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Bipolar Disorder Unit Treatment, Department of Psychiatry, Catholic University Medical School, Rome, Italy.

 

Whoever wishes to investigate medicine properly, should proceed thus:

in the first place to consider the seasons of the year, and what effects

each of them produces for they are not at all alike, but differ much

from themselves in regard to their changes. Then the winds, the hot

and the cold, especially such as are common to all countries, and

then such as are peculiar to each locality. We must also consider

the qualities of the waters, for as they differ from one another in

taste and weight, so also do they differ much in their qualities…”

(Hippocrates, “Airs, waters and places”, 400 B.C.E.)

 

Biometeorology is that branch of ecology which deals with the effects on living organisms of the extraorganic aspects of the physical environment (such as temperature, humidity, barometric pressure, rate of air flow, and air ionization). It considers not only the natural atmosphere but also artificially created atmospheres such as those to be found in buildings and shelters, and in closed ecological systems, such as satellites and submarines. Meteorotropism is the response to influence by meteorological factors noted in certain biological events, such as sudden death, attacks of angina, joint pain, insomnia, and traffic accidents. Meteoropathology is the pathology of conditions caused by atmospheric conditions, while meteoropathy is a term which indicates any disorder due to conditions of climate.

The term meteoropathy, from the Greek ‘meteora’ (things high in the air or celestial phenomena) and ‘pathos’ (illness, suffering, pain), indicates every pathological dimension in some way related to weather conditions. This concept is referred to a set of temperature, humidity, barometric pressure and brightness. Someone said to suffer from meteoropathy is called a meteoropathic. Some people may feel tired when weather changes but still can’t sleep, some people get nervous when winds become strong, or some people may feel sad and depressed when it rains. Those people are meteoropathic and their ability to function properly depends greatly on weather. According to the recent research the number of people who feel the effects of weather changes is growing. And with them the interest for meteoropathy.

Meteoropathy is different from historical conceptions of "air" causing diseases and strongly influencing people's sense of well-being. There appear to be significant and measurable correlations between particular atmospherical events (such as a sudden increase in humidity and temperature) and the onset of disease. Meteoropathy is a syndrome, that is, a group of symptoms and pathological reactions that manifest when there is a gradual or sudden change in one or more meteorological factors in a given area.  Meteorological factors are represented by the air temperature, relative humidity, wind speed, atmospheric pressure, rain and thunderstorms with the typical effects on the air that they have – ionization, the electrical state and turbulence.  These variations can manifest themselves in a brusque manner as cold fronts pass, with thunderstorms or with squalls, or in a gradual way.  For example, on Continental Europe, after a period of good weather, when a disturbance from the Atlantic arrives, we can detect various effects on the body manifested in the various organs and systems. This phenomenon is more noticeable when more atmospheric factors are involved at the same moment. The living organism is constantly affected by natural electromagnetic influences covering a wide range of frequencies and amplitudes. One of these influences, with frequencies in the very low frequency (VLF) range, (1-100 kHz) is represented by a phenomenon called VLF-atmospherics or VLF-sferics. Sferics are very short, weak, and dampened electromagnetic impulses generated by atmospheric discharges (lightning). Due to this fact, they can be used to study the characteristics of lightning, as well as the lower ionosphere. Besides their significance as indicators of thunderstorm activity, it has been hypothesized that sferics are able to affect the functioning of living organisms and physico-chemical systems. More specifically, this atmospheric parameter has been considered a possible trigger for changes in the somatic and emotional well-being of humans, sometimes referred to as weather sensitivity symptoms or meteoropathy (Schienle et al, 2006).

