Search Results (7)

Background/Objectives: Healthcare workers (HCWs) experienced marked psychological distress during and after the COVID-19 pandemic, including high levels of burnout, depression, and suicidal ideation. Italy, one of the first Western countries to be severely affected, recorded high mortality, even among healthcare staff. Emerging evidence suggests that suicidal ideation may also occur in the absence of major depressive episodes, possibly linked to subthreshold mood dysregulation and circadian rhythm disturbances, described within the construct of Dysregulation of rhythms and hyper-energy Syndrome (DYMERS). This study examined the prevalence of suicidal ideation and/or death-related thoughts among Italian HCWs, with particular attention to clinically relevant signs emerging in the absence of a full depressive episode. Methods: A cross-sectional analysis was conducted on 97 HCWs at the University Hospital of Cagliari, Italy, compared with a pre-pandemic community sample from the same region. Depressive symptoms and suicidal ideation or death-related thoughts were assessed with the Patient Health Questionnaire-9 (PHQ-9), considering their presence both in individuals with and without a depressive episode. Daily activation and energy were measured using item 10 of the 12-Item Short Form Health Survey (SF-12), while circadian rhythm dysregulation was evaluated with the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN). Results: HCWs showed a significantly higher prevalence of suicidal or death-related thoughts than the community sample (14.4% vs. 5.7%, p = 0.001; OR = 2.81, 95% CI 1.4–4.4). Notably, 8.2% of HCWs without probable depression reported such thoughts; given the very small number of events (n = 4), this estimate is exploratory, and inferential statistics should be interpreted with caution. Based on descriptive data, these individuals appeared to show higher perceived activation (SF-12, item 10) and rhythm dysregulation (BRIAN). This observation is exploratory and consistent with the DYMERS heuristic framework. Conclusions: Subthreshold symptoms and DYMERS may represent critical risk factors in suicide prevention strategies for HCWs. Full article

Background/Objectives: The Mood Disorder Questionnaire (MDQ) is a widely used tool for the early detection of Bipolar Disorder (BD), yet its diagnostic accuracy remains debated. In particular, the MDQ often yields false positives in individuals with anxiety, stress-related, or personality disorders, raising questions about its clinical utility. This study aimed primarily to evaluate the sensitivity, specificity, and predictive values of the MDQ in identifying BD within a large, community-based sample using structured clinical interviews. Additionally, we explored the construct of DYMERS (Dysregulation of Mood, Energy, and Social Rhythms Syndrome), a proposed condition characterized by mood instability, hyperactivation traits, and rhythm dysregulation among MDQ-positive individuals without a formal psychiatric diagnosis. Methods: A total of 4999 adults were surveyed across six Italian regions using a stratified random sampling method. Psychiatric diagnoses were established using DSM-IV-TR criteria via the Advanced Neuropsychiatric Tools and Assessment Schedule (ANTAS). The MDQ was administered face to face in its validated Italian version, with a positivity cut-off of ≥7. The MDQ exhibited low sensitivity and high specificity (0.962; 95% CI: 0.961–0.963). Results: Among 2337 analyzable cases, the MDQ showed high specificity (96.2%) but low sensitivity (42.9%) for BD, indicating limited effectiveness as a screening tool. In clinical terms, this implies that while MDQ-positive individuals are unlikely to be false positives, a substantial proportion of true BD cases are not identified. Notably, a significant subgroup of MDQ-positive individuals without psychiatric diagnoses displayed features consistent with DYMERS. Conclusions: Our findings confirm the limited screening value of the MDQ for BD in community samples. However, MDQ positivity may help identify a broader spectrum of mood and rhythm dysregulation not captured by current diagnostic systems. Future research should focus on validating DYMERS as a clinical entity and on developing targeted diagnostic instruments capable of capturing this emerging dimension of psychopathology. Full article

Background/Objectives: Dysregulation of Mood, Energy, and Social Rhythms Syndrome (DYMERS) characterizes the poor regulation of biological (sleep/waking), social, and behavioral rhythms that affected the level of burnout in healthcare professionals during the pandemic in particular. The aim is to provide an initial scoping review of publications on this topic. Methods: The keywords “Stress Rhythms Dysregulation Bipolar Disorder Burnout DYMERS Healthcare professionals COVID-19” were searched on 9 December 2024 following PRISMA 2020 guidelines, using five primary databases (OVID, ProQuest, PubMed, Scopus, Web of Science), one register (Cochrane COVID-19 register), and one supplementary database (Google Scholar). Included were peer-reviewed publications. Excluded were duplicates, reports lacking either a research study or any keywords, or including irrelevant information regarding them. Results: The returns for all the databases were (n = 0) except for ProQuest (n = 4) and Google Scholar (n = 14). Of these, three ProQuest returns were duplicates of the Google Scholar search. The remaining report contained irrelevant information on healthcare professionals. The Google Scholar search results produced two relevant reports—neither duplicated with ProQuest. The excluded contained a duplicate in the search itself, three that did not mention healthcare professionals, two that contained irrelevant information concerning them, four returns that were not a research study, and three that were not peer-reviewed. Conclusions: The two studies published on this topic are by various members of the same investigating institution. DYMERS has provided valuable insights regarding burnout in healthcare professionals. The suggestion is for further DYMERS research by this team and others, anticipating future pandemics. Full article

