Int J Biometeorol (2005) 49:238–243
DOI 10.1007/s00484-004-0236-0
ORIGINAL ARTICLE
A. Bulbena · G. Pailhez · R. Ace
a · J. Cunillera ·
A. Rius · C. Garcia-Ribera · J. Gutirrez · C. Rojo
Panic anxiety, under the weather?
Received: 6 April 2004 / Revised: 8 September 2004 / Accepted: 30 September 2004 / Published online: 18 November 2004

ISB 2004
Abstract The relationship between weather conditions
and psychiatric disorders has been a continuous subject of
speculation due to contradictory findings. This study at-
tempts to further clarify this relationship by focussing on
specific conditions such as panic attacks and non-panic
anxiety in relation to specific meteorological variables.
All psychiatric emergencies attended at a general hospital
in Barcelona (Spain) during 2002 with anxiety as main
complaint were classified as panic or non-panic anxiety
according to strict independent and retrospective criteria.
Both groups were assessed and compared with meteoro-
logical data (wind speed and direction, daily rainfall,
temperature, humidity and solar radiation). Seasons and
weekend days were also included as independent vari-
ables. Non-parametric statistics were used throughout
since most variables do not follow a normal distribution.
Logistic regression models were applied to predict days
with and without the clinical condition. Episodes of panic
A. Bulbena ()) · R. Acea · C. Garcia-Ribera
Department of Psychiatry, Institut d’Atenci Psiquitrica: Salut
Mental i Toxicomanies, IMAS, Hospital del Mar,
Universitat Autonoma Barcelona,
Passeig Maritim 29, 08003 Barcelona, Spain
e-mail: abulbena@acmcb.es
Tel.: +34-93-2483175
Fax: +34-93-2483445
G. Pailhez
Centres Assistencials Dr. Emili Mira i Lpez,
Recinte Torribera, Sta Coloma de Gramanet,
Barcelona, Spain
J. Cunillera · A. Rius
Servei Meteorolgic de Catalunya,
Spain
J. Gutirrez
Servei Urgncies,
Hospital del Mar, IMAS,
Barcelona, Spain
C. Rojo
Centre de Salut,
Port de la Selva, Girona, Spain
were three times more common with the poniente wind
(hot wind), twice less often with rainfall, and one and a
half times more common in autumn than in other seasons.
These three trends (hot wind, rainfall and autumn) were
accumulative for panic episodes in a logistic regression
formula. Significant reduction of episodes on weekends
was found only for non-panic episodes. Panic attacks,
unlike other anxiety episodes, in a psychiatric emergency
department in Barcelona seem to show significant mete-
orotropism. Assessing specific disorders instead of overall
emergencies or other variables of a more general quality
could shed new light on the relationship between weather
conditions and behaviour.
Keywords Weather · Wind · Rain · Panic · Anxiety
Introduction
The relationship between meteorological variables and
human behaviour has been the subject of conjecture since
Hippocrates. This interaction has been held more in
popular belief than in scientific verification. However,
since the mid-1900s it has been more thoroughly studied,
and we are now in a better position to test popular beliefs
regarding this connection.
Numerous studies in different fields have been carried
out in an attempt to assess this relationship and its im-
plications. Studies regarding meteorological variables and
stroke onset (Wang et al. 2002), myocardial infarction
(Larcan et al. 1983) and arthritic pain (Redelmeier and
Tversky 1996) have shown significant results. Moreover,
subjective experience from patients, such as variations in
pain thresholds and mood swings when the weather
changes, points towards an association and paves the road
towards further research.
In the psychiatric field, findings have been irregular
and speculations about the physiological process of such
interaction unclear. However, research has posed several
hypotheses as to how the weather influences behaviour. A
few syndromes have been proposed in the literature. The

“serotonin irritation syndrome” is an anxiety state oc-
curring in the presence of elevated levels of atmospheric
or ambient cations, and is associated with elevated central
and peripheral serotonin levels. It is characterized by,
among other symptoms, anxiety, insomnia, migraines,
vomiting, breathing difficulty and rheumatoid pain (Gi-
annini 1978; Giannini et al. 1983). Although based mainly
on animal evidence, Sulman (1976) described the “ex-
haustion syndrome” associated with warm winds and heat
waves, which is caused by a deficiency of cate-
cholamines; symptoms include hypotension, fatigue, ap-
athy, lack of concentration and episodes of hypogly-
caemia. Although appealing, a word of caution should be
taken into account as no conclusive confirmation data for
humans is available. Moreover, exposure to cold tem-
peratures could be responsible for inducing physiological
stresses, including sympathetic autonomic system acti-
vation (Zvan et al. 1998; Douglas et al. 1995). The core
interaction between meteorological variables and physi-
ological variables is still being sought, but current studies
are elucidating this issue.
