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Carta MG, Fornaro M, Primavera D, Nardi AE, Karam E. Dysregulation of mood, energy, and social rhythms syndrome (DYMERS): A working hypothesis. J Public Health Res 2024; 13:22799036241248022. [PMID: 38680762 PMCID: PMC11047225 DOI: 10.1177/22799036241248022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/02/2024] [Indexed: 05/01/2024] Open
Abstract
A syndrome centered on the dysregulation of behavioral rhythms (DBR) is discussed. Recent pandemic brought to observe: (1) Having a DBR affecting sleep patterns, eating habits, and social interactions, before the lockdown period, was a determinant for depressive episodes during the lockdown; (2) In tighter lockdowns, DBR triggered depressive episodes in bipolar patients; (3) DBR in healthcare workers under pressure was a determinant of burnout; (4) DBR influenced the course of chronic diseases by altering immune responses. In addition, it was found that scoring positive on the Mood Disorder Questionnaire (MDQ) was closely associated with the dysregulation of sleep rhythms. MDQ is a screening tool for bipolar disorder (BD), criticized for detecting too many false positives. Studies showed that positivity to the MDQ implied a severe impairment of quality of life even in people without psychiatric diagnoses. According to this evidence, three different hyperactivation levels could be proposed (from normality to pathology): firstly, an adaptive increase in energy (e.g. athletes performing well); secondly, a DBR determined from the continuous stimulation of stress hormones, with possible positive scores on the MDQ without a diagnosis of bipolar disorder, like in burnout syndromes and, thirdly, hyperactivity during manic episodes. The Dysregulation of Mood, Energy, and Social Rhythms Syndrome (DYMERS), the second level of the scale, is proposed as a working hypothesis. DYMERS is also seen as a vulnerable condition that may evolve in other disorders (including BD) according to the individual susceptibility (including genetic predisposition) and the specific nature/level of the stressor.
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Affiliation(s)
| | - Michele Fornaro
- Section of Psychiatry - Department of Neuroscience, Reproductive Sciences, and Dentistry, University School of Medicine Federico II, Naples, Italy
| | - Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - Antonio Egidio Nardi
- Laboratory Panic and Respiration, Institute of Psychiatry (IPUB), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Elie Karam
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon and Department of Psychiatry and Clinical Psychology, St Georges University of Beirut, Beirut, Lebanon
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Sancassiani F, Cossu G, Cantone E, Romano F, Perra A, Urban A, Pinna S, Del Giacco S, Littera R, Firinu D, Chessa L, Tramontano E, Nardi AE, Carta MG. The Stability of Social and Behavioral Rhythms and Unexpected Low Rate of Relevant Depressive Symptoms in Old Adults during the COVID-19 Pandemic. J Clin Med 2024; 13:2005. [PMID: 38610769 PMCID: PMC11012795 DOI: 10.3390/jcm13072005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/24/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Background: The disruption of social rhythms was found to be associated with depressive disorders during the COVID-19 pandemic; lower rates of these disorders were surprisingly found in old adults. The present study aims to verify the stability of social rhythms during lockdown in a sample of elderly people. Methods: Controlled cohort study (secondary analyses) of a previous randomized-controlled trial with the first evaluation in April 2019 (T0) and then 48 weeks later (T1) during the lockdown. The regulation of social and behavioral rhythms was measured through the Brief Social Rhythms Scale (BSRS); the Patient Health Questionnaire-9 (PHQ9) was adopted to detect relevant depressive symptoms. Results: 93 elderlies (73.36 ± 4.97 years old, 50.5% females) were evaluated at T0 and T1. Neither the total score of BSRS nor any of the 10 items showed a statistically significant difference comparing the two survey periods. The frequency of relevant depressive symptoms was 5.3% at T0 and 6.4% at T1 (OR = 0.8, CI95% 0.2-24). Conclusions: Among elderlies who did not show an increased risk of depression during the lockdown, social and behavioral rhythms remained exceptionally stable during the same period. Considering previous evidence about rhythms dysregulation preceding depression, their stability may be considered a factor of resilience.
