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Faurholt-Jepsen M, Busk J, Tønning ML, Rohani D, Bardram JE, Kessing LV. Mood, Activity, and Instability in Bipolar Disorder and Unipolar Disorder-An Exploratory Post Hoc Study Using Digital Data. Acta Psychiatr Scand 2025; 151:426-433. [PMID: 39617464 DOI: 10.1111/acps.13771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 09/26/2024] [Accepted: 10/29/2024] [Indexed: 02/04/2025]
Abstract
BACKGROUND Mood, activity, and instability in symptomatology hold significant roles in bipolar disorder (BD) and unipolar disorder (UD). The objectives were to examine disparities in these symptoms among patients with BD and UD. METHODS Data from two studies including patients with BD and UD, respectively, were combined for exploratory analyses. Patients provided daily smartphone-based evaluations of mood and activity/energy for a 6-month period. A total of 47 patients with BD and 59 patients with UD were included in the analyses. The dataset contains more than 13,000 patient-reported evaluations of mood and activity. Daily mood and activity instability measures were calculated using the root squared successive difference method. RESULTS In linear mixed effect regression models adjusted for age, sex, and work status, there were statistically significant lower levels of activity in patients with BD as compared with patients with UD overall, during euthymic states and during depressive states (B: -0.61, 95% CI: -0.98; -0.24, p = 0.001). There were no statistically significant differences in mood instability and activity instability between patients with BD and patients with UD overall, during euthymic states and during depressive states, when accounting for multiple testing (p > 0.012). LIMITATIONS Analyses were exploratory and post hoc. Findings should be interpreted with caution. The sample size was modest. CONCLUSION Patients with BD presented with lower level of activity as compared with patients with UD. There were no differences in mood and activity instability between these groups. Future studies including larger sample sizes should investigate differences between BD and UD. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03033420.
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Affiliation(s)
- Maria Faurholt-Jepsen
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Frederiksberg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonas Busk
- Department of Energy Conversion and Storage, Technical University of Denmark, Lyngby, Denmark
| | - Morten Lindberg Tønning
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Frederiksberg, Denmark
| | - Darius Rohani
- Kuatro Group ApS, Copenhagen, Denmark
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Jakob Eyvind Bardram
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Frederiksberg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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2
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Wang TW, Gong J, Wang Y, Liang Z, Pang KL, Wang JS, Zhang ZG, Zhang CY, Zhou Y, Li JC, Wang YN, Zhou YJ. Differences in Non-suicidal Self-injury Behaviors between Unipolar Depression and Bipolar Depression in Adolescent Outpatients. Curr Med Sci 2023; 43:998-1004. [PMID: 37558867 DOI: 10.1007/s11596-023-2772-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/24/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE Non-suicidal self-injury (NSSI) has a higher prevalence in adolescents with depressive disorders than in community adolescents. This study examined the differences in NSSI behaviors between adolescents with unipolar depression (UD) and those with bipolar depression (BD). METHODS Adolescents with UD or BD were recruited from 20 general or psychiatric hospitals across China. The methods, frequency, and function of NSSI were assessed by Functional Assessment of Self-Mutilation. The Beck Suicide Ideation Scale was used to evaluate adolescents' suicidal ideation, and the 10-item Kessler Psychological Distress Scale to estimate the anxiety and depression symptoms. RESULTS The UD group had higher levels of depression (19.16 vs.17.37, F=15.23, P<0.001) and anxiety symptoms (17.73 vs.16.70, F=5.00, P=0.026) than the BD group. Adolescents with BD had a longer course of NSSI than those with UD (2.00 vs.1.00 year, Z=-3.39, P=0.001). There were no statistical differences in the frequency and the number of methods of NSSI between the UD and BD groups. Depression (r=0.408, P<0.01) and anxiety (r=0.391, P<0.01) were significantly and positively related to NSSI frequency. CONCLUSION Adolescents with BD had a longer course of NSSI than those with UD. More importantly, NSSI frequency were positively and strongly correlated with depression and anxiety symptoms, indicating the importance of adequate treatment of depression and anxiety in preventing and intervening adolescents' NSSI behaviors.
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Affiliation(s)
- Ting-Wei Wang
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, 518000, China
| | - Jian Gong
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Yang Wang
- College of Management, Shenzhen University, Shenzhen, 518000, China
| | - Zhen Liang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, 518000, China
| | - Ke-Liang Pang
- School of Pharmaceutical Sciences, IDG/McGovern Institute for Brain Research, Tsinghua University-Peking University Joint Center for Life Sciences, Tsinghua University, Beijing, 100000, China
| | - Jie-Si Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100000, China
| | - Zhi-Guo Zhang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, 518000, China
| | - Chun-Yan Zhang
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, 518000, China
| | - Yue Zhou
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Jun-Chang Li
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, 518000, China
| | - Yan-Ni Wang
- School of Public Health, Lanzhou University, Lanzhou, 730000, China.
| | - Yong-Jie Zhou
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, 518000, China.
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Ghaemi SN, Angst J, Vohringer PA, Youngstrom EA, Phelps J, Mitchell PB, McIntyre RS, Bauer M, Vieta E, Gershon S. Clinical research diagnostic criteria for bipolar illness (CRDC-BP): rationale and validity. Int J Bipolar Disord 2022; 10:23. [PMID: 36227452 DOI: 10.1186/s40345-022-00267-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the 1970 s, scientific research on psychiatric nosology was summarized in Research Diagnostic Criteria (RDC), based solely on empirical data, an important source for the third revision of the official nomenclature of the American Psychiatric Association in 1980, the Diagnostic and Statistical Manual, Third Edition (DSM-III). The intervening years, especially with the fourth edition in 1994, saw a shift to a more overtly "pragmatic" approach to diagnostic definitions, which were constructed for many purposes, with research evidence being only one consideration. The latest editions have been criticized as failing to be useful for research. Biological and clinical research rests on the validity of diagnostic definitions that are supported by firm empirical foundations, but critics note that DSM criteria have failed to prioritize research data in favor of "pragmatic" considerations. RESULTS Based on prior work of the International Society for Bipolar Diagnostic Guidelines Task Force, we propose here Clinical Research Diagnostic Criteria for Bipolar Illness (CRDC-BP) for use in research studies, with the hope that these criteria may lead to further refinement of diagnostic definitions for other major mental illnesses in the future. New proposals are provided for mixed states, mood temperaments, and duration of episodes. CONCLUSIONS A new CRDC could provide guidance toward an empirically-based, scientific psychiatric nosology, and provide an alternative clinical diagnostic approach to the DSM system.