Most studies regarding psychiatric disorders and
weather have assessed general variables such as overall
emergency consultations (Garca-Carretero et al. 1989;
Maes et al. 1994; Makie et al. 2002), number of telephone
calls (Driscoll and Stillman 2002; Hribersek et al. 1987;
Noble 1996), or suicide rates (Barker et al. 1994; Garca
et al. 1991; Linkowski et al. 1992; Maes et al. 1993; Salib
1997; Salib and Gray 1997; Wang et al. 1997). Results
have been more suggestive when studying specific ill-
nesses (schizophrenia, mania, etc.) rather than complex
dimensions like service utilisation (Albert et al. 1991;
Peck 1990; Salib and Sharp 2002; Summers and Shur
1992). San Gil, a psychiatrist and meteorologist, pub-
lished results confirming an association between clinical
cases treated at emergency services and weather condi-
tions (San Gil et al. 1988, 1994).
There are few studies designed to specifically assess
the association between meteorological variables and
clearly defined psychiatric disorders. In this paper, the
relationship between the weather and anxiety and panic
attacks is addressed specifically. Anxiety disorders are a
clinically heterogeneous group that should be evaluated
by differentiating panic and non-panic anxiety states due
to their different clinical features. Panic disorder has been
associated with an alteration in collagen fibres (Bulbena
et al. 1993, 1988; Gago 1992; Gratacs et al. 2001), which
is not seen in generalised anxiety disorder. In patients
with panic disorder, the benign joint hypermobility syn-
drome (a heritable collagen disorder) is almost 17 times
more common than in any other group of patients or the
general population (Martn-Santos et al. 1998). Due to
this association, the physical variables tend to be more
relevant, as seen in pain threshold variations present in
both joint hypermobility (Grahame 2000) and panic dis-
order (Schmidt et al. 2002). More recently, joint hyper-
mobility patients have been found to suffer more often
from dysautonomia, which includes, among other symp-
toms, disregulation of blood pressure, heart rate, heat
239
intolerance, etc. (Gazit et al. 2003). Due to findings
confirming that joint hypermobility patients and panic
disorder patients tend to overlap (Bulbena et al. 2004), it
is plausible that their autonomic nervous system might be
over-reactive to some environmental stimuli, such as the
weather. This evidence has partly motivated the need to
assess the association of meteorological variables with
anxiety disorders and panic attacks separately and
specifically.
Moreover, results from studies assessing overall psy-
chiatric emergency consultations and weather are not
clear because significant interactions in some subgroups
might be hidden within huge samples. Examining psy-
chiatric emergencies according to syndromic profiles such
as panic attacks can minimise this bias and help verify the
specificity of each.
This study aims to determine the relationship between
meteorological variables and anxiety emergency consul-
tations grouped as panic and non-panic episodes in Bar-
celona (Spain) during the 365 days of the year 2002.
Materials and methods
All emergency consultations with anxiety as main complaint at-
tended at Hospital del Mar, Barcelona, during 2002 were selected
for the study. Cases were classified into panic and non-panic epi-
sodes by review of patient’s history records and retrospective cri-
teria. The clinical information provided by the psychiatric emer-
gency department included main complaint, clinical description,
results of clinical severity scales and diagnosis based on DSM IV
criteria (Diagnostic and statistical manual of mental disorders, 4th
edn; American Psychiatric Association) enabling a strict retro-
spective distinction between panic attacks and other anxiety states.
The selected cases could be associated with other conditions (i.e.
depression) provided that anxiety manifestations were predominant
and had appeared in the previous 12 h.