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Affiliation(s)
- Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.C.); (E.C.); (A.P.); (A.U.); (S.P.); (S.D.G.); (D.F.); (L.C.); (M.G.C.)
| | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.C.); (E.C.); (A.P.); (A.U.); (S.P.); (S.D.G.); (D.F.); (L.C.); (M.G.C.)
| | - Elisa Cantone
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.C.); (E.C.); (A.P.); (A.U.); (S.P.); (S.D.G.); (D.F.); (L.C.); (M.G.C.)
| | - Ferdinando Romano
- Department of Public Health and Infectious Diseases, University of Rome “La Sapienza”, 00185 Roma, Italy;
| | - Alessandra Perra
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.C.); (E.C.); (A.P.); (A.U.); (S.P.); (S.D.G.); (D.F.); (L.C.); (M.G.C.)
| | - Antonio Urban
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.C.); (E.C.); (A.P.); (A.U.); (S.P.); (S.D.G.); (D.F.); (L.C.); (M.G.C.)
- University Hospital of Cagliari, 09124 Cagliari, Italy
| | - Samantha Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.C.); (E.C.); (A.P.); (A.U.); (S.P.); (S.D.G.); (D.F.); (L.C.); (M.G.C.)
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.C.); (E.C.); (A.P.); (A.U.); (S.P.); (S.D.G.); (D.F.); (L.C.); (M.G.C.)
| | - Roberto Littera
- Medical Genetics, “R. Binaghi” Hospital, 09126 Cagliari, Italy;
- AART-ODV (Association for the Advancement of Research on Transplantation), 09131 Cagliari, Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.C.); (E.C.); (A.P.); (A.U.); (S.P.); (S.D.G.); (D.F.); (L.C.); (M.G.C.)
| | - Luchino Chessa
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.C.); (E.C.); (A.P.); (A.U.); (S.P.); (S.D.G.); (D.F.); (L.C.); (M.G.C.)
| | - Enzo Tramontano
- Department of Life and Environmental Sciences, University of Cagliari, 09124 Cagliari, Italy;
| | - Antonio Egidio Nardi
- Institute of Psychiatry-IPUB, Federal University of Rio de Janeiro, Rio de Janeiro 22290-140, Brazil;
| | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.C.); (E.C.); (A.P.); (A.U.); (S.P.); (S.D.G.); (D.F.); (L.C.); (M.G.C.)
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Primavera D, Carta MG, Romano F, Sancassiani F, Chessa E, Floris A, Cossu G, Nardi AE, Piga M, Cauli A. Quality of Life in Systemic Lupus Erythematosus and Other Chronic Diseases: Highlighting the Amplified Impact of Depressive Episodes. Healthcare (Basel) 2024; 12:233. [PMID: 38255120 PMCID: PMC10815265 DOI: 10.3390/healthcare12020233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/12/2024] [Accepted: 01/13/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Extensive research has explored SLE's impact on health-related quality of life (H-QoL), especially its connection with mental wellbeing. Recent evidence indicates that depressive syndromes significantly affect H-QoL in SLE. This study aims to quantify SLE's impact on H-QoL, accounting for comorbid depressive episodes through case-control studies. METHODS A case-control study was conducted with SLE patients (meeting the ACR/EULAR 2019 criteria of age ≥ 18). The control group was chosen from a community database. H-QoL was measured with the SF-12 questionnaire, and PHQ-9 was used to assess depressive episodes. RESULTS SLE significantly worsened H-QoL with an attributable burden of 5.37 ± 4.46. When compared to other chronic diseases, only multiple sclerosis had a worse impact on H-QoL. Major depressive episodes had a significant impact on SLE patients' H-QoL, with an attributable burden of 9.43 ± 5.10, similar to its impact on solid cancers but greater than its impact on other diseases. CONCLUSIONS SLE has a comparable impact on QoL to serious chronic disorders. Concomitant depressive episodes notably worsened SLE patients' QoL, exceeding other conditions, similar to solid tumors. This underscores the significance of addressing mood disorders in SLE patients. Given the influence of mood disorders on SLE outcomes, early identification and treatment are crucial.