Background: This study aims to verify the accuracy of item 10 on the energy level of the Short-Form Health Survey (SF-12) in an item screening according to Mood Disorder Questionnaire (MDQ) results, providing a measure of hyper-energy. Methods: Regression techniques were employed in a dataset comprising 4093 records of respondents to test both linear and nonlinear relationships between predictor and outcome variables (energy level and symptoms considered in the MDQ). We examined the relationship of energy level with cases identified using MDQ with a cut-off of 7. Results: Levels of energy, as rated on item 10 of the SF-12, were related to the MDQ score with sensitivity = 0.72 and specificity = 0.70. In linear regression, the associations were stronger with MDQ items on excessive energy or activity, showing a medium effect size and an explained variance of 10% or higher. A greater association was observed for items on excessive energy and activity, as expected, as well as for items concerning self-confidence, sociability, and talkativeness. Conclusions: This result may have implications for the research on risk factors and the pathogenesis of the dysregulation of mood, energy, and social rhythms syndrome (DYMERS), a syndrome that is hypothesized to occur in stressful conditions like those shown under the COVID-19 pandemic. Full article

Background: Obstructive sleep apnea (OSA) is characterized by repeated airway obstructions during sleep, causing hypopnea, apnea, intermittent hypoxia, and sleep fragmentation. The severity of OSA is measured using the apnea–hypopnea index (AHI), with AHI ≥ 5 indicating OSA. This study aims to assess the frequency and type of depressive disorder characteristics of OSA patients and to evaluate the impact on quality of life, also considering the presence of hyperactivity. Methods: A case-control study using OSA patients referred to Cagliari’s sleep disorder center. Controls were matched by age and sex from community databases. OSA diagnoses were made with AHI > 15. Depressive episodes were identified using BDI-SF, and H-QoL (Health related Quality of Life) was measured with the SF-12, focusing on item 10 for hyper-energy. Results: The clinical sample (n = 25) had a higher frequency of depressive episodes (36%) compared to controls (7% and 4%). Depressed OSA patients had worse H-QoL and higher hyper-energy scores, but the additional burden from depression was relatively low. Conclusions: The OSA sample has a higher frequency of depressive episodes compared to the general population. Depressive episodes in OSA patients are linked to higher scores on item 10 of the SF-12, indicating hyper-energy despite lower overall quality of life scores. While OSA significantly impacts quality of life, the additional burden from depression is less severe than in other chronic diseases. These findings suggest that depressive episodes in OSA may be related to rhythm dysregulation and hyperactivity (DYMERS). Full article

Objective: The COVID-19 lockdown periods have given rise to the “Dysregulation of Mood, Energy, and Social Rhythms Syndrome” (DYMERS). This syndrome is characterized by a poor regulation of biological, social, and behavioral rhythms, including sleep, nutrition, and social contacts. The purpose of this cohort study was to examine whether older adults with pre-existing DYMERS had a more negative perception of their health-related quality of life (H-QoL) during the COVID-19 pandemic lockdown, regardless of the presence of concurrent mood disorders. Method: The entire study population (N = 93; age > 65 year) was categorized based on whether they exhibited dysregulated rhythms at the outset of the study. A comparison was made between DYMERS-positive individuals and DYMERS-negative individuals, and we assessed their H-QoL at the conclusion of the study. We also compared the H-QoL of individuals in the cohort who did not have a positive depression score to understand the impact of the rhythm dysregulation alone. Results: The frequency of individuals with a critical health-related quality of life score (SF12 < 25) was higher in the cohort with pre-existing DYMERS during lockdown (33.33% vs. 6.17%). This difference remained significant even when only individuals without depressive symptomatology were considered (27.27% vs. 2.60%). Conclusion: The results of this study indicate that DYMERS can exert a substantial influence on health-related quality of life (H-QoL), even when mood disturbances are not present. Additional research is required to investigate the relationship between DYMERS and other psychiatric conditions as well as its nature as a standalone disorder. Full article

The aim of this paper is to verify if people with a positive score on the Mood Disorder Questionnaire (MDQ) without comorbidity of mood disorders showed a worse level of Health-related Quality of life (HRQol) compared to a control-matched sample of MDQ negatives, identifying a specific syndrome. This is a case-control study based on a database from a community survey. Cases: MDQ-positive without mood disorders; Controls: MDQ negatives matched by sex, age, and psychiatric diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) criteria. Tools: MDQ, the Advanced Neuropsychiatric Tools and Assessment Schedule (ANTAS) semi-structured interview for psychiatric diagnosis, and the Health Survey Short Form (SF-12) for measuring HRQol. People scoring positive on the MDQ without a diagnosis of mood disorders showed significantly lower scores on the SF-12 compared to people of the same age and of the same sex with an equal diagnosis of psychiatric disorders not related to mood disorders (35.21 ± 6.30 vs. 41.48 ± 3.39, p < 0.0001). In the debate whether a positive score on the MDQ selects an area of “malaise” due to the presence of disorders differing from Bipolar Disorders, or if a positive score on the MDQ may be considered a “subthreshold” form of bipolar disorder in people who may later develop bipolar disorder, a third hypothesis can be advanced, i.e., that a positive score on the MDQ identifies a specific “Dysregulation of Mood, Energy, and Social Rhythms Syndrome” (DYMERS), characterized by a considerable amount of suffering and not attributable to other disorders, and which might represent a trigger for the previously mentioned disorders with which a positive score on the MDQ is associated, probably including, in severe conditions, bipolar disorder. Full article