Eventos de vida estressores e episódios de humor: uma amostra comunitária / Stressful life events and mood disorders: a community sample

Transtornos de humor são consequentes de uma interação entre fatores biológicos e ambientais. O objetivo deste estudo foi identificar associações entre eventos vitais estressores e transtornos de humor em uma amostra comunitária de jovens do Sul do Brasil. Trata-se de estudo transversal de base populacional com jovens de 18 a 24 anos. A seleção da amostra foi realizada por conglomerados. Os episódios de alteração do humor foram avaliados através da Mini International Neuropsychiatric Interview , enquanto os eventos vitais estressores foram mensurados através da escala de reajustamento social de Holmes e Rahe. A amostra foi de 1172 jovens. A proporção de eventos vitais estressores no último ano, em cada categoria, no total da amostra, foi de: 53,8% trabalho, 42,4% perda de suporte social, 63,8% família, 50,9% mudanças ambientais, 61,1% dificuldades pessoais e 38,7% finanças. Houve associação significativa entre eventos vitais estressores e episódios de alteração de humor. Foi verificada maior ocorrência de eventos vitais estressores entre os jovens em episódio misto, quando comparados aos jovens em episódio depressivo, (hipo) maníaco e controles. Esses achados sugerem uma interação psicossocial entre eventos vitais estressores e os episódios de alteração de humor.

Mood disorders are a consequence of the interaction between environmental and biological factors. The objective of this study was to identify associations between stressful life events (LEs) and mood disorders in a community sample of young people in southern Brazil. It is a cross-sectional population-based study on young people between 18 and 24 years of age. The selection of the sample was conducted via conglomerates. Mini International Neuropsychiatric Interviews were used to evaluate mood disorders, and the Social Readjustment Rating Scale to assess stressful life events. The sample included 1172 young people. Of the total sample, the proportion of stressful life events in the last year in each category was: 53.8% work, 42.4% loss of social support, 63.8% family, 50.9% environmental changes, 61.1% personal difficulties, and 38.7% finances. A significant relationship was found between categories of stressful life events and mood disorder episodes. A higher incidence of stressful life events was found among young people in a mixed episode compared to young people in a depressive, (hypo)maniac episode with controls. This finding suggests a psychosocial interaction between stressful life events and the occurrence of mood disorders.

Re-evaluation of Bipolar Patients Hospitalized for Manic Episode: Possibility of Diagnosing as a Mixed Episode / 신경정신의학

OBJECTIVE: Mixed states are difficult to define precisely and to recognize accurately. Moreover, the DSM-IV criteria for diagnosis of a mixed episode might be too restrictive. The purpose of this study was to investigate the possibility of a mixed episode in bipolar inpatients hospitalized with DSM-IV manic episodes using the Cincinnati criteria, which is a broader criteria compared to DSM-IV. METHODS: Inpatient charts of manic patients were carefully evaluated to determine the presence of depressive symptoms in the Cincinnati criteria. The probable mixed patient group was compared with the definitely manic patient group on demographic and clinical variables. The predictability of depressive symptoms for a mixed episode was assessed. RESULTS: Twenty-one out of 101 manic inpatients were possibly diagnosed as mixed episodes. They showed more psychiatric family history, comorbid personality disorder and suicide attempts. Two symptoms (suicidal ideation and helplessness or hopelessness) had good positive predictive value. CONCLUSION: Diagnosis of a mixed episode can be increased with careful interview and by using a broader diagnostic criteria. The presence of suicidal ideation and helplessness or hopelessness may suggest a mixed state.