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Affiliation(s)
- Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy; (M.G.C.); (F.S.); (E.C.); (G.C.); (M.P.); (A.C.)
| | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy; (M.G.C.); (F.S.); (E.C.); (G.C.); (M.P.); (A.C.)
| | - Ferdinando Romano
- Department of Public Health and Infectious Diseases, University of Rome La Sapienza, 00100 Rome, Italy;
| | - Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy; (M.G.C.); (F.S.); (E.C.); (G.C.); (M.P.); (A.C.)
| | - Elisabetta Chessa
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy; (M.G.C.); (F.S.); (E.C.); (G.C.); (M.P.); (A.C.)
- UOC Reumatologia, Azienda Ospedaliero Universitaria Cagliari, 09124 Cagliari, Italy
| | - Alberto Floris
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy; (M.G.C.); (F.S.); (E.C.); (G.C.); (M.P.); (A.C.)
- UOC Reumatologia, Azienda Ospedaliero Universitaria Cagliari, 09124 Cagliari, Italy
| | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy; (M.G.C.); (F.S.); (E.C.); (G.C.); (M.P.); (A.C.)
| | - Antonio Egidio Nardi
- Panic and Respiration Laboratory, Federal University of Rio de Janeiro, Rio de Janeiro 22725, Brazil;
| | - Matteo Piga
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy; (M.G.C.); (F.S.); (E.C.); (G.C.); (M.P.); (A.C.)
- UOC Reumatologia, Azienda Ospedaliero Universitaria Cagliari, 09124 Cagliari, Italy
| | - Alberto Cauli
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy; (M.G.C.); (F.S.); (E.C.); (G.C.); (M.P.); (A.C.)
- UOC Reumatologia, Azienda Ospedaliero Universitaria Cagliari, 09124 Cagliari, Italy
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Primavera D, Aviles Gonzalez CI, Romano F, Kalcev G, Pinna S, Minerba L, Scano A, Orrù G, Cossu G. Does the Response to a Stressful Condition in Older Adults with Life Rhythm Dysregulations Provide Evidence of the Existence of the "Dysregulation of Mood, Energy, and Social Rhythms Syndrome"? Healthcare (Basel) 2023; 12:87. [PMID: 38200993 PMCID: PMC10778618 DOI: 10.3390/healthcare12010087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE The COVID-19 lockdown periods have given rise to the "Dysregulation of Mood, Energy, and Social Rhythms Syndrome" (DYMERS). This syndrome is characterized by a poor regulation of biological, social, and behavioral rhythms, including sleep, nutrition, and social contacts. The purpose of this cohort study was to examine whether older adults with pre-existing DYMERS had a more negative perception of their health-related quality of life (H-QoL) during the COVID-19 pandemic lockdown, regardless of the presence of concurrent mood disorders. METHOD The entire study population (N = 93; age > 65 year) was categorized based on whether they exhibited dysregulated rhythms at the outset of the study. A comparison was made between DYMERS-positive individuals and DYMERS-negative individuals, and we assessed their H-QoL at the conclusion of the study. We also compared the H-QoL of individuals in the cohort who did not have a positive depression score to understand the impact of the rhythm dysregulation alone. RESULTS The frequency of individuals with a critical health-related quality of life score (SF12 < 25) was higher in the cohort with pre-existing DYMERS during lockdown (33.33% vs. 6.17%). This difference remained significant even when only individuals without depressive symptomatology were considered (27.27% vs. 2.60%). CONCLUSION The results of this study indicate that DYMERS can exert a substantial influence on health-related quality of life (H-QoL), even when mood disturbances are not present. Additional research is required to investigate the relationship between DYMERS and other psychiatric conditions as well as its nature as a standalone disorder.
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Affiliation(s)
- Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (D.P.); (G.K.); (S.P.); (L.M.)
| | - Cesar Ivan Aviles Gonzalez
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (D.P.); (G.K.); (S.P.); (L.M.)
- Nursing Program, Faculty of Health Sciences, Universidad Popular del Cesar, Valledupar 200002, Colombia
| | - Ferdinando Romano
- Chair of Public Health, La Sapienza University, Rome, Italy 00185 Rome, Italy;
| | - Goce Kalcev
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (D.P.); (G.K.); (S.P.); (L.M.)
| | - Samantha Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (D.P.); (G.K.); (S.P.); (L.M.)
| | - Luigi Minerba
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (D.P.); (G.K.); (S.P.); (L.M.)
| | - Alessandra Scano
- Department of Surgical Sciences, University of Cagliari, 09042 Cagliari, Italy; (A.S.); (G.O.)
| | - Germano Orrù
- Department of Surgical Sciences, University of Cagliari, 09042 Cagliari, Italy; (A.S.); (G.O.)
| | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (D.P.); (G.K.); (S.P.); (L.M.)
