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The Seasonality of Mania: Preliminary Findings

1992; King Faisal Specialist Hospital and Research Centre; Volume: 12; Issue: 5 Linguagem: Inglês

10.5144/0256-4947.1992.472

0975-4466

Fathi Aleem Abdul-Rahim, Abdulla Al-Sabai, Abdul Razag Al-Hamad, Elijah A. Bamgboye,

Circadian rhythm and melatonin

Original ArticlesThe Seasonality of Mania: Preliminary Findings Fathi Aleem Abdul-Rahim, DPM, MRCPsch Abdulla Al-Sabai, FRCP(C) Abdul Razag Al-Hamad, and M.Med Psych Elijah BamgboyePhD (Lond.) Fathi Aleem Abdul-Rahim Address reprint requests and correspondence to Dr. Abdul-Rahim: Department of Psychiatry (55), King Saud University, P.O. Box 2925, Riyadh 11461, Saudi Arabia. From the Department of Psychiatry, College of Medicine, King Saud University, Riyadh Search for more papers by this author , Abdulla Al-Sabai From the Department of Psychiatry, College of Medicine, King Saud University, Riyadh Search for more papers by this author , Abdul Razag Al-Hamad From the Department of Psychiatry, King Khalid University Hospital, Riyadh Search for more papers by this author , and Elijah Bamgboye From the Department of Community and Family Medicine, King Saud University, Riyadh Search for more papers by this author Published Online:1 Sep 1992https://doi.org/10.5144/0256-4947.1992.472SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutABSTRACTABSTRACTThe relationship between climatic variables and monthly manic admissions to a teaching hospital in Riyadh, Saudi Arabia was examined over a six-year period. The results indicate a weak but significant correlation between monthly admission rates of mania and day length, humidity, air pressure, and temperature. The correlation did not seem, however, to be strong enough to indicate a seasonal trend. Also, current month climatic variables are better correlated than previous months. The prevalence of sunshine throughout the year may explain the low correlation with mania admissions unlike reports from other countries.IntroductionThe onset or relapse of affective disorders have been reported to relate to seasonal variations [1]. Studies of suicide (being heavily contributed to by major depressive disorders), support these findings [2], Studies of the seasonal incidence of affective disorders have demonstrated a tendency for spring and fall peaks of depression and a summer peak of mania [1]. A sex differential has also been observed. In fact, Symon and Williams [3] reported a seasonal variation for female manic admissions; the peak being in August-September, while for males they found no significant seasonal pattern. Walter [4], however, reanalyzed the Symon and Williams data and found significant seasonal variations for both sexes. Myers and Davies [5] reported on the seasonal incidence of mania and its relationship to climatic variables and found a significant annual cycle with a peak in summer and trough in winter, the current month temperature being the best predictor of mania admission rate. In the study conducted by Carney et al [6], the influence of climate on the prevalence of mania demonstrated a striking peak during spring and summer, with a decline in autumn and increase again during winter. They also found that sunshine and day length correlated significantly with mania admission rates while current month temperatures did not.Our clinical experience in Riyadh suggests an increase in admission rates for mania during the winter months. Also, both the fact that the extremely hot climate of Saudi Arabia contrasts sharply with temperate climates in countries where previous studies have been conducted and the paucity of similar studies in hot regions prompted us to initiate this study. Therefore, our objectives were to verify whether there was a seasonal variation in the prevalence of mania in Riyadh and to examine the association between monthly mania admission rates and individual climatic variables.MATERIAL AND METHODSThere are three psychiatric admitting facilities in Riyadh. One is strictly for military people while the other two are available for the general population. One of the two facilities is King Khalid University Hospital (KKUH), where this study was carried out. Cases of DSM III diagnosis of mania admitted to King Khalid University Hospital in Riyadh during the period 1984 to 1989 were retrospectively reviewed. The following parameters were assessed: demographic data, admission related information e.g., age at admission, number and duration of admissions, duration of the illness and drug status prior to admission, and family history of mental illness including affective disorders. Cases of schizoaffective disorders were excluded. Monthly records included averages of temperatures, rainfall, air pressure, day length and relative humidity as recorded at the meteorological station located in Riyadh during the six-year study period and plotted against the monthly rates of manic admissions. Series analysis using the autoregressive model was adjusted to investigate seasonal variations in temperatures, day length, and manic admissions. Correlations were measured using Spearman's rank order correlation coefficient. The student's t-test was used to investigate statistical significance of seasonal differences in monthly admissions at the 5% level. Finally, a stepwise multiple regression analysis was carried out to examine the joint effect of climatic variables on manic admissions [7].RESULTSDuring the study period there were 84 patients; 55 males (66%) and 29 females (34%), and a total of 142 admissions; males included 89 (63%) and females 53 (37%). Forty-one patients (23 males and 18 females) had more than one admission. Table 1 shows the patients' ages during last admission. Prior to the last admission, 11 patients were on lithium maintenance therapy, 16 on neuroleptics, and 6 on antidepressants (Table 2). Twenty-four patients had a family history of affective disorders. The average duration of illness prior to admission was 1.3 weeks for males and 2.5 weeks for females. The average duration of hospitalization was 3.6 weeks for both sexes.Table 1. Patients' age on last admission.Table 1. Patients' age on last admission.Table 2. Treatment (last admission).Table 2. Treatment (last admission).During 1984 to 1989, there appeared to be a monthly fluctuation in the frequency of admissions but an autoregressive integrated moving average model adjusted to the mania admission data suggested no dependence on seasons in both sexes. The autocorrelations were all within two standards on the plot. A Spearman's correlation matrix noting frequency of admissions and the climatic factors are shown in Table 3.Table 3. Univariate