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Affiliation(s)
- S Nassir Ghaemi
- Department of Psychiatry, Tufts University, 800 Washington St, Boston, MA, 02111, USA. .,Department of Psychiatry, Harvard Medical School, Boston, USA.
| | | | - Paul A Vohringer
- Department of Psychiatry, Tufts University, 800 Washington St, Boston, MA, 02111, USA.,Department of Psychiatry, University of Chile, Santiago, Chile
| | - Eric A Youngstrom
- Departments of Psychology, Neuroscience, and Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - James Phelps
- Department of Psychiatry, Good Samaritan Regional Medical Center, Corvallis, OR, USA
| | - Philip B Mitchell
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Samuel Gershon
- Department of Psychiatry, University of Miami, Miami, USA
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4
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Chakrabarti S, Singh N. Psychotic symptoms in bipolar disorder and their impact on the illness: A systematic review. World J Psychiatry 2022; 12:1204-1232. [PMID: 36186500 PMCID: PMC9521535 DOI: 10.5498/wjp.v12.i9.1204] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/02/2022] [Accepted: 08/26/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lifetime psychotic symptoms are present in over half of the patients with bipolar disorder (BD) and can have an adverse effect on its course, outcome, and treatment. However, despite a considerable amount of research, the impact of psychotic symptoms on BD remains unclear, and there are very few systematic reviews on the subject.
AIM To examine the extent of psychotic symptoms in BD and their impact on several aspects of the illness.
METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. An electronic literature search of six English-language databases and a manual search was undertaken to identify published articles on psychotic symptoms in BD from January 1940 to December 2021. Combinations of the relevant Medical Subject Headings terms were used to search for these studies. Articles were selected after a screening phase, followed by a review of the full texts of the articles. Assessment of the methodological quality of the studies and the risk of bias was conducted using standard tools.
RESULTS This systematic review included 339 studies of patients with BD. Lifetime psychosis was found in more than a half to two-thirds of the patients, while current psychosis was found in a little less than half of them. Delusions were more common than hallucinations in all phases of BD. About a third of the patients reported first-rank symptoms or mood-incongruent psychotic symptoms, particularly during manic episodes. Psychotic symptoms were more frequent in bipolar type I compared to bipolar type II disorder and in mania or mixed episodes compared to bipolar depression. Although psychotic symptoms were not more severe in BD, the severity of the illness in psychotic BD was consistently greater. Psychosis was usually associated with poor insight and a higher frequency of agitation, anxiety, and hostility but not with psychiatric comorbidity. Psychosis was consistently linked with increased rates and the duration of hospitalizations, switching among patients with depression, and poorer outcomes with mood-incongruent symptoms. In contrast, psychosis was less likely to be accompanied by a rapid-cycling course, longer illness duration, and heightened suicidal risk. There was no significant impact of psychosis on the other parameters of course and outcome.
CONCLUSION Though psychotic symptoms are very common in BD, they are not always associated with an adverse impact on BD and its course and outcome.
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Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, UT, India
| | - Navdeep Singh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, UT, India
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5
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Clark CT, Sit DK, Zumpf KB, Ciolino JD, Yang A, Fisher SD, Wisner KL. A comparison of symptoms of bipolar and unipolar depression in postpartum women. J Affect Disord 2022; 303:82-90. [PMID: 35041868 DOI: 10.1016/j.jad.2022.01.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 01/08/2022] [Accepted: 01/13/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Distinguishing postpartum women with bipolar from unipolar depression remains challenging, particularly in obstetrical and primary care settings. The post-birth period carries the highest lifetime risk for the onset or recurrence of Bipolar Disorder (BD). Characterization of differences between unipolar and bipolar depression symptom presentation and severity is critical to differentiate the two disorders. METHODS We performed a secondary analysis of a study of 10,000 women screened by phone with the Edinburgh Postnatal Depression Scale at 4-6 weeks post-birth. Screen-positive mothers completed the Structured Clinical Interview for DSM-4 and those diagnosed with BD and unipolar Major Depressive Disorder (UD) were included. Depressive symptoms were assessed with the 29-item Structured Interview Guide for the Hamilton Rating Scale for Depression (SIGH-ADS). RESULTS The sample consisted of 728 women with UD and 272 women with BD. Women with BD had significantly elevated levels of depression severity due to the higher scores on 8 of the 29 SIGH-ADS symptoms. Compared to UD, women with BD had significantly higher rates of comorbid anxiety disorders and were twice as likely to report sexual and/or physical abuse. LIMITATIONS Only women who screened positive for depression were included in this analysis. Postpartum women with unstable living situations, who were hospitalized or did not respond to contact attempts did not contribute data. CONCLUSIONS Severity of specific symptom constellations may be a useful guide for interviewing postpartum depressed women along with the presence of anxiety disorder comorbidity and physical and/or sexual abuse.
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Affiliation(s)
- Crystal T Clark
- Northwestern University Feinberg School of Medicine, 676 North St. Clair Suite 1000, Chicago, IL 60611, United States
| | - Dorothy K Sit
- Northwestern University Feinberg School of Medicine, 676 North St. Clair Suite 1000, Chicago, IL 60611, United States
| | - Katelyn B Zumpf
- Northwestern University Feinberg School of Medicine, 676 North St. Clair Suite 1000, Chicago, IL 60611, United States
| | - Jody D Ciolino
- Northwestern University Feinberg School of Medicine, 676 North St. Clair Suite 1000, Chicago, IL 60611, United States
| | - Amy Yang
- Northwestern University Feinberg School of Medicine, 676 North St. Clair Suite 1000, Chicago, IL 60611, United States
| | - Sheehan D Fisher
- Northwestern University Feinberg School of Medicine, 676 North St. Clair Suite 1000, Chicago, IL 60611, United States
| | - Katherine L Wisner
- Northwestern University Feinberg School of Medicine, 676 North St. Clair Suite 1000, Chicago, IL 60611, United States.
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6
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Hebbrecht K, Stuivenga M, Birkenhäger T, van der Mast RC, Sabbe B, Giltay EJ. Symptom Profile and Clinical Course of Inpatients with Unipolar versus Bipolar Depression. Neuropsychobiology 2021; 79:313-323. [PMID: 31655820 DOI: 10.1159/000503686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 09/21/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although differences in symptom profiles and outcome between depressive patients with an underlying major depressive disorder (MDD) and bipolar depression (BD) have been reported, studies with sequential short-interval assessments in a real-life inpatient setting are scarce. OBJECTIVES To examine potential differences in symptom profile and course of depressive symptomatology in depressive inpatients with underlying MDD and BD. METHODS A cohort of 276 consecutive inpatients with MDD (n = 224) or BD (n = 52) was followed during their hospitalization using routine outcome monitoring (ROM), which included a structured diagnostic interview at baseline (Mini-International Neuropsychiatric Interview Plus [MINI-Plus]) and repeated 17-item Hamilton Depression Rating Scale every 2 weeks. MDD and BD were compared regarding their symptom profiles and time to response and remission. Furthermore, the concordance between the MINI-Plus and clinical diagnosis was analyzed. RESULTS Patients were on average 52 and 47 years old in the MDD and BD group, respectively, and 66 versus 64% were female. Compared to patients with BD, patients with MDD scored higher on weight loss (p = 0.02), whereas the BD group showed a higher long-term likelihood of response (hazard ratio = 1.93, 95% confidence interval 1.16-3.20, p for interaction with time = 0.04). Although the same association was seen for remission, the interaction with time was not significant (p = 0.48). Efficiency between the MINI-Plus and clinical diagnosis of BD was high (0.90), suggesting that the MINI-Plus is an adequate ROM diagnostic tool. CONCLUSIONS In routine clinical inpatient care, minor differences in the symptom profile and the course of depressive symptomatology may be helpful in distinguishing MDD and BD, particularly when using sequential ROM assessments.