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Giovanni Carta M, Kalcev G, Scano A, Aviles Gonzalez CI, Ouali U, Pinna S, Carrà G, Romano F, Preti A, Orrù G, Minerba L, Cossu G, Nardi AE, Primavera D. The impact of MDQ positivity on quality of life impairment: Does it support the hypothesis of "Dysregulation of Mood, Energy, and Social Rhythms Syndrome" (DYMERS)? J Public Health Res 2023; 12:22799036231208356. [PMID: 37927350 PMCID: PMC10625312 DOI: 10.1177/22799036231208356] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/09/2023] [Indexed: 11/07/2023] Open
Abstract
Background DSM-5 separates bipolar (BD) from depressive disorders, but some experts consider BD as part of a spectrum of mood disorders. The interpretation of numerous false positives of BD screened by the Mood Disorders Questionnaire (MDQ) is part of this debate. Recent study results suggest that the worsening of health-related quality of life (H-Qol) associated with MDQ positivity does not depend solely on mood disorders. This study aims to clarify whether the impairment may be due to other concomitant disorders, unrelated to mood disorders, leading to a worsening of H-Qol. Additionally, the study aims to explore if MDQ positivity itself observe clinical significance. Design and methods The study involved pairs of cases (MDQ+) and controls (MDQ-) matched for sex, age, and absence of DSM-IV psychiatric comorbidity. The impact of MDQ positivity on the quality of life in a sample of MDQ+ comorbid with MDD was measured and compared to impact of MDD in other chronic disorders. Results The H-Qol was significantly worse in MDQ+ than in controls (both groups without any psychiatric co-morbidity). The worsening was similar to severe chronic disorders The burden of worsening quality of life due to MDD was mild in another sample of MDQ positives with comorbid MDD. Conclusion The study hypothesizes that MDQ positivity may be related to hyperactivation and dysregulation of rhythms typical of stress disorders. In fact, MDQ+ was found strongly related to sleep disturbances. Future studies could verify if a "Dysregulation of Mood, Energy, and Social Rhythms Syndrome" (DYMERS), causes worsening the H-Qol in MDQ+.
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Affiliation(s)
- Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Monserato Blocco I (CA), Cagliari, Italy
| | - Goce Kalcev
- Department of Medical Sciences and Public Health, University of Cagliari, Monserato Blocco I (CA), Cagliari, Italy
| | - Alessandra Scano
- Department of Surgical Science, Molecular Biology Service Lab, University of Cagliari, Cagliari, Italy
| | - Cesar Ivan Aviles Gonzalez
- Faculty of Health Sciences, Nursing Program, Univesidad Popular del Cesar, Sede Sabanas, Valledupar, Colombia
| | - Uta Ouali
- Razi Hospital, La Manouba 2010, Faculty of Medicine of Tunisia, University of Tunis, El Manar, Tunisia
| | - Samantha Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Monserato Blocco I (CA), Cagliari, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Division of Psychiatry, University College London, Maple House, London, UK
| | - Ferdinando Romano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, Torino, Italy
| | - Germano Orrù
- Department of Surgical Science, Molecular Biology Service Lab, University of Cagliari, Cagliari, Italy
| | - Luigi Minerba
- Department of Medical Sciences and Public Health, University of Cagliari, Monserato Blocco I (CA), Cagliari, Italy
| | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, Monserato Blocco I (CA), Cagliari, Italy
| | - Antonio Egidio Nardi
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, Monserato Blocco I (CA), Cagliari, Italy
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Carta MG, Kalcev G, Fornaro M, Pinna S, Gonzalez CIA, Nardi AE, Primavera D. Does Screening for Bipolar Disorders Identify a "Dysregulation of Mood, Energy, and Social Rhythms Syndrome" (DYMERS)? A Heuristic Working Hypothesis. J Clin Med 2023; 12:5162. [PMID: 37568562 PMCID: PMC10419483 DOI: 10.3390/jcm12155162] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/31/2023] [Accepted: 08/05/2023] [Indexed: 08/13/2023] Open
Abstract
