Seasonal relapses in affective disorder in the Tropics: a prospective follow-up of 12 patients

Seasonality of Admissions for Mania: Results From a General Hospital Psychiatric Unit in Pondicherry, India

INTRODUCTION

Bipolar disorder is affected by variables that modulate circadian rhythm, including seasonal variations. There is evidence of a seasonal pattern of admissions of mania in various geographical settings, though its timing varies by region and climate. Variables such as age and gender have been shown to affect seasonality in some studies.

METHODOLOGY

Data on monthly admission patterns for mania at a general hospital psychiatry unit in Pondicherry, India, were collected for 4 years (2010-2013) and analyzed for seasonality and seasonal peaks. The effects of age and gender were analyzed separately.

RESULTS

There was overall evidence of a seasonal pattern of admissions for mania (P < .01, Friedman test for seasonality), with a peak beginning during the rainy season and ending before summer (P < .0.1, Ratchet circular scan test). Male sex (P < .005, Ratchet circular scan test) and age > 25 years (P < .005, Ratchet circular scan test) were specifically associated with this seasonal peak.

DISCUSSION

The effect of seasons on mania is complex and is modulated by a variety of variables. Our study is consistent with earlier research findings: a greater degree of seasonality for mania in men. It is possible that climatic and individual variables interact to determine seasonal patterns in bipolar disorder in a given setting.

A follow up study of seasonality in affective disorders: A preliminary study

BACKGROUND

Researchers have evinced interest in the effect of seasonality on certain behavioural and emotional disorders, the most prominent being Affective Disorders.

AIM

To assess the pattern of seasonality and the clinical course in cases of affective disorder in a tertiary care psychiatric centre in North India.

MATERIALS AND METHODS

Thirteen patients diagnosed as cases of affective disorder as per ICD- 10 DCR (F30-39) were re-assessed using seasonal pattern assessment questionnaire (SPAQ) after a period of 5-7 years.

RESULTS

Majority of the patients (53.8%) were males. Recurrent depressive disorder current episode moderate with/without somatic syndrome was the commonest current diagnosis as per ICD-10 DCR. Mean global seasonality score was 3.46 (S.D, 6.55; range 1-24) as assessed by SPAQ. Most of the patients did not report any variation in mood, behaviour, sleep pattern and weight fluctuations.

CONCLUSIONS

It has been demonstrated that manifestation of an affective disorder is not necessarily associated with high seasonality change.

Seasonal affective disorder: report from India (latitude 26 degrees 45'N)

BACKGROUND

A number of studies have established the entity of seasonal affective disorder (SAD) and delineated the presence of atypical depressive features of carbohydrate craving, hyperphagia and hypersomnia. Most literature has emanated from research carried out in temperate climates, and only few reports are available from tropical countries, especially India.

METHODS

Consecutive patients with recurrent mood disorder (who had at least 2 episodes of depression in the past) comprised the study sample. The diagnosis of mood disorder was made according to DSM-III-R criteria. The sample was divided into two groups - seasonal and non-seasonal according to the DSM-III-R criteria of seasonal pattern. The depressed patients were rated on SADD and HDRS, and manic patients on BRMRS.

RESULTS

Eighteen of 93 patients fulfilled the criteria of seasonal pattern; 7 of these seasonal patients, and 25 of the non-seasonal patients were currently in depressive phase. Males dominated the sample in both the groups. The seasonal and non-seasonal groups as regards symptomatology, differed only on a few items - decreased libido on SADD, and suicidal ideation and helplessness on HDRS. Atypical vegetative features were not seen in any of the seasonal patients.

CONCLUSIONS

SAD is seen at lower latitudes also, although atypical vegetative features are not a prominent part of the symptomatology.

LIMITATIONS

The study sampled was obtained from a very select population, and thus does not indicate the prevalence of SAD in India. Secondly, the small sample size precludes any categorical comments of the symptomatology. Moreover, winter and summer depressives were considered as one group.

CLINICAL RELEVANCE

Emphasising the presence of SAD in a tropical country where there is relatively less variation in daylight periods, this report forms a base for future studies. It also raises the question of the role of variations in daylight in the aetiology SAD.

Seasonal affective disorder: some epidemiological findings from a tropical climate

OBJECTIVE

To determine whether a predominantly summer-focussed pattern of seasonal affective disorder (SAD) exists in tropical northern Australia.

METHOD

A mail survey containing a modified form of the Seasonal Pattern Assessment Questionnaire (SPAQ) was administered to 176 households in the city of Townsville (latitude: 19 degrees south).

RESULTS

Using previously reported screening criteria, 9% of respondents reported a degree of summer impairment indicative of SAD, while the incidence rate for winter SAD was 1.7%. This summer-winter ratio is typically reversed in more temperate latitudes.

CONCLUSIONS

Excessive heat and humidity were reported to be the two most influential environmental factors affecting mood and behaviour. It is likely that respondents meeting criteria for summer SAD represent the extreme end of a spectrum of summer-related mood and behaviour change that affects many individuals in northern Australia. Strategies for further clinical and epidemiological research on SAD in tropical climates are proposed.

Climate and admissions for mania in the tropics

Seasonality of admissions for mania has been commonly reported. Most reports are from temperature zones. We analyzed admissions for mania covering a 9 year period and looked for any seasonal trends using existing methods. No seasonal variation was found. The hospital lies in the tropical zone with a relatively constant climate. This may influence the seasonal pattern of relapses in affective disorder.