ABSTRACT
Objective: To determine whether people with a Sardinian genetic background who live in the megacities of South America have a higher frequency of hypomania than residents of Sardinia. Methods: A community survey of Sardinian immigrants was carried out in four Brazilian metropoles (n=218) and Buenos Aires (n=306). The results were compared with those of a study involving a similar methodology (Mood Disorder Questionnaire [MDQ] as a screening tool) conducted in seven Italian regions, including a sub-sample from Sardinia. Results: There was a higher prevalence of lifetime hypomania among Sardinians living in the Brazilian metropoles than among those living in Sardinia. This result was also consistent with Sardinian immigrants in Buenos Aires. After stratification by sex and age, the lifetime prevalence of MDQ scores ≥ 8 among Sardinians in South-American megacities and Sardinia was 8.6% vs. 2.9%, respectively (p < 0.0001). Conclusions: The higher frequency of hypomania in migrant populations appears to favor an evolutionary view in which mood disorders may be a maladaptive aspect of a genetic background with adaptive characteristics.
Subject(s)
Humans , Male , Female , Adult , Transients and Migrants/psychology , Bipolar Disorder/epidemiology , Argentina/epidemiology , Brazil/epidemiology , Cross-Cultural Comparison , Prevalence , Surveys and Questionnaires , Risk Factors , Cities/epidemiology , Sex Distribution , Age Distribution , Italy/ethnologyABSTRACT
Objective: To ascertain lifetime prevalence of positivity to a screening questionnaire for bipolar disorders (BD) in Sardinian immigrants to Argentina and residents of Sardinia and assess whether such positivity affects quality of life (QoL) in either group. Our hypothesis is that screen positivity for BD may be more frequent in immigrants. Methods: Observational study. Subjects were randomly selected from the membership lists of associations of Sardinian immigrants in Argentina. A study carried out in Sardinia using the same methodology was used for comparison. The Mood Disorder Questionnaire was used to screen for mania/hypomania and the Short-Form Health Survey-12 to measure QoL. Results: A higher prevalence of manic/hypomanic episodes was found in Sardinian immigrants to Argentina (p < 0.0001; odds ratio = 3.0, 95% confidence interval 1.87-4.77). Positivity at screening was associated with a lower QoL both in Sardinian immigrants to Argentina and in residents of Sardinia. Conclusions: To the best of our knowledge, this is the first study to show a higher lifetime prevalence of manic/hypomanic episodes in a general-population sample of individuals who migrated to a foreign country. Our results are in agreement with the hypothesis that hyperactive/novelty-seeking features may represent an adaptive substrate in certain conditions of social change.
Subject(s)
Humans , Male , Female , Adult , Bipolar Disorder/epidemiology , Emigrants and Immigrants/psychology , Argentina/epidemiology , Psychiatric Status Rating Scales/standards , Quality of Life/psychology , Logistic Models , Sex Factors , Prevalence , Cross-Sectional Studies , Surveys and Questionnaires/standards , Risk Factors , Age Factors , Sex Distribution , Age Distribution , Emigrants and Immigrants/statistics & numerical data , Italy/ethnologyABSTRACT
Background: Lithium is a light, metallic element and minerals containing it are most abundant in the Andes. John Cade introduced lithium carbonate for the treatment of mania in 1949, opening the era of modern clinical psychopharmacology. Lithium remains the most extensively studied mood-stabilizing agent. It has had a revolutionary impact in supporting bipolar manic-depressive disorder as a discrete diagnosis, and on psychiatric therapeutics. Methods: We survey the development of lithium treatment in psychiatry, including findings concerning effects on suicide. Results: Lithium is the most extensively studied treatment for bipolar disorder and the prototypical mood-stabilizing agent, despite emergence of anticonvulsants and modern antipsychotics. In addition to limiting recurrences of mania, and some reduction of recurrences of bipolar depression, lithium has demonstrated protective effects against suicide. All treatments for bipolar disorder have notable limitations, including sometimes serious adverse effects, incomplete prevention of recurrences of mania and limited prevention of depression, which accounts for three-quarters of the approximately 50% time-ill in long-term follow-up with standard treatments. Lithium can be toxic in untreated overdoses; safe dosing requires monitoring of serum concentrations. Lithium also may have mild teratogenic effects, but far less than those of anticonvulsants used for bipolar disorder. Conclusions: Lithium opened the era of modern psychopharmacology and continues as the best-established mood-stabilizing treatment for bipolar disorder as well as having strong evidence of suicide-preventing effects.
Antecedentes: Litio es un elemento metálico ligero y los minerales que lo contienen abundan predominantementeen la región andina. John Cade introdujo el uso de carbonato de litio para el tratamiento de manía en 1949, iniciando con ello la era de la moderna psicofarmacología clínica. Litio se mantiene como el más extensamente estudiando agente estabilizador del ánimo. Ha tenido un impacto revolucionario en la preservación del trastorno maniaco-depresivo o bipolar como un diagnóstico discreto y en el campo de la terapéutica psiquiátrica.Métodos: Se examina el desarrollo histórico del tratamiento con litio en psiquiatría, incluyendo hallazgos en relación a su efecto sobreconducta suicida. Hallazgos:Litio es el tipo de tratamiento más extensamente estudiado en el manejo de trastorno bipolar disorder, constituido como el prototipo de agente estabilizador del ánimo, a pesar de la emergencia de agentes anticonvulsivantes y de los antipsicóticos modernos. Además de limitar la recurrencia de episodios maniacos y reducir en algo las recurrencias de depresión bipolar, litio ha demostrado efectos protectores en relación a suicidio y conducta suicida. Todos los tipos de tratamiento de trastorno bipolar tienen limitaciones notables, incluyendo algunas veces serios efectos adversos, prevención incompleta de recurrencias de manía y prevención limitada de depresión, todo lo cual constituye las tres cuartas partes de aproximadamente el 50 % de tiempo con enfermedad en estudios de seguimiento a largo plazo con tratamientos estándar.
Subject(s)
Depression/therapy , Lithium/therapeutic use , Suicide , Bipolar Disorder/therapyABSTRACT
Lithium has been the major cause of the psychopharmacological revolution in the treatment of mood disorders. Discovered nearly 200 years, throughout its history, has had several therapeutic uses. The research conducted by Cade and Schou allowed its final incorporation in the therapeutic arsenal, emphasize its antidepressant effect, prevention of relapse in bipolar disorder and suicidal behavior. Its main indication is treat diverse stages of manic depressive psychosis. Although various side effects have been discovered, the cost / benefi t of lithium use, despite their lack of knowledge caused by the pharmaceutical industry, have led it grow progressively in clinical practice worldwide.
El litio ha sido el mayor causante de la revolución psicofarmacológica en el tratamiento de los trastornos del estado de ánimo. Descubierto hace casi 200 años, a lo largo de su historia, ha tenido diversos usos terapéuticos. Las investigaciones realizadas por Cade y Schou permitieron su incorporación definitiva en el arsenal terapéutico, destacando su efecto antidepresivo, la prevención de recaídas en bipolares y la de conductas suicidas. Su indicación principal es tratar diversas fases de la psicosis maniaco- depresiva. Aunque se han descubierto diversos efectos secundarios, el costo/beneficio del uso del litio, pese a su escasa difusión debida a por parte de la industria farmacéutica, lo ha llevado a crecer progresivamente en la práctica clínica a nivel mundial.