The aim of this paper is to verify if people with a positive score on the Mood Disorder Questionnaire (MDQ) without comorbidity of mood disorders showed a worse level of Health-related Quality of life (HRQol) compared to a control-matched sample of MDQ negatives, identifying a specific syndrome. This is a case-control study based on a database from a community survey. Cases: MDQ-positive without mood disorders; Controls: MDQ negatives matched by sex, age, and psychiatric diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) criteria. Tools: MDQ, the Advanced Neuropsychiatric Tools and Assessment Schedule (ANTAS) semi-structured interview for psychiatric diagnosis, and the Health Survey Short Form (SF-12) for measuring HRQol. People scoring positive on the MDQ without a diagnosis of mood disorders showed significantly lower scores on the SF-12 compared to people of the same age and of the same sex with an equal diagnosis of psychiatric disorders not related to mood disorders (35.21 ± 6.30 vs. 41.48 ± 3.39, p < 0.0001). In the debate whether a positive score on the MDQ selects an area of "malaise" due to the presence of disorders differing from Bipolar Disorders, or if a positive score on the MDQ may be considered a "subthreshold" form of bipolar disorder in people who may later develop bipolar disorder, a third hypothesis can be advanced, i.e., that a positive score on the MDQ identifies a specific "Dysregulation of Mood, Energy, and Social Rhythms Syndrome" (DYMERS), characterized by a considerable amount of suffering and not attributable to other disorders, and which might represent a trigger for the previously mentioned disorders with which a positive score on the MDQ is associated, probably including, in severe conditions, bipolar disorder.
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Affiliation(s)
- Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy; (M.G.C.); (S.P.); (D.P.)
| | - Goce Kalcev
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy; (M.G.C.); (S.P.); (D.P.)
| | - Michele Fornaro
- Department of Psychiatry, Federico II University of Naples, 80126 Naples, Italy;
| | - Samantha Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy; (M.G.C.); (S.P.); (D.P.)
| | - Cesar Ivan Aviles Gonzalez
- Nursing Program, Faculty of Health Sciences, Universidad Popular del Cesar, Sede Sabanas, Valledupar 20002, Colombia;
| | - Antonio Egidio Nardi
- Laboratory Panic and Respiration, Institute of Psychiatry (IPUB), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 22725, Brazil;
| | - Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy; (M.G.C.); (S.P.); (D.P.)
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Carta MG, Kalcev G, Scano A, Pinna S, Gonzalez CIA, Nardi AE, Orrù G, Primavera D. Screening, Genetic Variants, and Bipolar Disorders: Can Useful Hypotheses Arise from the Sum of Partial Failures? Clin Pract 2023; 13:853-862. [PMID: 37623258 PMCID: PMC10453758 DOI: 10.3390/clinpract13040077] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/20/2023] [Accepted: 07/23/2023] [Indexed: 08/26/2023] Open
Abstract
Bipolar disorder (BD) is a relevant public health issue, therefore accurate screening tools could be useful. The objective of this study is to verify the accuracy of the Mood Disorder Questionnaire (MDQ) and genetic risk as screeners, and their comparison in terms of reliability. Older adults (N = 61, ≥60 years) received a clinical psychiatric evaluation, the MDQ, and were evaluated according to the presence of the genetic variant RS1006737 of CACNA1C. MDQ+ versus the diagnosis of BD as a gold standard shows a sensitivity of 0.286 (Cl 95% 0.14-0.39); a specificity of 0.925 (Cl 95% 0.85-0.08); a predictive positive value (PPV) of 0.667 (Cl 95% 0.33-0.91); and a predictive negative value (PNV) of 0.702 (Cl 95% 0.65-0.75). The positivity for the variant RS1006737 of the CACNA1C against the diagnosis of BD as a gold standard shows a sensitivity of 0.750 (Cl 95% 0.55-0.90); a specificity of 0.375 (Cl 95% 0.28-0.45); a PPV of 0.375 (Cl 95% 0.28-0.45); and a PNV of 0.750 (Cl 95% 0.55-0.90). The reliability between the MDQ+ and positivity for the variant RS1006737 of the CACNA1C was very low (K = -0.048, Cl 95% -0.20-0.09). The study found that both the genetic and the paper and pencil test were quite accurate, but were not reliable in case finding. In fact, despite some validity, albeit specular (in the case of a positive genetic test, the probability of having the disorder is very high, whereas in the case of a negative score on the paper and pencil test, the probability of not having the disorder is very high), the unreliability of the two tests (i.e., they certainly do not measure the same underlying dimension) opens the door to the need for an interpretation and the possibility of a synergistic use for screening. From a heuristic perspective, which obviously requires all of the necessary verifications, this study seems to suggest the hypothesis that a condition of hyperactivation common to disorders and stress conditions, and identified by a positive score on the MDQ (which is common to BD, post-traumatic stress disorder (PTSD), and anxiety disorders and whose genetic basis has not yet been clarified) can trigger BD in people with a predisposition to hyperactivity (i.e., in people with the condition identified by the analyzed genetic variant).