Daily meteorological data were obtained from the closest ob-
servatory to the hospital area, supplied by the Meteorological
Service of Catalonia. Variables included were: (1) maximum,
minimum and average temperatures ( C), (2) average relative hu-
midity (%), (3) average barometric pressure (hPa), (4) average wind
speed (m/s), (5) predominant wind direction [according to the wind
rose in the area and therefore not analysed as a numerical variable:
tramontana (winds from the north), gregal (from the northeast),
levante (from the east), xaloc (from the southeast), migjorn (from
the south), garb
(from the southwest), poniente (from the west),
and mestral (from the nothwest)], (6) daily precipitation (mm
equivalent to l/m2), and (7) solar radiation (MJ/m2). Barcelona has
a Mediterranean climate, with warm summers with little rainfall
and mild winters. Mean values of meteorological variables men-
tioned above for the period 1993–2002 are in Table 1. The seasons
and number of days with predominance of each of the major winds
were registered. Rainfall as a categorical variable (presence/ab-
sence) was also examined. Finally, the day of the week was in-
troduced in the analysis to control a frequent bias in emergency
services derived from the lower incidence of consultations during
the weekend.
Statistical analysis was performed using the JMP program
(version 5.01; SAS 2003). Nonparametric correlation was applied
to assess simple association between meteorological variables and
number of anxiety episodes, both collected on a daily basis. The
non-parametric Spearman’s correlation coefficient (rho) is com-
puted on the ranks of the data. On the other hand, to test whether
group means or medians differ across groups, the nonparametric
Wilcoxon rank test (two independent groups compared) and
Kruskal-Wallis test (more than two independent groups compared)
240
Table 1 Mean values of meteorological variables during the period Results are presented as successive analyses between
1993–2002 in Barcelona anxiety episodes, or cases, per day (overall anxiety epi-
Annual mean temperature 16.7 C sodes, panic attacks, and non-panic episodes) and each
Annual mean of maximum temperatures 19.4 C meteorological variable by comparing each group by
Annual mean of minimum temperatures 14.0 C season, wind, precipitation, day before rainfall and, fi-
Annual average precipitation 523.3 mm
Annual average of days with precipitation 71 days nally, day of the week.
Annual mean relative humidity 72% The total number of anxiety episodes, panic attacks
Annual mean barometric pressure 1,016 hPa and non-panic episodes was correlated with eight mete-
Annual mean wind speed 2.9 m/s orological variables. Correlations did not reach signifi-
Annual predominant wind direction Northeast (gregal) cance, except for a negative correlation between rainfall
Annual mean of daily solar radiation 14.7 MJ/m2
and panic attacks. In other words, panic attacks seem to
be less frequent with rainfall (Table 2). Autumn had the
highest number of anxiety episodes and spring the fewest,
were used because most of the studied variables did not follow a both overall and separately. However, the differences did
normal distribution. Finally, logistic regression models were ap- not reach statistical significance (Table 3). As for the
plied to predict days with anxiety. Dichotomous (0/1) dependent
variables chosen were: days with anxiety episodes (any), days with predominant wind, no significant differences were found
panic anxiety episodes, and days with non-panic anxiety episodes. for total anxiety episodes and for non-panic episodes.
The corresponding odds ratio (OR), with 95% confidence intervals However panic attacks were significantly more common
(CI), were obtained for every selected variable. Significance is in days with poniente wind (P=0.006; Table 4).
reached when the 95% confidence intervals do not include 1.
The total number of anxiety episodes, panic episodes
and non-panic episodes per day were compared according
to the presence or absence of rainfall on that day. No
Results significant differences were found for total anxiety epi-
sodes and for non-panic episodes. However, panic attacks
A total of 368 psychiatric emergencies with anxiety as were significantly less frequent in days with rain
main complaint were registered during 2002 in Hospital (P=0.008; Table 5).
del Mar. This results in an average of around one case per Total number of anxiety episodes, panic episodes and
day even though there were days with none. There were non-panic episodes per day were also compared according
223 (60.6%) cases of non-panic anxiety (94 males and to their appearance during the week (Monday–Friday) and
129 females) and 145 (39.4%) cases of panic attacks (48 weekends. No significant differences were found for
males and 97 females). The mean age of all patients was panic attacks. However, non-panic episodes and total
37.8 years. number of anxiety episodes were found significantly less
Cases with anxiety symptoms were attended on often during the weekend (P=0.025; Table 6).
212 days of the year (57.1%). Panic attacks were present
on 118 days of the year (32.3%) and non-panic anxiety on
155 days (42.5%). Both conditions coincided on 57 days Predictive model of days with anxiety
(15.6%).