Scientists claimed that middle aged persons, especially women are at greater risk of becoming meteoropathic, but even children are at risk. It is becoming clear that meteoropathy is a disease of modern times, and, in fact, it is probably caused by modern way of life. Spending too much time indoors and in spaces that are climatised reduces our ability to cope with changes of weather and weather conditions in general. People who have disturbances in the neural system, especially anxious and depressed persons, are more vulnerable to meteoropathy. Nowadays, neural instability is influenced by the increase in frequency of negative factors in life, such as stress, loss of values, difficulty finding work or the disadvantages of retirement, the continuing competition to get ahead, and, not least, pollution – both atmospheric and aural. Usually, around 48-24 hours before the arrival of the weather change, particularly sensitive people may show various symptoms which, taken together, make up the meteoropathic syndrome.  The most frequent symptoms are an increase in depression, both mental and physical, weakness, hypertension, cephalea, a desire to remain indoors, increased susceptibility to pain in the joints and muscles, difficulty in breathing and a heavy feeling in the stomach.  There may also be mood disturbances, irritability and symptoms in the cardiovascular system, such as palpitations or pain in the sternum. These symptoms last for one or two days.  They begin to decrease once the weather has changed, but return if the weather changes again.  When the changes follow one after another, the symptoms decrease in intensity each time, as a sort of adapting process occurs. 

Everyone has a different level of sensitivity to weather changes. Physically active people and people who spend a few hours a day outdoors usually do not even notice the changes in weather.

On the other hand older people, people who had surgery even long ago, especially ones that don’t spend time outdoors feel and suffer from every change in weather no matter how insignificant it might seem.

The difference between the terms ‘meteorosensibility’ and ‘meteoropathy’ is quantitative: ‘meteorosensitive’ are those biologically susceptible to feel the effect of particular atmospherical events on mind and body; ‘meteoropathic’ are those individuals who develop a specific illness or a worsening of the existing diseases as a consequence of these climatic changes.

 Table 1. Ways to fight meteoropathy. (adapted from www. jubave.com)

 

Spending time outdoors is essential for your ability to cope with weather changes. No matter how busy you are you can always find some free time to spend outdoors.

Try to learn to love cold weather and humidity. Teach yourself to enjoy snow falling. When you do that meteoropathywill become a part of history, because it is caused by our love of comfort.

Your body can be trained to adapt to changes in weather, by going to sauna or taking hot and cold showers. It is recommended this to persons with low blood pressure who are especially sensitive to weather changes.

Become physically active when outdoors, ride a bike, maybe run, even when it is cold and when it rains. Develop resistance to weather changes by spending timeout doors in all weather conditions. Cold, rain, snow, shouldn’t bother you anymore.

Meteoropathy is a new disease. This disease is a product of your own behavior.

 

 Effect of weather on mood, behavior and psychiatric disorders

 Weather has long been regarded to impact everyday behavior. Behavioral changes result from physical characteristics of the environment stimulating the organism. Evidence indicates a pattern of alternating sympathetic and parasympathetic nervous system stimulation by contrasting meteorological conditions, with each system’s incitement, in turn, causing secondary behavioural changes (Persinger, 1980). Recently, it has been developed the hypothesis of a possible interaction between the periodic variations of climatic-environmental factors and the biological systems underlying a variety of disturbances: hypertension, cardiovascular disease, arthropathy, hyperthyroidism, stress syndrome, level of anxiety. Along with the implication of hormonal and neurotrasmettitorial systems, observations derived from clinical practice testify as environmental stimulus, in particular physical variables, can have a role in the complex pathogenic mechanism underlying psychiatric disorders.

The literature shows contradictory evidence as it relates to weather and mood. One of the largest examinations of the mood-weather hypothesis found no significant correlation between mood (measured by self-report using the Positive and Negative Affect Scale, or PANAS) and any of the assessed weather variables (barometric pressure, precipitation, sunshine, and temperature) (Watson, 2000). On the other hand, some studies have investigated how identical weather conditions may impact affect of individuals who have spent a significant time period in differing geographic and climatic locations. In particular, it has been documented that geographically-relocated individuals display grater mood variability attributable to weather conditions and heightened responsiveness to external environmental agents or events, of which physical light constitutes one (Reid et al, 2000). Finally, in two correlational studies and an experiment manipulating participants’ time outdoors, pleasant weather (higher temperature or barometric pressure) was related to higher mood, better memory and broadened cognitive style during the spring as time spent outside increased. The same relationships between mood and weather were not observed during other times of the year, and indeed hotter weather was associated with lower mood in the summer. These results suggest that pleasant weather improves mood and broadens cognition in the spring because people have been deprived of such weather during the winter (Keller et al, 2005).