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Affiliation(s)
- Kaat Hebbrecht
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium, .,University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium,
| | - Mirella Stuivenga
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.,University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium
| | - Tom Birkenhäger
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.,University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium.,Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Roos C van der Mast
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.,University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Bernard Sabbe
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.,University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium
| | - Erik J Giltay
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.,University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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7
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Neuroprogression as an Illness Trajectory in Bipolar Disorder: A Selective Review of the Current Literature. Brain Sci 2021; 11:brainsci11020276. [PMID: 33672401 PMCID: PMC7926350 DOI: 10.3390/brainsci11020276] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/01/2021] [Accepted: 02/15/2021] [Indexed: 01/29/2023] Open
Abstract
Bipolar disorder (BD) is a chronic and disabling psychiatric condition that is linked to significant disability and psychosocial impairment. Although current neuropsychological, molecular, and neuroimaging evidence support the existence of neuroprogression and its effects on the course and outcome of this condition, whether and to what extent neuroprogressive changes may impact the illness trajectory is still poorly understood. Thus, this selective review was aimed toward comprehensively and critically investigating the link between BD and neurodegeneration based on the currently available evidence. According to the most relevant findings of the present review, most of the existing neuropsychological, neuroimaging, and molecular evidence demonstrates the existence of neuroprogression, at least in a subgroup of BD patients. These studies mainly focused on the most relevant effects of neuroprogression on the course and outcome of BD. The main implications of this assumption are discussed in light of specific shortcomings/limitations, such as the inability to carry out a meta-analysis, the inclusion of studies with small sample sizes, retrospective study designs, and different longitudinal investigations at various time points.
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8
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Denier N, Walther S, Schneider C, Federspiel A, Wiest R, Bracht T. Reduced tract length of the medial forebrain bundle and the anterior thalamic radiation in bipolar disorder with melancholic depression. J Affect Disord 2020; 274:8-14. [PMID: 32469836 DOI: 10.1016/j.jad.2020.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/29/2020] [Accepted: 05/06/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The supero-lateral medial forebrain bundle (slMFB) and the anterior thalamic radiation (ATR) play a core role in reward anticipation and motivational processes. In this study, the slMFB and the ATR were investigated in a group of depressed bipolar disorder (BD) and in healthy controls (HC) using tract length as a measure of fibre geometry and fractional anisotropy (FA) as a measure of white matter microstructure. We hypothesized reduced tract length and FA of the slMFB and the ATR in BD. We expect alterations to be driven by the melancholic subtype. METHODS Nineteen depressed patients with BD and 19 HC matched for age and gender underwent diffusion-weighted magnetic resonance imaging (MRI) scans. Diffusion tensor imaging (DTI) based tractography was used to reconstruct bilateral slMFB and ATR. Mean tract length and FA were computed for the slMFB and the ATR. Mixed-model ANCOVAs and post-hoc ANCOVAs, controlling for age and intracranial volume, were used to compare tract length and FA of bilateral slMFB and ATR between HC and BD and between HC and subgroups with melancholic and non-melancholic symptoms. RESULTS In BD we found a significantly shortened tract length of the right slMFB and ATR in BD compared to HC. Subgroup analyses showed that these findings were driven by the melancholic subgroup. Mean-FA did not differ between HC and BD. LIMITATIONS Sample size CONCLUSIONS: Tract length of the right slMFB and the right ATR is reduced in BD. Those changes of fibre geometry are driven by the melancholic subtype.
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Affiliation(s)
- Niklaus Denier
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sebastian Walther
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph Schneider
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Andrea Federspiel
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Roland Wiest
- Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Bern, Switzerland
| | - Tobias Bracht
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
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9
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Tondo L, Vázquez GH, Baldessarini RJ. Melancholic versus Nonmelancholic Major Depression Compared. J Affect Disord 2020; 266:760-765. [PMID: 32217259 DOI: 10.1016/j.jad.2020.01.139] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/03/2019] [Accepted: 01/25/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The concept of melancholia has been associated with psychiatric nosology for centuries. Nevertheless, its definition, relationship to the contemporary concept of Major Depressive Disorder, and clinical implications remain uncertain. METHODS In a total sample of 3211 closely evaluated patient-subjects diagnosed with DSM-5 Major Depressive or Bipolar Disorder and meeting DSM-5 criteria for major depression with melancholic features or not at a European mood disorder center, we matched 1833 for depression severity (baseline HDRS21 score ≥18) and compared rates and ratings of characteristics of interest between the subgroups, using bivariate and multivariate methods. RESULTS Observed prevalence of melancholic features was 35.2% in the 1833 subjects matched for severity, and 21.0% among all 3211 subjects. Diagnosis was highly dependent on depression-severity measured three ways. Very few clinical characteristics differed between melancholic and nonmelancholic subjects matched for illness-severity; more suicidal ideation with melancholic features was a notable exception. CONCLUSIONS Study findings leave the distinction of melancholic features from depression-severity unclear and the potential clinical value of diagnosing melancholic features uncertain.
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Affiliation(s)
- L Tondo
- International Consortium for Mood & Psychotic Disorders Research, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States; Lucio Bini Mood Disorders Centers, Cagliari and Rome, Italy.