The diagnostic distribution of non-panic anxiety was: A logistic regression model was developed taking the
anxious-depressive features (mixed anxiety and depres- presence or absence of anxiety episodes (total, panic and
sion symptoms) in 23.5% of cases, adjustment disorder non-panic) as the dependent variable. The independent
with anxiety (symptoms of anxiety appearing after a clear variables included the three significant variables in the
life event) in 21.5%, anxiety disorder due to general unvariate model: precipitation, poniente wind and week-
medical condition or substance-induced in 16.7%, non- end days. Autumn was also included as a variable because
specified anxiety disorder in 10%, generalised anxiety it was over-represented in all types of anxiety episodes
disorder in 9 and 19.3% of others. despite not being significant. The OR and 95% CI were
calculated for each selected variable.

Table 2 Non-parametric correlations (Spearman’s rho) between number of anxiety episodes and meteorological variables
Variable Total anxiety episodes Panic anxiety episodes Non-panic anxiety episodes
rho P rho P rho P
Maximum temperature 0.09 0.08 0.06 0.27 0.10 0.06
Minimum temperature 0.09 0.07 0.06 0.26 0.10 0.07
Average temperature 0.09 0.09 0.06 0.24 0.09 0.08
Relative humidity
0.07 0.21
0.04 0.47
0.05 0.30
Barometric pressure 0.01 0.90 0.04 0.43
0.04 0.47
Wind speed 0.05 0.35 0.03 0.62 0.05 0.38
Precipitation
0.08 0.15
0.11 0.03 0.00 0.94
Solar radiation 0.05 0.37 0.04 0.39 0.03 0.62
 241
Table 3 Anxiety episodes by Season N Total anxiety episodes Panic anxiety episodes Non-panic anxiety episodes
season. P values obtained by per day per day per day
Kruskal-Wallis test. SE Stan-
dard error Daily average SE Daily average SE Daily average SE
Spring 92 0.84 0.11 0.35 0.06 0.48 0.08
Summer 92 1.12 0.11 0.39 0.06 0.72 0.08
Autumn 90 1.19 0.11 0.45 0.07 0.73 0.08
Winter 91 0.89 0.11 0.39 0.07 0.49 0.08
P=0.14 P=0.40 P=0.16

Table 4 Anxiety episodes by Kind of Number Total anxiety Panic anxiety Non-panic anxiety
predominant wind. P values wind episodes episodes episodes
obtained by Kruskal-Wallis test
Mean SE Mean SE Mean SE
Tramontana 55 1.13 0.15 0.44 0.08 0.69 0.11
Gregal 40 1.13 0.17 0.40 0.10 0.73 0.13
Levante 29 1.03 0.20 0.38 0.12 0.66 0.16
Xaloc 54 0.91 0.15 0.35 0.09 0.56 0.12
Migjorn 46 0.72 0.16 0.33 0.09 0.39 0.13
Garbi 37 0.97 0.18 0.24 0.10 0.73 0.14
Poniente 47 1.28 0.16 0.74 0.09 0.53 0.12
Mestral 57 0.93 0.14 0.28 0.08 0.65 0.11
P=0.21 P=0.006 P=0.53

Table 5 Anxiety episodes by Rain conditions N Total anxiety Panic anxiety Non-panic anxiety
days with rain. P values ob- episodes episodes episodes
tained by Wilcoxon rank test
Average SE Average SE Average SE
Days with rain 95 0.86 0.11 0.26 0.06 0.60 0.08
Days with no rain 270 1.06 0.06 0.44 0.04 0.61 0.05
P = 0.14 P=0.008 P=0.98

Table 6 Anxiety episodes by Days N Total anxiety Panic anxiety Non-panic anxiety
weekend. P values obtained by episodes episodes episodes
Wilcoxon rank test
Mean SE Mean SE Mean SE
Monday-Friday 261 1.099 0.067 0.409 0.03 0.689 0.05
Saturday-Sunday 104 0.778 0.106 0.365 0.06 0.413 0.08
P=0.025 P=0.76 P=0.006

Table 7 Odds ratio (OR) for Variable Any anxiety days Panic anxiety days Non-panic anxiety days
days with anxiety (all, panic and
non-panic), through logistic re- OR (95% CI) OR (95% CI) OR (95% CI)
gression models. CI Confidence
interval Poniente wind 1.23 0.66 2.36 3.32 1.76 6.34 0.60 0.30 1.15
Saturday–Sunday 0.69 0.43 1.09 0.92 0.55 1.52 0.55 0.34 0.89
Autumn 1.63 0.99 2.72 1.67 1.00 2.77 1.40 0.86 2.27
Rain 0.78 0.49 1.26 0.55 0.31 0.93 0.94 0.58 1.51
Whole model P 0.11 0.0003 0.035

When any anxiety episode was used as dependent
variable (days with anxiety episodes = 1; days without
anxiety episodes = 0), the model was not significant with
a chi square of 7.37; df=4 (P=0.11). When days with/
without panic attacks was used as dependent variable, the
model reached significance with a chi square of 21.12;
df=4 (P<0.0003). The presence of rainfall had an OR of
0.55 (CI 95% 0.31–0.93). The poniente wind had an OR
of 3.32 (CI 95% 1.76–6.34) and autumn had an OR of
1.67 (CI 95% 1.0–2.77). However, weekend days did not
reach significant OR in the model. Finally, taking days
with/without non-panic anxiety as dependent variable, the
model was significant with a chi square of 10.32; df=4
(P=0.035). The only variable in this model that reached
significance was weekend days, which were significantly
less likely to be associated with non-panic anxiety in the
emergency department (Table 7).