Concerning the effect of weather on psychiatric disorders, several trials have shown an efficacy of bright light on depressive symptomatology in non-seasonal depression (Deltito, 1991; Martiny, 2004). Some studies of suicide and parasuicide behaviour have shown a relation to weather conditions. A significant correlation between parasuicide rates and meteorological parameters has been found in women but not in men (Barker, 1994). Other studies have demonstrated correlations between violent suicides and temperature and sunlight duration (Linkowsky, 1992; Maes, 1994). Moreover, Salib (1997) outlined a significant positive association between suicide in an elderly population and hours of sunshine and relative humidity.

In Bipolar Disorder, the factors inducing a new episode are probably many and still unknown. As seasonal variation has been noticed, it has been suggested that weather conditions may play a role. Myers & Davies (1978) found a peak of mania episodes in summer and a nadir in winter and a relation between number of admissions due to mania and 1) temperature in the current month and 2) mean day-length and mean daily hours of sunshine in the month before. Several investigations have showed a relation between amount of hours of sunshine and mania episodes (Carney, 1988; Peck, 1990, Lee, 2002). In a recent study Christensen et al. (2008) tried to elucidate whether meteorological parameters such as change in mean and maximum temperature, rainfall plus atmospheric pressure, hours of sunshine and cloudiness might influence the development of new bipolar phases. They found that though meteorological factors may have an impact on triggering new episodes in bipolar patients, they do not constitute a dominant cause.

The demand for psychiatric services is not randomand may fluctuate with climatic variables. Seasonal variabilityand weather have been shown to predict hospital admissions amongpatients with major psychiatric disorders. In particular, a recent study showed that rain and average temperaturewere predictive of emergency department visits. More patientswere visited on warmer days and on days without rain (Santiago et al, 2005). Besides, climate factors have been demonstrated to have an impact on inpatient psychiatric length of stay. In a study by Federman et al. (2000), medical centers in colder climates had the longest lengths of stay in winter and fall.

 

 A questionnaire for the detection of meteoropathy and meteorosensibility: the Q-METEO

 According to the possible effect of weather conditions on mood disorders, a sample of 139 patients with a diagnosis of bipolar disorder type I, bipolar disorder type II, and cyclotimic disorder (DSM-IV-TR) was administered a recently formulated questionnaire, the Q-METEO, in order to assess the sensitivity to climate changes, their impact on symptomatologic modifications and on phases of disease. The Q-METEO consists in 11 items and a structured checklist aiming to identify the physical and psychological symptoms mainly related to climate variations. Excluded were patients under 18 and over 75 years, patients with Seasonal Affective Disorder (SAD) or ‘‘rapid cycling’’ disorder, those suffering from endocrine diseases, patients with a primary diagnosis of cannabis, drug or alcohol abuse, and patients with serious organic brain disorders.

A control group consisting of 331 non-clinical subjects, matching for socio-demographic characteristics with the clinical group, was also evaluated.

In bipolar patients the assessment of mood, phase of disease (euthymic, manic and depressive) and psychiatric symptoms was made according to Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS) and the Mania Rating Scale (MRS).All patients were also assessed by the Temperament and Character Inventory-Revised (TCI-R) to evaluate personality profile, subsequently correlated with scores derived from the questionnaire Q-METEO and with the phase of disease.

Preliminary results have shown a greater presence in the experimental group of meteorosensibility and meteoropathy traits compared with the control group and a significant difference between mania phase and euthymia ( p<0.005). Moreover we found a significant prevalence of physical and psychological symptoms identified with the structured checklist and significant correlations with specific character and temperamental dimensions in the clinical group compared with the control group (Mazza et al, unpublished data).

The accuracy of the Q-METEO, measured by the area under the ROC curve, is 0.72 (figure 1). The Q-METEO would be considered to be “fair” at separating bipolar patients with or without meteoropathic symptoms. On the other hand, this test represents a sufficiently accurate discrimination to correctly classify those with and without meteoropathic symptoms also in the sample of healthy controls (figure 2). Though our findings support the relevance of dimensions such as meteoropathy and meteorosensibility in the cyclical progress of bipolar disorders and the possible use of Q-METEO to evaluate these traits, a larger sample of subjects and multiple comparisons would be necessary to confirm or complete these results.

