Efecto de la variación estacional en el estado de ánimo de adolescentes, estudio prospectivo, Santiago / Relationship between the seasonal variation and the mood of adolescents: prospective study

Introducción: El Trastorno Afectivo Estacional (TAE) es caracterizado por síntomas depresivos que se manifiestan recurrentemente durante el invierno y ceden espontáneamente en primavera-verano. Existen pocos estudios sobre TAE en niños y adolescentes. Objetivo: Estudiar la relación entre la variación estacional” y el estado de ánimo en adolescentes. Metodología: Se realizó un estudio de cohorte prospectivo a 220 estudiantes de 1° Medio a 4° Medio de dos colegios de la Región Metropolitana de diferente nivel socioeconómico, elegidos al azar. A los estudiantes se les aplicó en invierno y en primavera 2008, Cuestionario de Depresión Infantil (CDI) y Cuestionario de Evaluación de Perfil Estacional versión para niños y adolescentes (SPAQ-CA). Resultados: La prevalencia de “Sospecha de Depresión”(SD) fue mayor en invierno(20 por ciento) que en primavera(13 por ciento) (p<0,01). La “Autopercepción de tener Problemas con la Variación Estacional” (APPVE) no varió significativamente entre los periodos encuestados. La APPVE fue 2,8 veces más frecuente en mujeres que en hombres(p<0,01). Se encontró una correlación positiva entre SD y APPVE, solo en invierno. Conclusión: En una misma población de adolescentes hay variación en el autoreporte de SD según la estación del año, siendo significativamente mayor en invierno. La variación estacional influye en el ánimo de los adolescentes encuestados, especialmente en mujeres, siguiendo el patrón descrito en la literatura.

Background: Seasonal affective disorder (SAD) is characterized by depressive symptoms that appear repeatedly in the winter and subside spontaneously in Spring-summer. There are few studies of SAD in children and adolescents. Objective: To study the relationship between the seasonal variation (SV) and the mood of adolescents. Methodology: A prospective cohort study of 220 high school students from two randomly chosen schools of different socioeconomic status in the metropolitan area of Santiago was conducted. Students were surveyed in winter and spring 2008 with the Childhood Depression Inventory (CDI) and Seasonal Pattern Assessment Questionnaire for Children and Adolescents (SPAQ-CA). Results: The prevalence of suspected depression (SD) was higher in winter (20 percent) than in spring (13 percent) (p <0.01). The perception of problems with seasonal variation (PPSV) did not differ significantly between surveys. The PPSV was 2.8 times higher in women than in men (p <0.01). We found a positive correlation between SD and PPSV only in winter. Conclusion: There is SV in adolescent self-reported SD, being higher in woman, following the pattern described in the literature.

Estacionalidad en admisiones hospitalarias por Trastorno Bipolar en Santa María, Córdoba, Argentina / Seasonal pattern in hospital admissions due to bipolar disorder in Santa María, Córdoba, Argentina

Introducción: el objetivo del trabajo es establecer si existe un patrón de estacionalidad en las internaciones hospitalarias por trastorno bipolar en el Hospital Colonia Santa María, Córdoba, Argentina, entre los años 2000 y 2003. Materiales y métodos: se tomaron los episodios afectivos internados con diagnóstico de trastorno bipolar (CIE-IO) durante el período y se analizaron las historias clínicas según los criterios del DSM-IV. Se incluyeron las internaciones de toda la historia patobiográfica del individuo. Resultados: se incluyeron 84 episodios afectivos: 43 maníacos (51%), 20 depresivos (24%), 15 mixtos (18%) y 6 hipomaníacos (7%). Se encontró una asociación estadísticamente significativa (p<0,001) entre episodios afectivos del trastorno bipolar y estación del año, con un patrón estacional de manía-hipomanía en verano y depresión en invierno. Los episodios mixtos presentan pico en verano pero se distribuyen más uniformemente en el año. Conclusiones: existe estacionalidad en las internaciones por trastorno bipolar.