Spearman correlation coefficient (r =) of mania admission frequencies and climatic factors.Table 3. Univariate Spearman correlation coefficient (r =) of mania admission frequencies and climatic factors.The correlation between temperatures, humidity, air pressure, day length, and frequency of mania admissions were low, but statistically significant (P < 0.05). In fact, day length and temperatures had a negative correlation with frequency of admission; the maximum temperatures were recorded between July and August and this corresponded with the low frequency of admission (r = 0.21, P < 0.05). A multiple stepwise regression analysis was carried out to assess the joint effect of climatic factors on the frequency of admission for mania. Temperatures, humidity, and air pressure combined explains only 16.7% of the total variation of patients admitted for mania. Analysis of variance showed the regression to be statistically significant (F-Ratio = 10.03 on 3,150 degrees of freedom, P < 0.0001). But, when the full model with interaction effects were adjusted, approximately 70% of the total variation in mania admission rates were explained by these climatic variables (Table 4). The analysis of variance to test the significance of regression coefficients presented an F-ratio of 46.50 on 7,146 degrees of freedom and statistical significance of (P < 0.0001). However, interpretations of the independent effects of the climatic factors are difficult because of the significant interaction effects.Table 4. Multiple regression coefficient of the relation of mania admission and climatic factor.Table 4. Multiple regression coefficient of the relation of mania admission and climatic factor.An analysis of previous month's climatic variables including total admissions averaged during the six-year period showed poor negative correlations with temperatures, humidity, and rainfall (P > 0.05). But the correlation with barometric pressure was positive and statistically significant (P < 0.05). Also, the joint effect of the previous month's climatic variables explained approximately 50% of the variability in total admissions. The significance of the regression coefficients using these variables as independent and total admissions as dependent, investigated by the analysis of variance resulted in an F-value of 49.6 on 5,148 degrees of freedom (P < 0.0001). However, the result of the simple correlation analysis (Table 5) showed that current month climatic variables were better correlated with total admissions for mania than the previous month's variables.Table 5. Spearman correlation coefficients of climatic variables.Table 5. Spearman correlation coefficients of climatic variables.DISCUSSIONThe results of this study did not demonstrate a seasonal trend of mania as reported in the literature. Riyadh is located in the central region of Saudi Arabia with a hot dry desert climate. Winter and summer are the main seasons when temperatures drop to as low as –3°C during winter and reaches 46°C or higher during the summer, with scanty rainfall, plenty of sunshine during the whole year and variation of day length throughout the year. Little variability in variables other than temperature confirms Carney et al, findings that both sunshine and day length, but not temperatures, correlated significantly with admissions for mania rate [6]. The authors suggested that the onset or relapse of mania may be due to an abnormal response to increasing exposure to light. The results of our study suggest temperatures as the highest correlate with mania admissions followed by humidity and air pressure. Myers and Davies [5] argued that since temperature had the highest correlation with manic admission rates, it acts as a fine adjustment determining which month admission actually occurred.The findings of the present study suggest that factors other than climate contribute to the onset or relapse of mania. The low admission rates for mania during the summer (July-August) corresponding to the period with the highest temperatures lends support to our impression that admission rates for mania increase during the winter months. These findings may be partly due to the Hajj (pilgrimage) operations and annual vacations during this time of the year. Since 27 patients were on maintenance therapy prior to last admission, one may hypothesize that maintenance therapy modifies or prevents the seasonal effect in the patients, but fails to act as a prophylactic. Male patients were over-represented in our sample. This is a frequently reported observation in hospital based studies in this country [8]. Female manics seem to be more tolerated by family members which is reflected by the longer duration of illness prior to admission. The finding that current month variables correlated better with monthly admission rates than previous month variables is also similar to that previously reported by Myers and Davies [5].The present study is limited because it has been conducted in one of the three hospitals recruiting psychiatric patients in Riyadh, Saudi Arabia. However, in spite of the seemingly lack of seasonal variation in manic admission rates, a nationwide study may be desirable to further paint a clearer picture on the perspective.ARTICLE REFERENCES:1. Rosenthal NE, Sack DA, Wehr TA. Seasonal variation in affective disorders. In: Orcadian rhythms in psychiatry. Wehr TA, Goodwin FK, eds. Pacific Grove: Boxwood Press, 1983. Google Scholar2. Seager CP, Flood RA. "Suicide in Bristol" . Br J Psychiatry. 1965; 111:919–32. Google Scholar3. Symon RL, Williams P. "Seasonal variation in the incidence of mania" . Br J Psychiatry. 1976; 129:45–8. Google Scholar4. Walter SD. "Seasonality of Mania: a reappraisal" . Br J Psychiatry. 1977; 131:345–50. Google Scholar5. Myers MD, Davies P. "The seasonal incidence of mania and its ralation to climate variables" . Psychol Med. 1978; 8:433–40. Google Scholar6. Carney PA, Fitzgerald CT, Monaghan CE. "Influence of climate on the prevalence of mania" . Br J Psychiatry. 1988; 152:820–3. Google Scholar7. Kleinbaum DG, Kupper LL. Applied regression analysis and other multivariable methods. University of North Carolina, Boston: Duxbury Press, 1985. Google Scholar8. Al-Sabaie A. "Psychiatry in Saudi Arabia: cultural perspective" . Transcult Psychiatr Res Rev. 1989; 26:245–62. Google Scholar Previous article Next article FiguresReferencesRelatedDetailsCited byQureshi N (2019) Questionable Seasonality of Mania, Annals of Saudi Medicine , 13:5, (479-480), Online publication date: 1-Sep-1993. Volume 12, Issue 5September 1992 Metrics History Accepted15 January 1992Published online1 September 1992 InformationCopyright © 1992, Annals of Saudi MedicinePDF download