 

 References

Balsamo V, Sirtori PG, Miani A Jr, Di Francesco A, Franceschini R, Mauro F, Alberti G, Grassi G. Meteoropathy: a syndrome continuously on the increase. La Clinica Terapeutica 141(7):3-8, 1992.

Barker A, Hawton K, Fagg J, Jennison C. Seasonal and weather factors in parasuicide. British Journal of Psychiatry 165:375-80, 1994.

 Carney PA. Influence of climate on the prevalence of mania. British Journal of Psychiatry 152:820-23, 1998.

 Christensen EM, Larsen JK, Gjerris A, Peacock L, Jacobi M, Hassenbalch E. Climatic factors and bipolar affective disorder. Nord Journal of Psychiatry 62:55-58, 2008.

 Deltito JA, Moline M, Pollak C, Martin LY, Maremmani I. Effects of Phototherapy on non-seasonal unipolar and bipolar depressive spectrum disorders. Journal of Affective Disorders 23:231-7, 1991.

Federman EJ, Drebing CE, Boisvert C, Penk W, Binus G, Rosenheck R. Relationship between climate and psychiatric impatient length of stay in veterans health administration hospitals. American Journal of Psychiatry 157; 1669-1673, 2000.

Hippocrates, Ancient Medicine, Volume I, translated by W.H.S. Jones, Harvard University Press, 1923.

Keller MC, Fredrickson BL, Ybarra O, Cotè S, Johnson K, Mikels J, Conway A, Wager T. A warm heart and a clear head. The contingent effects of weather on mood and cognition. Psychological Science 16 (9): 724-731, 2005.

Lee H-J, Kim L, Joe S-H, Suh K-Y. Effects of season and climate on the first manic episode of bipolar affective disorder in Korea. Psychiatry Research 113:151-9, 2002.

 Linkowsky P, Marin F, De Maertelaer V. Effect of some climatic factors on violent and non-violent suicides in Belgium. Journal of Affective Disorders 25:161-6, 1992.

 Lopez del Val LJ, Rubio E, Calatayud V, Lopez del Val JA, Sanchez E. Effect of atmospheric factors on the presentation of cerebrovascular accidents. Neurologia 6(2):52-55, 1991.

 Maes M, De Meyer F, Thompson P, Peeters D, Cosyns P. Synchronized annual rhythms in violent suicide rate, ambient temperature and the light_dark span. Acta Psychiatr Scand 90:391-6, 1994.

 Martiny K. Adjunctive bright light in non-seasonal major depression. Acta Psychiatr Scand Suppl 425:7-28, 2004.

 Myers DH, Davies P. The seasonal incidence of mania and its relationship to climatic variables. Psychological Medicine 8:433-40, 1978.

 Peck DF. Climatic variables and admissions for mania: A reanalysis. Journal of Affective Disorder 20:249-50, 1990.

Persinger MA. The weather matrix and human behavior. New York: Praeger Press, 1980.

Reid S, Towell AD, Golding JF. Seasonality, social zeitgebers and mood variability in entrainment of mood: implications for seasonal affective disorder. Journal of Affective Disorders 59: 47-54, 2000.

Salib E. Elderly suicide and weather conditions: Is there a link? International Journal of Geriatric Psychiatry 12:937-41, 1997.

Santiago PN, McLay RN, Hammer PS. Meteorologic Factors in Emergency Evaluation, Admission, and Discharge. Psychiatric Services 56: 1625, 2005.

Schienle A, Stark R, Vaitl D. Biological Effects of Very Low Frequency (VLF) Atmospherics in Humans: A Review. Journal of Scientific Explorations 12 (3), 6, 2006.

Watson D. Mood and temperament. New York: Guilford Press, 2000.

Journal online "Ecology, Psichiatry and Mental Health, Cardiology & Dermatology " - Supplemento del Journal "Ecology, Psychiatry and Mental Health"
Rivista ufficiale della Società Italiana di Ecologia, Psichiatria & Salute Mentale - Sezione Speciale della Società Italiana di Psichiatria.
Autorizzazione n. 1 del 2001 - Tribunale di Imperia reg. P e G.
Direttore Responsabile: Giuseppe Spinetti
Direttore Editoriale: Luigi Janiri
Co-Direttore Editoriale: Antonello Ranise