| | - G H Vázquez
- International Consortium for Mood & Psychotic Disorders Research, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Queen's University School of Medicine, Kingston, Ontario, Canada
| | - R J Baldessarini
- International Consortium for Mood & Psychotic Disorders Research, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
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10
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Barbuti M, Mainardi C, Pacchiarotti I, Verdolini N, Maccariello G, Angst J, Azorin JM, Bowden CL, Mosolov S, Young AH, Vieta E, Perugi G. The role of different patterns of psychomotor symptoms in major depressive episode: Pooled analysis of the BRIDGE and BRIDGE-II-MIX cohorts. Bipolar Disord 2019; 21:785-793. [PMID: 31400256 DOI: 10.1111/bdi.12816] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Psychomotor agitation (PA) or retardation (PR) during major depressive episodes (MDEs) have been associated with depression severity in terms of treatment-resistance and course of illness. OBJECTIVES We investigated the possible association of psychomotor symptoms (PMSs) during a MDE with clinical features belonging to the bipolar spectrum. METHODS The initial sample of 7689 MDE patients was divided into three subgroups based on the presence of PR, PA and non-psychomotor symptom (NPS). Univariate comparisons and multivariate logistic regression models were performed between subgroups. RESULTS A total of 3720 patients presented PR (48%), 1971 showed PA (26%) and 1998 had NPS (26%). In the PR and PA subgroups, the clinical characteristics related to bipolarity, along with the diagnosis of bipolar disorder (BD), were significantly more frequent than in the NPS subgroup. When comparing PA and PR patients, the former presented higher rates of bipolar spectrum features, such as family history of BD (OR = 1.39, CI = 1.20-1.61), manic/hypomanic switches with antidepressants (OR = 1.28, CI = 1.11-1.48), early onset of first MDE (OR = 1.40, CI = 1.26-1.57), atypical (OR = 1.23, CI = 1.07-1.42) and psychotic features (OR = 2.08, CI = 1.78-2.44), treatment with mood-stabilizers (OR = 1.39, CI = 1.24-1.55), as well as a BD diagnosis according to both the DSM-IV criteria and the bipolar specifier criteria. When logistic regression model was performed, the clinical features that significantly differentiated PA from PR were early onset of first MDE, atypical and psychotic features, treatment with mood-stabilizers and a BD diagnosis according to the bipolar specifier criteria. CONCLUSIONS Psychomotor symptoms could be considered as markers of bipolarity, illness severity, and treatment complexity, particularly if PA is present.
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Affiliation(s)
- Margherita Barbuti
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Cecilia Mainardi
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy.,Bipolar Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Isabella Pacchiarotti
- Bipolar Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Norma Verdolini
- Bipolar Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.,Division of Psychiatry, Clinical Psychology and Rehabilitation, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.,FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Catalonia, Spain.,CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain
| | - Giuseppe Maccariello
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Jules Angst
- Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | | | - Charles L Bowden
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Sergey Mosolov
- Department for Therapy of Mental Disorders, Moscow Research Institute of Psychiatry, Moscow, Russia
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London & South London and Maudsley NHS Foundation Trust, London, UK
| | - Eduard Vieta
- Bipolar Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Giulio Perugi
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
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11
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Barbuti M, Mazzarini L, Vieta E, Azorin JM, Angst J, Bowden CL, Mosolov S, Young AH, Perugi G. Relationships between recurrence and polarity in major depressive disorders: Pooled analysis of the BRIDGE and BRIDGE-II-MIX cohorts. J Affect Disord 2019; 256:250-258. [PMID: 31195243 DOI: 10.1016/j.jad.2019.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/11/2019] [Accepted: 06/02/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND current classifications of mood disorders focus on polarity rather than recurrence, separating bipolar disorder from major depressive disorder (MDD). The aim of the present study is to explore the possible relationships between number and frequency of depressive episodes and clinical variables associated to bipolarity, in a large sample of MDD patients. METHODS the clinical characteristics of 7055 patients with MDD were analyzed and compared according to the number and frequency of depressive episodes. Two stepwise backward logistic regression model were used to identify the predictive value of clinical features based on the presence of high number (≥3 episodes) and high frequency (≥3 episodes/year) of depressive episodes. RESULTS high-recurrence and high-frequency MDD patients showed greater family history for bipolar disorder, higher prevalence of psychotic features, more suicide attempts, higher rates of treatment resistance and mood switches with antidepressants (ADs) and higher rates of bipolarity diagnosis according to Angst criteria, compared to low-recurrence and low-frequency patients. Logistic regressions showed that a brief current depressive episode, a previous history of treatment resistance and AD-induced mood switches, a diagnosis of bipolarity and comorbid borderline personality disorder were the variables associated with both high-recurrence and high-frequency depression. LIMITATIONS the study participating centers were not randomly selected and several variables were retrospectively assessed. CONCLUSIONS even in the absence of hypomanic/manic episodes, high-recurrence and high-frequency MDD seem to be in continuity with the bipolar spectrum disorders in terms of clinical features and, perhaps, treatment response.
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Affiliation(s)
- Margherita Barbuti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Lorenzo Mazzarini
- NESMOS Department, School of Medicine and Psychology, Sapienza University, Rome, Italy; Salvator Mundi International Hospital, Rome, Italy
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | | | - Jules Angst
- Department of Psychiatry, Psychotherapy, and Psychosomatic, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Charles L Bowden
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA
| | - Sergey Mosolov
- Department for Therapy of Mental Disorders, Moscow Research Institute of Psychiatry, Moscow, Russia
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Giulio Perugi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Via Savi 10, 56126, Pisa, Italy.
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12
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Choi KW, Na EJ, Hong JP, Cho MJ, Fava M, Mischoulon D, Jeon HJ. Comparison of suicide attempts in individuals with major depressive disorder with and without history of subthreshold hypomania: A nationwide community sample of Korean adults ✰,✰✰. J Affect Disord 2019; 248:18-25. [PMID: 30710859 DOI: 10.1016/j.jad.2019.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 01/16/2019] [Accepted: 01/19/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Subthreshold hypomania is defined as a distinct period of elevated, expansive or irritable mood lasting for at least four days, but insufficient to fulfill the criteria of hypomania. This study aimed to investigate the association between suicidality and subthreshold hypomania in subjects with and without major depressive disorder (MDD). METHODS Face-to-face interviews were completed for 12,526 adults, randomly selected through a one-person-per-household method, using the Korean version of the Composite International Diagnostic Interview (K-CIDI) and a questionnaire relative to lifetime suicide attempts (LSA). RESULTS Of the 12,526 participants, 11,701 did not have MDD, and 825 were diagnosed with MDD. The MDD with subthreshold hypomania group (n = 72) revealed significantly higher rates of LSA and post-traumatic stress disorder (PTSD) than those without (n = 753). Compared to the no MDD without subthreshold hypomania group (n = 11,571), the no MDD with subthreshold hypomania group (n = 130) showed a significantly higher prevalence of suicidality and comorbid conditions. In multivariate logistic regression analyses of depressive symptoms, subthreshold hypomania was significantly associated with morning worsening of mood. The MDD with subthreshold hypomania group was significantly associated with LSA (AOR=16.82, 95% CI 9.81-28.83, p< 0.001), compared to the no MDD group without subthreshold hypomania. Compared to the MDD without subthreshold hypomania group, the MDD with subthreshold hypomania group revealed a significant association with LSA (AOR=2.08, 95% CI 1.20-3.62, p< 0.001). CONCLUSIONS A history of subthreshold hypomania doubled the risk of LSA in patients with MDD compared to those without subthreshold hypomania.
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Affiliation(s)
- Kwan Woo Choi
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Jin Na
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Korean Psychological Autopsy Center (KPAC), Seoul, Korea
| | - Jin Pyo Hong
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Maeng Je Cho
- Department of Psychiatry, Seoul National University, College of Medicine, Seoul, Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Korean Psychological Autopsy Center (KPAC), Seoul, Korea; Department of Health Sciences & Technology, Department of Medical Device Management & Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea.