242
Discussion
In this study, all cases of anxiety attended in the psychi-
atric emergency unit of a general hospital in Barcelona
during 2002 were assessed for associations with weather
conditions. Anxiety consultations were classified as panic
and non-panic episodes using strict independent retro-
spective criteria. The distinction of panic and non-panic
anxiety was important in this study because of the dif-
ferent clinical and biological features of each. Maximum
diagnostic precision was guaranteed by examining both
groups separately, which distinguishes this work from
previous studies.
To date, documented correlations between meteoro-
logical variables and number of global psychiatric emer-
gencies have produced inconsistent results (Garca-Car-
retero et al.1989; Maes et al. 1994; Makie et al. 2002).
This study offers some preliminary evidence indicating
that weather-related and seasonal variables have a dif-
ferent association with panic and non-panic anxiety. Panic
attacks have shown a significant association with weather
conditions while other anxiety states have not. Panic at-
tacks have been found to be more frequent with the warm
poniente wind and less frequent after rain onset.
Some patients with anxiety express feeling worse be-
fore rainfall and better after its onset. The influence of
storms on anxiety was suggested in a study by Garca-
Carretero et al. (1989). Anxiety episodes seemed to in-
crease just before a storm set in and decrease after onset.
The decreasing number of panic attacks during rainfall
might offer some indirect evidence for the improvement
after rain onset described by patients. However, a previ-
ous worsening registered as an increase of episodes before
rain was not studied. It should be noted that not all pre-
cipitation events are the same: a thunderstorm might have
different effects than prolonged rain with frontal over-
running, and these details deserve particular attention.
Also, lag analysis could be performed to determine if
panic attacks increase before rain sets in.
The effect of the poniente wind probably reflects what
also happens in other geographical areas due to warm
winds. This interaction has been described and pointed
out by some authors (San Gil et al. 1988, 1994). The
poniente wind is a warm wind of western origin, of
moderate and high intensity in the Mediterranean. Warm
and dry winds are known to increase the concentration of
positive ions in the atmosphere. The high positive ion
concentration might be a relevant factor in the strong
correlation between panic attack cases and the poniente
wind. No previous evidence has been described in the
literature regarding this positive correlation between
panic attacks specifically and warm winds; however,
there are positive results regarding suicide and agitation
(San Gil et al. 1988).
Another finding in our study is that no peak for panic
attacks is found in spring, while a peak in autumn is
present in both panic and non-panic anxiety. Non-panic
anxiety is also more frequent during the summer. This
might also be related to early onset of seasonal affective
disorder.
The “weekend effect”, in other words, a significant
decrease in the mean number of emergencies on Saturday
and Sunday, can be found only in non-panic anxiety.
However, there was no significant difference in panic
attacks when comparing the mean number of episodes
between weekdays and weekend days.
This paper has some limitations that deserve comment.
First, it is a retrospective analysis, although based on
prospective data very carefully reviewed. Secondly, lag
analysis was not carried out since only exploratory anal-
ysis was intended in this initial work. Lag analysis and
analysis with other diagnostic categories will be per-
formed for longer periods of at least 2 years. Third, po-
tential interactions among meteorological variables as
well as between these variables and seasonal parameters
are probably present in the study data. Nevertheless, be-
cause of the exploratory type of design of this study, di-
rect association and comparison measures were assessed
as the main target. Multivariate analysis, including com-
bination of variables, was carried out only with variables
showing some relevance in the first analysis. Further
multivariate analysis is underway and therefore the results
of this paper must be considered as preliminary. Another
relevant issue might be the fact that indoor and outdoor
conditions are quite different, and therefore interactions
with clinical variables may also be different for both.