Introduction: The purpose of this research is to establish if there is a seasonal pattern in hospitalizations due to affective episodes of bipolar disorder in Hospital Colonia Santa Maria, Córdoba, Argentina, between 2000-2003. Materials and methods: The affective episodes considered were those which required patient hospitalization with bipolar disorder diagnosis (ICD-I0). Medical histories were analyzed subsequently, according to the DSM-IV criteria. The episodes considered were those with hospitalization during all the pathobiographical history of the patient. Outcome: 84 affective episodes were considered. 43 were maniac (51 %), 20 were depressive (24%), 15 were mixed (18%) and 6 were hypomaniac (7%). A statistically significant association was found (p<0,00l) between affective episodes of bipolar disorder and the season of the year, with a seasonal pattern of mania-hypomania in summer and depression in winter. Mixed episodes were distributed more consistently in the year with a peak in summer. Conclusion: In this research a relationship is established between bipolar disorder and seasonal nature in hospitalizations.

Pituitary volume and the effects of phototherapy in patients with seasonal winter depression: a controlled study

OBJECTIVES: Our aims were to investigate the pituitary volume in patients with seasonal winter depression and healthy volunteers in winter and summer, and to assess the effects of phototherapy in these patients. METHOD: The pituitary volume of 12 patients with winter depression and 12 healthy controls, paired according gender, age and menstrual cycle, were obtained from magnetic resonance imaging in winter and summer. Eight patients were submitted to phototherapy (10000 vs. 2500 lux) in a double-blind crossover fashion during the winter, and reassessed (symptoms and magnetic resonance imaging) after treatment. RESULTS: There were no significant differences in pituitary volume between controls and patients in winter or summer. Exposure to phototherapy (10000 lux) decreased the depressive symptoms (p = 0.004), but the glandular volume did not change (p = 0.5). However, the pituitary volume in winter showed a positive correlation with the severity of depression in these patients (r = 0.69, p = 0.04). CONCLUSIONS: The results suggest that neither winter depression nor the change of seasons is associated with significant change in the pituitary volume. Despite the fact that this study was performed in a tropical area, phototherapy with 10000 lux showed to be an efficient treatment in this SAD patients sample.

OBJETIVOS: Nossos objetivos foram investigar o volume da pituitária em pacientes com depressão sazonal de inverno e controles sadios, no inverno e verão, e avaliar os efeitos da fototerapia nesses pacientes. MÉTODO: O volume da pituitária de 12 pacientes com depressão de inverno e 12 controles sadios, pareados quanto ao gênero, idade e fase do ciclo menstrual, foi examinado por meio de imagem por ressonância magnética no inverno e verão. Oito pacientes foram submetidos à fototerapia (10.000 vs 2.500 lux) de forma duplo-cega e cruzada durante o inverno e reavaliados (sintomas e imagem por ressonância magnética) após o tratamento. RESULTADOS: Não houve diferença significativa no volume da pituitária entre controles e pacientes, no inverno e verão. A fototerapia (10.000 lux) reduziu os sintomas depressivos (p = 0,004), mas não alterou o volume glandular (p = 0,5). Contudo, o volume da pituitária, no inverno, mostrou uma correlação positiva com a gravidade da depressão nesses pacientes (r = 0,69, p = 0,04). CONCLUSÕES: Os resultados sugerem que nem a depressão de inverno, nem a mudança das estações estão associadas com a mudança significativa do volume da pituitária. Apesar do fato deste estudo ter sido realizado em uma região tropical, a fototerapia com 10.000 lux mostrou-se um tratamento eficaz nesta amostra.

Trastornos invernales del ánimo / Winter mood disorders

La existencia de trastornos del ánimo de recurrencia estacional está plenamente demostrada en el mundo, siendo denominado trastorno afectivo estacional (TAE). En Chile, el TAE no ha sido formlmente descrito. El presente trabajo tiene por objeto estudiar la concordancia clínica y terapéutica de una serie de pacientes con depresiones de recurrencia invernal, con las características de series extrajeras de TAE. Se reclutaron 12 pacientes con depresión mayor actual, que cumplieron con los requisitos internacionales de recurrencia estacional y se estudió su pérfil de síntomas y se evaluó su respuesta a 10 sesiones de fototerapia de acuerdo a un protocolo estandarizado. Se observó una estrecha concordancia de los síntomas y la respuesta a fototerapia con las series extranjeras. Se trata de la primera serie nacional de TAE. Se discute su relevancia clínica