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13
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Terziivanova P, Haralanova E, Milushev E, Dimitrov R, Claussen CF, Haralanov S. Objective quantification of psychomotor disturbances in patients with a major depressive episode. J Eval Clin Pract 2018; 24:826-831. [PMID: 29603511 DOI: 10.1111/jep.12916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/26/2018] [Accepted: 03/01/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Petya Terziivanova
- Department of Psychiatry and Medical Psychology, Medical University, Sofia, Bulgaria.,University Hospital of Neurology and Psychiatry "St. Naum", Sofia, Bulgaria
| | - Evelina Haralanova
- Department of Psychiatry and Medical Psychology, Medical University, Sofia, Bulgaria.,University Hospital of Neurology and Psychiatry "St. Naum", Sofia, Bulgaria.,International Neuroscience Research Institute, Bad Kissingen, Germany
| | - Emil Milushev
- University Hospital of Neurology and Psychiatry "St. Naum", Sofia, Bulgaria.,Department of Neurology, Medical University, Sofia, Bulgaria
| | - Rumen Dimitrov
- Department of Psychiatry and Medical Psychology, Medical University, Sofia, Bulgaria.,University Hospital of Neurology and Psychiatry "St. Naum", Sofia, Bulgaria
| | | | - Svetlozar Haralanov
- Department of Psychiatry and Medical Psychology, Medical University, Sofia, Bulgaria.,University Hospital of Neurology and Psychiatry "St. Naum", Sofia, Bulgaria.,International Neuroscience Research Institute, Bad Kissingen, Germany
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14
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Bruschi A, Mazza M, Camardese G, Calò S, Palumbo C, Mandelli L, Callea A, Gori A, Di Nicola M, Marano G, Berk M, di Sciascio G, Janiri L. Psychopathological Features of Bipolar Depression: Italian Validation of the Bipolar Depression Rating Scale (I-BDRS). Front Psychol 2018; 9:1047. [PMID: 29977223 PMCID: PMC6022061 DOI: 10.3389/fpsyg.2018.01047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 06/04/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Aim of the study was the validation of the Bipolar Disorder Rating Scale (BDRS) in an Italian population. Secondary aim was the evaluation of differences between unipolar and bipolar depression and between bipolar I and II depressed patients. Method: 125 Bipolar Disorder and 60 Major Depressive Disorder patients were administered an Italian translation of the BDRS (I-BDRS), Hamilton Depression Rating Scale (HDRS), Montgomery-Asberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS) and Temperament and Character Inventory-Revised (TCI-R). Results: I-BDRS showed considerable validity and reliability. Factor analysis found 3 subscales, two linked to depressive symptoms and one to mixed symptoms. Measures concerning depression (MADRS and HAM-D) were positively related to the I-BDRS's subscales, but mostly to the two subscales measuring depression. In mixed symptoms, the mean of the bipolar group was significantly higher than the unipolar group suggesting that the BDRS was able to distinguish between unipolar and bipolar depressed patients. Conclusion: I-BDRS is a valid scale for the measurement of depression in BD patients, with a notable internal consistency (Cronbach's α 0.82), a significant consistency between items/total (Cronbach's α from 0.80 to 0.82) and positive correlation with other scales (MADRS r = 0.67, p < 0.001; HDRS r = 0.81, p < 0.001; YMRS r = 0.46 p < 0.0001). The mixed state sub-scale shows usefulness in differentiating bipolar from unipolar patients. I-BDRS could be a sensitive tool, both in pure depression and in mixed states, and could be used in the everyday screening and treatment of Bipolar Disorder.
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Affiliation(s)
- Angelo Bruschi
- Institute of Psychiatry and Psychology, Department of Geriatrics, Neuroscience and Orthopedics, Catholic University of Sacred Heart, Rome, Italy
- Istituto di Psicopatologia, Rome, Italy
- Department of Mental Health, ASL Viterbo, Rome, Italy
| | - Marianna Mazza
- Institute of Psychiatry and Psychology, Department of Geriatrics, Neuroscience and Orthopedics, Catholic University of Sacred Heart, Rome, Italy
| | - Giovanni Camardese
- Institute of Psychiatry and Psychology, Department of Geriatrics, Neuroscience and Orthopedics, Catholic University of Sacred Heart, Rome, Italy
| | - Salvatore Calò
- Department of Psychiatry, Policlinico Hospital Bari, Bari, Italy
- Department of Mental Health, ASL Lecce, Lecce, Italy
| | - Claudia Palumbo
- Department of Psychiatry, Policlinico Hospital Bari, Bari, Italy
- Esine Hospital, ASST Valcamonica, Esine, Italy
| | - Laura Mandelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Alessio Gori
- Department of Human Science, LUMSA University, Rome, Italy
- Department of Education and Psychology, University of Florence, Florence, Italy
| | - Marco Di Nicola
- Institute of Psychiatry and Psychology, Department of Geriatrics, Neuroscience and Orthopedics, Catholic University of Sacred Heart, Rome, Italy
| | - Giuseppe Marano
- Institute of Psychiatry and Psychology, Department of Geriatrics, Neuroscience and Orthopedics, Catholic University of Sacred Heart, Rome, Italy
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia
- Orygen Youth Health Research Centre, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | | | - Luigi Janiri
- Institute of Psychiatry and Psychology, Department of Geriatrics, Neuroscience and Orthopedics, Catholic University of Sacred Heart, Rome, Italy
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15
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Holmskov J, Licht R, Andersen K, Bjerregaard Stage T, Mørkeberg Nilsson F, Bjerregaard Stage K, Valentin J, Bech P, Ernst Nielsen R. Diagnostic Conversion to Bipolar Disorder in Unipolar Depressed Patients Participating in Trials on Antidepressants. Eur Psychiatry 2016; 40:76-81. [DOI: 10.1016/j.eurpsy.2016.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/19/2016] [Accepted: 08/19/2016] [Indexed: 01/10/2023] Open
Abstract
AbstractObjectiveIn unipolar depressed patients participating in trials on antidepressants, we investigated if illness characteristics at baseline could predict conversion to bipolar disorder.MethodA long-term register-based follow-up study of 290 unipolar depressed patients with a mean age of 50.8 years (SD = 11.9) participating in three randomized trials on antidepressants conducted in the period 1985–1994. The independent effects of explanatory variables were examined by applying Cox regression analyses.ResultsThe overall risk of conversion was 20.7%, with a mean follow-up time of 15.2 years per patient. The risk of conversion was associated with an increasing number of previous depressive episodes at baseline, [HR 1.18, 95% CI (1.10–1.26)]. No association with gender, age, age at first depressive episode, duration of baseline episode, subtype of depression or any of the investigated HAM-D subscales included was found.LimitationsThe patients were followed-up through the Danish Psychiatric Central Research Register, which resulted in inherent limitations such as possible misclassification of outcome.ConclusionIn a sample of middle-aged hospitalized unipolar depressed patients participating in trials on antidepressants, the risk of conversion was associated with the number of previous depressive episodes. Therefore, this study emphasizes that unipolar depressed patients experiencing a relatively high number of recurrences should be followed more closely, or at least be informed about the possible increased risk of conversion.