Finally, the results refer to a single year, and to one
Mediterranean city, Barcelona, which has a different
setting than other cities, even within Spain.
On the whole, the results show a higher meteorological
sensitivity in patients suffering from panic disorder. In
these patients, warm wind increases the risk by three, rain
onset reduces it to one-half, and autumn increases it by
one and a half (although the latter case was nearly non-
significant). This is not observed in non-panic anxiety,
where meteorological effects were not found to be sig-
nificant.
Finally, the use of emergency episodes as a subject of
analysis instead of individuals should be pointed out.
Individual meteorological sensitivity cannot be deduced
therefrom. Because of the specificity of the findings in
this study it would be interesting to examine panic attack
meteorological sensitivity prospectively, since it appears
to be significant.
There is no doubt that psychiatric emergencies are
caused by much more complex circumstances than just
meteorological factors. Nevertheless, in some cases,
weather might be a triggering factor, although it is un-
likely to happen equally for all cases and conditions.
However, setting aside these important considerations, the
results of this study suggest a higher meteorological
sensitivity in patients with panic attacks. Although these
preliminary findings offer new ground to elucidate the
biological basis for panic disorder, further studies are
needed to replicate these associations between panic
anxiety and meteorological and seasonal variables.

Acknowledgements To Jordi Sunyer, Xavier Basagaa and Lili
Sperry for their invaluable help in data analysis and in reviewing
previous versions of the manuscript
References
Albert PS, Rosen LN, Alexander JR Jr, Rosenthal NE (1991) Effect
of daily variation in weather and sleep on seasonal affective
disorder. Psychiatr Res 36:51–63
Barker A, Hawton K, Fagg J, Jennison C (1994) Seasonal and
weather factors in parasuicide. Br J Psychiatr 165:375–380
Bulbena A, Dur JC, Mateo A, Porta M, Vallejo J (1988) Joint
hypermobility syndrome and anxiety disorders. Lancet 2:694
Bulbena A, Dur JC, Porta M, Martn-Santos R, Mateo A, Molina
L, Vallescar R, Vallejo J (1993) Anxiety disorder in the joint
hypermobility syndrome. Psychiatr Res 43:59–68
Bulbena A, Gago J, Pailhez G (2004) “Connective tissue” between
panic disorder and dysautonomia. Am J Med 116:783–784
Douglas AS, Dunnigan MG, Allan TM, Rawles JM (1995) Seasonal
variation in coronary heart disease in Scotland. J Epidemiol
Community Health 49:575–582
Driscoll DM, Stillman DN (2002) Weather and emotional state: a
search for associations between weather and calls to telephone
counselling services. Int J Biometeorol 47:21–34
Gago J (1992) Estudio de prevalencias y asociacin de laxitud
articular y trastornos ansioso-fbicos en el medio rural. MD
Thesis, Universidad Autnoma de Barcelona
Garca-Carretero L, Llorca G, Villoria MJ, Blzquez JM, Ledesma
A (1989) Relaciones entre las urgencias psiquitricas y los
factores meteorolgicos. Actas Luso Esp Neurol Psiquiatr
17:59–67
Garca A, Bobes J, Bousoo M, Surez LA, Gonzlez JM (1991)
Aspectos epidemiolgicos del suicidio en Asturias en relacin
con la climatologa, lo estacional y otros factores. Actas Luso
Esp Neurol Psiquiatr 19:185–190
Gazit Y, Nahir M, Grahame R, Jacob G (2003) Dysautonomia in
the joint hypermobility syndrome. Am J Med 115:33–40
Giannini AJ (1978–1979) Serotonin irritation syndrome: a hy-
pothesis. Int J Psychiatr Med 9:199–204
Giannini AJ, Castellani S, Dvoredsky AE (1983) Anxiety Sates:
relationship to atmospheric cations and serotonin. J Clin Psy-
chiatr 44:262–264
Grahame R (2000) Pain, distress and joint hyperlaxity. Joint Bone
Spine 67:157–163
Gratacs M, Nadal M, Martn-Santos R, Pujana MA, Gago J, Peral
B, Armengol L, Ponsa I, Mir R, Bulbena A, Estivill X (2001)
A polymorphic genomic duplication on human chromosome 15
is a susceptibility factor for panic and phobic disorders. Cell
106:367–379
Hribersek E, Van De Voorde H, Poppe H, Casselman J (1987)
Influence of the day of the week and the weather on people
using a telephone support system. Br J Psychiatr 150:189–192
Larcan A, Gilgenkrantz JM, Stoltz JF, Lambert H, Laprevote-
Heully MC, Evrard D, Kempf JB, Lambert J (1983) Climato-
logic parameters and myocardial infarction. Ann Cardiol An-
geiol (Paris) 32:83–89
243
Linkowski P, Martin F, De Maertelaer V (1992) Effect of some
climatic factors on violent and non-violent suicides in Belgium.
