moon quarter in our EMU during our studied timeframe.

CONCLUSION

Our results are not concordant with the results of a similarly designed past study, raising the possibility that psychogenic nonepileptic events are not influenced by lunar phase.

Retrospective evaluation of canine and feline maxillomandibular trauma cases. Comparison of lunar cycle and seasonality with non-maxillomandibular traumatic injuries (2003-2012)

OBJECTIVES

To determine relationships between seasonality and lunar cycle and the frequency of maxillomandibular (MM) and non-maxillomandibular (non-MM) injury in canine and feline trauma patients.

METHODS

A medical records database was searched to identify all MM trauma patients (n = 67) and a random sample of non-MM trauma patients (n = 129) according to search criteria. Season of injury, moon phase, and moon luminosity were calculated for the date of injury.

RESULTS

Maxillomandibular injury occurred predominately in the spring and decreased through winter while non-MM injury occurred more frequently in the summer and fall. The difference in the frequency of MM and non-MM injuries during different seasons was not significant (p = 0.071). When comparing the amount of moon illuminated when injuries occurred during the quarters before or after the full moon, a difference (p = 0.007) was noted with a greater number of injuries occurring immediately following the full moon.

CLINICAL SIGNIFICANCE

These results may guide clinicians to closely evaluate trauma patients that are presented on emergency during a particular season or lunar phase. Based on the season at the time of injury, close evaluation for MM versus non-MM trauma may be appropriate.