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16
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Orsel S, Karadag H, Turkcapar H, Kahilogullari AK. Diagnosis and Classification Subtyping of Depressive Disorders: Comparison of Three Methods. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/10177833.2010.11790635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sibel Orsel
- Ankara Dışkapı Research and Training Hospital
| | | | - Hakan Turkcapar
- Ministry of Health Primary Health Care Services-Department of Mental Health
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17
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Differences in symptom expression between unipolar and bipolar spectrum depression: Results from a nationally representative sample using item response theory (IRT). J Affect Disord 2016; 204:24-31. [PMID: 27318596 PMCID: PMC6447294 DOI: 10.1016/j.jad.2016.06.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 06/10/2016] [Accepted: 06/12/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND The inclusion of subsyndromal forms of bipolarity in the fifth edition of the DSM has major implications for the way in which we approach the diagnosis of individuals with depressive symptoms. The aim of the present study was to use methods based on item response theory (IRT) to examine whether, when equating for levels of depression severity, there are differences in the likelihood of reporting DSM-IV symptoms of major depressive episode (MDE) between subjects with and without a lifetime history of manic symptoms. METHODS We conducted these analyses using a large, nationally representative sample from the USA (n=34,653), the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions. RESULTS The items sadness, appetite disturbance and psychomotor symptoms were better indicators of depression severity in participants without a lifetime history of manic symptoms, in a clinically meaningful way. DSM-IV symptoms of MDE were substantially less informative in participants with a lifetime history of manic symptoms than in those without such history. LIMITATIONS Clinical information on DSM-IV depressive and manic symptoms was based on retrospective self-report CONCLUSIONS The clinical presentation of depressive symptoms may substantially differ in individuals with and without a lifetime history of manic symptoms. These findings alert to the possibility of atypical symptomatic presentations among individuals with co-occurring symptoms or disorders and highlight the importance of continued research into specific pathophysiology differentiating unipolar and bipolar depression.
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18
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Lamers F, Cui L, Hickie IB, Roca C, Machado-Vieira R, Zarate CA, Merikangas KR. Familial aggregation and heritability of the melancholic and atypical subtypes of depression. J Affect Disord 2016; 204:241-6. [PMID: 27450632 DOI: 10.1016/j.jad.2016.06.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/18/2016] [Accepted: 06/11/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The heterogeneity of mood disorders has been a challenge to our understanding of their underlying biologic and genetic pathways. This report examines the specificity of the familial aggregation of atypical and melancholic subtypes of depression and their clinical correlates in a large community based family study of affective spectrum disorders. METHODS The sample includes 457 probands and their directly interviewed adult first degree relatives from the National Institute of Mental Health (NIMH) Family Study of Affective Spectrum Disorder. Depression subtypes were based on best estimate diagnoses using information from semi-structured diagnostic interviews by experienced clinical interviews and multiple family history reports. RESULTS Atypical depression in probands was significantly associated with the atypical subtype of depression in relatives (OR 1.75 [95%CI 1.02-3.02], p=0.04), independent of proband and relative comorbid disorders. Melancholic depression in probands was not associated with melancholic depression in relatives (OR 1.25 [95%CI 0.62-2.55], p=.53). The familial heritability of the atypical subtype was 0.46 (95%CI 0.21-0.71), whereas that of the melancholic subtype was 0.33 (95%CI 0.21-0.45). Melancholic depression was associated with greater severity in terms of treatment, global functioning, suicide attempts, comorbid disorders, and an earlier age at onset of depression. LIMITATIONS The subsample of interviewed relatives necessary to assess specific subtypes of depression reduced the power to detect the specificity of mood disorder subtypes. CONCLUSION The results indicate that the atypical subtype should be incorporated in future treatment, genetic and other etiologic studies of major depression. Findings further suggest that melancholic subtype may be an indicator of clinical severity of depression.
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Affiliation(s)
- Femke Lamers
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Lihong Cui
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Ian B Hickie
- Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, Camperdown, NSW, Australia
| | - Catherine Roca
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Rodrigo Machado-Vieira
- Experimental Therapeutics and Pathophysiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Kathleen R Merikangas
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA.
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19
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Clinical assessment of bipolar depression: validity, factor structure and psychometric properties of the Korean version of the Bipolar Depression Rating Scale (BDRS). BMC Psychiatry 2016; 16:239. [PMID: 27417178 PMCID: PMC4946103 DOI: 10.1186/s12888-016-0958-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 07/04/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The Bipolar Depression Rating Scale (BDRS) is a scale for assessment of the clinical characteristics of bipolar depression. The primary aims of this study were to describe the development of the Korean version of the BDRS (K-BDRS) and to establish more firmly its psychometric properties in terms of reliability and validity. METHODS The study included 141 patients (62 male and 79 female) who had been diagnosed with bipolar disorder, were currently experiencing symptoms of depression, and were interviewed using the K-BDRS. Other measures included the Montgomery and Asberg Depression Scale (MADRS), the 17-item Hamilton Depression Scale (HAMD), and the Young Mania Rating Scale (YMRS). Additionally, the internal consistency, concurrent validity, inter-rater reliability, and test-retest reliability of the K-BDRS were evaluated. RESULTS The Cronbach's α-coefficient for the K-BDRS was 0.866, the K-BDRS exhibited strong correlations with the HAMD (r = 0.788) and MADRS (r = 0.877), and the mixed symptoms score of the K-BDRS was significantly correlated with the YMRS (r = 0.611). An exploratory factor analysis revealed three factors that corresponded to psychological depressive symptoms, somatic depressive symptoms, and mixed symptoms. CONCLUSIONS The present findings suggest that the K-BDRS has good psychometric properties and is a valid and reliable tool for assessing depressive symptoms in patients with bipolar disorder.
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20
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State-related differences in the level of psychomotor activity in patients with bipolar disorder - Continuous heart rate and movement monitoring. Psychiatry Res 2016; 237:166-74. [PMID: 26832835 PMCID: PMC5408924 DOI: 10.1016/j.psychres.2016.01.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 09/07/2015] [Accepted: 01/21/2016] [Indexed: 11/22/2022]
Abstract
Measuring changes in psychomotor activity is a potential tool in the monitoring of the course of affective states in bipolar disorder. Previous studies have been cross-sectional and only some have used objective measures. The aim was to investigate state-related differences in objectively-measured psychomotor activity in bipolar disorder. During a 12 weeks study, repeated measurements of heart rate and movement monitoring over several days were collected during different affective states from 19 outpatients with bipolar disorder. Outcomes included activity energy expenditure (AEE) and trunk acceleration (ACC). Symptoms were clinically assessed using Hamilton Depression Rating Scale (HDRS-17) and Young Mania Rating Scale (YMRS). Compared to patients in a euthymic state, patients in a manic state had significantly higher AEE. Compared to patients in a depressive state, patients in a manic state had significantly higher ACC and AEE. There was a significant diurnal variation in ACC and AEE between affective states. Finally, there was a significant correlation between the severity of manic symptoms and ACC and AEE, respectively. This first study measuring psychomotor activity during different affective states using a combined heart rate and movement sensor supports that psychomotor activity is a core symptom in bipolar disorder that is altered during affective states.