J Affect Disord 25:161–166
Maes M, Demeyer F, Thompson P, Peeters D, Cosyns P (1994)
Synchronized annual rhythms in violent suicide rate, ambient
temperature and the light-dark span. Acta Psychiatr Scand
90:391–396
Maes M, De Meyer F, Peeters D, Meltzer H, Schotte C, Scharpe S,
Cosyns P (1993) The periodicities in and biometerological re-
lationships with bed occupancy of an acute psychiatric ward in
Antwerp, Belgium. Int J Biometeorol 37:78–82
Makie T, Harada M, Kinukawa N, Toyoshiba H, Yamanaka T,
Nose Y, Nakamura T, Sakamoto M (2002) Association of
meteorological and day-of-the-week factors with emergency
hospital admissions in Fukuoka, Japan. Int J Biometeorol
46:38–41
Martn-Santos R, Bulbena A, Porta M, Gago J, Molina L, Dur JC
(1998) Association between the joint hypermobility syndrome
and panic disorder. Am J Psychiatr 155:1578–1583
Noble RE (1996) Temporal fluctuations in suicide calls to a crisis
intervention service. Suicide Life Threat Behav 26:415–423
Peck DF (1990) Climatic variables and admissions for mania: a
reanalysis. J Affect Disord 20:249–250
Redelmeier DA, Tversky A (1996) On the belief that arthritis pain
is related to the weather. Proc Natl Acad Sci USA 93:2895–
2896
Salib E (1997) Elderly suicide and weather conditions: is there a
link? Int J Geriatr Psychiatr 12:937–941
Salib E, Gray N (1997) Weather conditions and fatal self-harm in
North Cheshire 1989–1993. Br J Psychiatr 171:473–477
Salib E, Sharp N (2002) Relative humidity and affective disorders.
Int J Psychiatr Clin Pract 6:147–153
San Gil J, Gonzlez de Rivera JL, Gonzlez J (1988) Mete-
orotropismo y estacionalidad de las urgencias psiquitricas en
la isla de Tenerife. Psiquis 10:349–359
San Gil J, Gonzlez de Rivera JL, Gonzlez Gonzlez J (1994)
Tiempo Clima y Conductas Auto y Heteroagresivas. In: Del-
gado-Bueno (ed) Psiquiatra Legal y Forense, Colex Madrid
SAS (2003) JMP version 5.01 user’s guide. Statistics and graphics
guide. SAS Institute, Cary, N.C.
Schmidt NB, Santiago HT, Trakowski JH, Kendren JM (2002) Pain
in patients with panic disorder: relation to symptoms, cognitive
characteristics and treatment outcome. Pain Res Manag 7:134–
141
Summers L, Shur E (1992) The relationship between onsets of
depression and sudden drops in solar irradiation. Biol Psychi-
atry 32:1164–1172
Sulman FG (1976) Effect of ambient heat stress on body devel-
opment of rats and effect of drugs on heat stress survival. Isr J
Med Sci 12:1134–1135
Wang H, Sekine M, Chen X, Kagamimori S (2002) A study of
weekly and seasonal variation of stroke onset. Int J Biometeorol
47:13–20
Wang YT, Wang D, Wang XY (1997) Suicide and meteorological
factors in Huhhot, Inner Mongolia. Crisis 18:115–117
Zvan B, Zaletel M, Pretnar J, Pogacnik T, Kiauta T (1998) Influ-
ence of the cold pressor test on the middle cerebral artery cir-
culation. Auton Nerv Syst 74:175–178