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Affiliation(s)
- Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy; (M.G.C.); (S.P.); (D.P.)
| | - Goce Kalcev
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy; (M.G.C.); (S.P.); (D.P.)
| | - Alessandra Scano
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, Blocco I, Asse Didattico Medicina P2, Monserrato (CA), 09042 Cagliari, Italy; (A.S.); (G.O.)
| | - Samantha Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy; (M.G.C.); (S.P.); (D.P.)
| | - Cesar Ivan Aviles Gonzalez
- Faculty of Health Sciences, Nursing Program, Univesidad Popular del Cesar, Sede Sabanas, Valledupar 20002, Colombia;
| | - Antonio Egidio Nardi
- Laboratory Panic and Respiration, Institute of Psychiatry (Ipub), Federal University of Rio De Janeiro (Ufrj), Rio De Janeiro 22725, Brazil;
| | - Germano Orrù
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, Blocco I, Asse Didattico Medicina P2, Monserrato (CA), 09042 Cagliari, Italy; (A.S.); (G.O.)
| | - Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy; (M.G.C.); (S.P.); (D.P.)
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Carta MG, Nardi AE, Pinna S, Cossu G, Gureje O. Multidisciplinary contributions towards an evolutive interpretation of bipolar disorders: Could it be the pathological drift of a potentially adaptive condition? Braz J Psychiatry 2023; 45. [PMID: 37307284 PMCID: PMC10668319 DOI: 10.47626/1516-4446-2023-3154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/25/2023] [Indexed: 06/14/2023]
Abstract
This paper tries to summarize the results of studies from different disciplines supporting the idea that temperamental traits, such as "reckless/hyper-exploratory" attitudes, commonly believed to be associated with psychopathology, surprisingly turn out as adaptive under specific stress conditions. In particular, this paper analyzes an ethologic line of research on primates suggesting models for a sociobiological interpretation of mood disorders in humans; a study that found high frequencies of a genetic variance associated with bipolar disorder in people without bipolar disorder but with hyperactivity/novelty-seeking traits; the outcomes of socio-anthropologicalhistorical surveys on the evolution of mood disorders in Western countries in the last centuries; surveys on changing societies in Africa and African migrants in Sardinia; and studies that found higher frequencies of mania and subthreshold mania among Sardinian immigrants in Latin American megacities. Although it is not unequivocally accepted that an increase in the prevalence of mood disorders has occurred, it would be logical to suppose that a nonadaptive condition should have disappeared over time; mood disorders, on the contrary, persist and their prevalence might have even increased. This new interpretation could lead to counter-discrimination and stigma towards people suffering from the disorder, and it would be a central point in psychosocial treatments in addition to drugs. The aim is to hypothesize that bipolar disorder, strongly characterized by these traits, may be the result of the interaction between genetic characteristics, not necessarily pathological, and specific environmental conditions, rather than a mere product of an aberrant genetic profile. If mood disorders were mere nonadaptive conditions, they would have disappeared over time, however, their prevalence, paradoxically, persists if not even increases over time. The hypothesis that bipolar disorder may result from the interaction between genetic characteristics, not necessarily pathological, and specific environmental factors, seem more credible than considering bipolar disorder as a mere product of an aberrant genetic profile.
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Affiliation(s)
- Mauro G. Carta
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Antonio E. Nardi
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Samantha Pinna
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Giulia Cossu
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
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