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21
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Pfennig A, Ritter PS, Höfler M, Lieb R, Bauer M, Wittchen HU, Beesdo-Baum K. Symptom characteristics of depressive episodes prior to the onset of mania or hypomania. Acta Psychiatr Scand 2016; 133:196-204. [PMID: 26252885 DOI: 10.1111/acps.12469] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Depressive episodes are typically the initial presentation of bipolar disorder. The evidence as to whether depressive episodes occurring in persons who later convert to bipolar disorder are symptomatically distinct from episodes of unipolar depression remains controversial. As there are crucial differences in the therapeutic management, symptom profiles indicating subsequent bipolar conversion may aid in appropriate treatment. METHOD A representative community sample of originally N = 3021 adolescents and young adults aged 14-24 years at baseline was assessed up to four times over 10 years. Assessment of symptoms was conducted by clinically trained interviewers using the standardized M-CIDI. Symptom profiles of depressive episodes were compared via logistic regression between subjects that subsequently developed (hypo-)manic episodes (n = 35) or remained unipolar depressive (n = 659). RESULTS Initial depression amongst prospective converters was characterized by significantly increased suicidality (odds ratio, OR = 2.31), higher rates of feelings of worthlessness and excessive guilt (OR = 2.52), complete loss of pleasure (OR = 2.53) and diurnal variation (OR = 4.30). No differences were found for hyperphagia, hypersomnia and psychomotor alterations. CONCLUSION Findings suggest that the symptom profile of initial depressive episodes may be useful in the identification of subjects with an elevated risk for the subsequent conversion to bipolar disorder.
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Affiliation(s)
- A Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - P S Ritter
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - M Höfler
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - R Lieb
- Clinical Psychology and Epidemiology, Max Planck Institute of Psychiatry, Munich, Germany.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - M Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - H-U Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Clinical Psychology and Epidemiology, Max Planck Institute of Psychiatry, Munich, Germany
| | - K Beesdo-Baum
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Behavioral Epidemiology, Technische Universität Dresden, Dresden, Germany
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22
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McMahon K, Herr NR, Zerubavel N, Hoertel N, Neacsiu AD. Psychotherapeutic Treatment of Bipolar Depression. Psychiatr Clin North Am 2016; 39:35-56. [PMID: 26876317 DOI: 10.1016/j.psc.2015.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The gold standard for treating bipolar depression is based on the combination of mood stabilizers and psychotherapy. Therefore, the authors present evidence-based models and promising approaches for psychotherapy for bipolar depression. Cognitive-behavioral therapy, family focused therapy, interpersonal and social rhythm therapy, mindfulness-based cognitive therapy, and dialectical behavior therapy are discussed. Behavioral activation, the cognitive behavioral analysis system of psychotherapy, and the unified protocol as promising future directions are presented. This review informs medical providers of the most appropriate referral guidelines for psychotherapy for bipolar depression. The authors conclude with a decision tree delineating optimal referrals to each psychotherapy approach.
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Affiliation(s)
- Kibby McMahon
- Cognitive-Behavioral Research and Treatment Program, Department of Psychology and Neuroscience, Duke University Medical Center, Duke University, 3026, 2213 Elba Street, Room 123, Durham, NC 27710, USA
| | - Nathaniel R Herr
- Department of Psychology, American University, 4400 Massachusetts Avenue Northwest, Washington, DC 20016, USA
| | - Noga Zerubavel
- Cognitive-Behavioral Research and Treatment Program, Department of Psychiatry and Behavioral Science, Duke University Medical Center, 3026, 2213 Elba Street, Room 123, Durham, NC 27710, USA
| | - Nicolas Hoertel
- Department of Psychiatry, Corentin Celton Hospital, Assistance Publique-Hôpitaux de Paris (APHP), 4 parvis Corentin Celton, Issy-les-Moulineaux 92130, France; INSERM UMR 894, Psychiatry and Neurosciences Center, 2 ter rue d'Alésia, Paris 75014, France; PRES Sorbonne Paris Cité, Paris Descartes University, 12 Rue de l'École de Médecine, Paris 75006, France
| | - Andrada D Neacsiu
- Cognitive-Behavioral Research and Treatment Program, Department of Psychiatry and Behavioral Science, Duke University Medical Center, 3026, 2213 Elba Street, Room 123, Durham, NC 27710, USA.
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Carvalho N, Laurent E, Noiret N, Chopard G, Haffen E, Bennabi D, Vandel P. Eye Movement in Unipolar and Bipolar Depression: A Systematic Review of the Literature. Front Psychol 2015; 6:1809. [PMID: 26696915 PMCID: PMC4678228 DOI: 10.3389/fpsyg.2015.01809] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 11/09/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The analysis of eye movements (EM) by eye-tracking has been carried out for several decades to investigate mood regulation, emotional information processing, and psychomotor disturbances in depressive disorders. METHOD A systematic review of all English language PubMed articles using the terms "saccadic eye movements" OR "eye-tracking" AND "depression" OR "bipolar disorders" was conducted using PRISMA guidelines. The aim of this review was to characterize the specific alterations of EM in unipolar and bipolar depression. RESULTS Findings regarding psychomotor disturbance showed an increase in reaction time in prosaccade and antisaccade tasks in both unipolar and bipolar disorders. In both disorders, patients have been reported to have an attraction for negative emotions, especially for negative pictures in unipolar and threatening images in bipolar disorder. However, the pattern could change with aging, elderly unipolar patients disengaging key features of sad and neutral stimuli. METHODological limitations generally include small sample sizes with mixed unipolar and bipolar depressed patients. CONCLUSION Eye movement analysis can be used to discriminate patients with depressive disorders from controls, as well as patients with bipolar disorder from patients with unipolar depression. General knowledge concerning psychomotor alterations and affective regulation strategies associated with each disorder can also be gained thanks to the analysis. Future directions for research on eye movement and depression are proposed in this review.
