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多学科对双相情感障碍进化性解释的贡献:它可能是一种潜在适应性状况的病理演变吗?

Multidisciplinary contributions towards an evolutive interpretation of bipolar disorders: Could it be the pathological drift of a potentially adaptive condition?

作者信息

Carta Mauro Giovanni, Nardi Antonio E, Pinna Samantha, Cossu Giulia, Gureje Oye

机构信息

Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Italia.

Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.

出版信息

Braz J Psychiatry. 2023 Jun 12;45(4):366-72. doi: 10.47626/1516-4446-2023-3154.

Abstract

This paper tries to summarize the results of studies from different disciplines supporting the idea that temperamental traits, such as "reckless/hyper-exploratory" attitudes, commonly believed to be associated with psychopathology, surprisingly turn out as adaptive under specific stress conditions. In particular, this paper analyzes an ethologic line of research on primates suggesting models for a sociobiological interpretation of mood disorders in humans; a study that found high frequencies of a genetic variance associated with bipolar disorder in people without bipolar disorder but with hyperactivity/novelty-seeking traits; the outcomes of socio-anthropologicalhistorical surveys on the evolution of mood disorders in Western countries in the last centuries; surveys on changing societies in Africa and African migrants in Sardinia; and studies that found higher frequencies of mania and subthreshold mania among Sardinian immigrants in Latin American megacities. Although it is not unequivocally accepted that an increase in the prevalence of mood disorders has occurred, it would be logical to suppose that a nonadaptive condition should have disappeared over time; mood disorders, on the contrary, persist and their prevalence might have even increased. This new interpretation could lead to counter-discrimination and stigma towards people suffering from the disorder, and it would be a central point in psychosocial treatments in addition to drugs. The aim is to hypothesize that bipolar disorder, strongly characterized by these traits, may be the result of the interaction between genetic characteristics, not necessarily pathological, and specific environmental conditions, rather than a mere product of an aberrant genetic profile. If mood disorders were mere nonadaptive conditions, they would have disappeared over time, however, their prevalence, paradoxically, persists if not even increases over time. The hypothesis that bipolar disorder may result from the interaction between genetic characteristics, not necessarily pathological, and specific environmental factors, seem more credible than considering bipolar disorder as a mere product of an aberrant genetic profile.

摘要

本文试图总结来自不同学科的研究结果,这些研究支持这样一种观点:通常被认为与精神病理学相关的气质特征,如“鲁莽/过度探索”态度,在特定压力条件下却出人意料地具有适应性。特别是,本文分析了一条关于灵长类动物的行为学研究路线,该路线为人类情绪障碍的社会生物学解释提供了模型;一项研究发现,在没有双相情感障碍但具有多动/寻求新奇特征的人群中,与双相情感障碍相关的基因变异频率很高;对上几个世纪西方国家情绪障碍演变的社会 - 人类学历史调查结果;对非洲不断变化的社会以及撒丁岛的非洲移民的调查;以及在拉丁美洲大城市中撒丁岛移民中躁狂和阈下躁狂发生率较高的研究。虽然人们并未明确接受情绪障碍的患病率有所增加这一观点,但合乎逻辑的推测是,一种非适应性状况应该会随着时间推移而消失;相反,情绪障碍持续存在,其患病率甚至可能有所上升。这种新的解释可能会导致对患有该疾病的人的反歧视和污名化,并且除了药物治疗外,它将成为心理社会治疗的核心要点。目的是假设,以这些特征为强烈特征的双相情感障碍可能是遗传特征(不一定是病理性的)与特定环境条件相互作用的结果,而不仅仅是异常基因图谱的产物。如果情绪障碍仅仅是非适应性状况,它们会随着时间推移而消失,然而,矛盾的是,它们的患病率即使没有随着时间增加,也依然持续存在。双相情感障碍可能源于遗传特征(不一定是病理性的)与特定环境因素相互作用的假设,似乎比将双相情感障碍仅仅视为异常基因图谱的产物更可信。

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