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Affiliation(s)
- Nicolas Carvalho
- Department of Clinical Psychiatry, University of Bourgogne Franche-Comté, University Hospital Besançon, France ; E.A. 481, Laboratory of Neurosciences, University of Franche-Comté Besançon, France
| | - Eric Laurent
- E.A. 3188, Laboratory of Psychology, University of Franche-Comté Besançon, France ; UMSR 3124/FED 4209 MSHE Ledoux, Centre National de la Recherche Scientifique/Université de Franche-Comté Besançon, France
| | - Nicolas Noiret
- Department of Clinical Psychiatry, University of Bourgogne Franche-Comté, University Hospital Besançon, France ; E.A. 3188, Laboratory of Psychology, University of Franche-Comté Besançon, France
| | - Gilles Chopard
- Department of Clinical Psychiatry, University of Bourgogne Franche-Comté, University Hospital Besançon, France ; E.A. 481, Laboratory of Neurosciences, University of Franche-Comté Besançon, France
| | - Emmanuel Haffen
- Department of Clinical Psychiatry, University of Bourgogne Franche-Comté, University Hospital Besançon, France ; E.A. 481, Laboratory of Neurosciences, University of Franche-Comté Besançon, France ; Fondation FondaMental, Albert Chenevier Hospital Créteil, France ; CIC-IT 808 Inserm, Besançon University Hospital Besançon, France
| | - Djamila Bennabi
- Department of Clinical Psychiatry, University of Bourgogne Franche-Comté, University Hospital Besançon, France ; E.A. 481, Laboratory of Neurosciences, University of Franche-Comté Besançon, France
| | - Pierre Vandel
- Department of Clinical Psychiatry, University of Bourgogne Franche-Comté, University Hospital Besançon, France ; E.A. 481, Laboratory of Neurosciences, University of Franche-Comté Besançon, France ; CIC-IT 808 Inserm, Besançon University Hospital Besançon, France
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Faurholt-Jepsen M, Vinberg M, Frost M, Christensen EM, Bardram JE, Kessing LV. Smartphone data as an electronic biomarker of illness activity in bipolar disorder. Bipolar Disord 2015; 17:715-28. [PMID: 26395972 DOI: 10.1111/bdi.12332] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 07/24/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Objective methods are lacking for continuous monitoring of illness activity in bipolar disorder. Smartphones offer unique opportunities for continuous monitoring and automatic collection of real-time data. The objectives of the paper were to test the hypotheses that (i) daily electronic self-monitored data and (ii) automatically generated objective data collected using smartphones correlate with clinical ratings of depressive and manic symptoms in patients with bipolar disorder. METHODS Software for smartphones (the MONARCA I system) that collects automatically generated objective data and self-monitored data on illness activity in patients with bipolar disorder was developed by the authors. A total of 61 patients aged 18-60 years and with a diagnosis of bipolar disorder according to ICD-10 used the MONARCA I system for six months. Depressive and manic symptoms were assessed monthly using the Hamilton Depression Rating Scale 17-item (HDRS-17) and the Young Mania Rating Scale (YMRS), respectively. Data are representative of over 400 clinical ratings. Analyses were computed using linear mixed-effect regression models allowing for both between individual variation and within individual variation over time. RESULTS Analyses showed significant positive correlations between the duration of incoming and outgoing calls/day and scores on the HDRS-17, and significant positive correlations between the number and duration of incoming calls/day and scores on the YMRS; the number of and duration of outgoing calls/day and scores on the YMRS; and the number of outgoing text messages/day and scores on the YMRS. Analyses showed significant negative correlations between self-monitored data (i.e., mood and activity) and scores on the HDRS-17, and significant positive correlations between self-monitored data (i.e., mood and activity) and scores on the YMRS. Finally, the automatically generated objective data were able to discriminate between affective states. CONCLUSIONS Automatically generated objective data and self-monitored data collected using smartphones correlate with clinically rated depressive and manic symptoms and differ between affective states in patients with bipolar disorder. Smartphone apps represent an easy and objective way to monitor illness activity with real-time data in bipolar disorder and may serve as an electronic biomarker of illness activity.
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Affiliation(s)
- Maria Faurholt-Jepsen
- The Copenhagen Clinic for Affective Disorder, Rigshospitalet, Psychiatric Center Copenhagen, Copenhagen, Denmark
| | - Maj Vinberg
- The Copenhagen Clinic for Affective Disorder, Rigshospitalet, Psychiatric Center Copenhagen, Copenhagen, Denmark
| | - Mads Frost
- The Pervasive Interaction Laboratory (PIT Lab), IT University of Copenhagen, Copenhagen, Denmark
| | - Ellen Margrethe Christensen
- The Copenhagen Clinic for Affective Disorder, Rigshospitalet, Psychiatric Center Copenhagen, Copenhagen, Denmark
| | - Jakob E Bardram
- The Pervasive Interaction Laboratory (PIT Lab), IT University of Copenhagen, Copenhagen, Denmark
| | - Lars Vedel Kessing
- The Copenhagen Clinic for Affective Disorder, Rigshospitalet, Psychiatric Center Copenhagen, Copenhagen, Denmark
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Parker G, Paterson A, Hadzi-Pavlovic D. Cleaving depressive diseases from depressive disorders and non-clinical states. Acta Psychiatr Scand 2015; 131:426-33. [PMID: 25565428 DOI: 10.1111/acps.12386] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We sought to determine whether putative depressive diseases could be differentiated categorically from clinical depressive disorders and non-clinical mood states. METHOD We interviewed volunteers who reported or denied any lifetime depressive mood state and analyzed data from the former group reporting on their 'most severe' depressive episode. We employed latent class analysis (LCA) to determine whether a two-class solution was supported and the contribution of individual variables to class allocations. RESULTS All variables were significant predictors of class allocation. LCA-assigned Class I participants reported more depressive symptoms, had more distressing episodes and more lasting consequences, were more likely to view their depression as 'like a disease', and as being both disproportionately more severe and persistent in relation to any antecedent stressor. Validation involved comparison of LCA assignment with DSM-IV diagnosis for their most severe depressive episode. Of those assigned to Class I, 89% had a DSM diagnosis of melancholic, psychotic or bipolar depression. Class II had all those failing to meet criteria for a depressive episode and the majority of those with a non-melancholic depressive condition. CONCLUSION Despite not including individual depressive symptoms, study variables strongly differentiated putative depressive diseases from a composite of clinical depressive conditions and subclinical depressive states.
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Affiliation(s)
- G Parker
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia
| | - A Paterson
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia
| | - D Hadzi-Pavlovic
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia
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Benvenuti A, Miniati M, Callari A, Mariani MG, Mauri M, Dell’Osso L. Mood Spectrum Model: Evidence reconsidered in the light of DSM-5. World J Psychiatry 2015; 5:126-137. [PMID: 25815262 PMCID: PMC4369542 DOI: 10.5498/wjp.v5.i1.126] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 12/03/2014] [Accepted: 01/20/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: to investigate studies conducted with the Mood Spectrum Structured Interviews and Self-Report versions (SCI-MOODS and MOODS-SR).
METHODS: We conducted a review of studies published between 1997 and August 2014. The search was performed using Pubmed and PsycINFO databases. Analysis of the papers followed the inclusion and exclusion criteria recommended by the PRISMA Guidelines, namely: (1) articles that presented a combination of at least two terms, “SCI-MOODS” [all fields] or “MOODS-SR” [all fields] or “mood spectrum” [all fields]; (2) manuscript in English; (3) original articles; and (4) prospective or retrospective original studies (analytical or descriptive), experimental or quasi-experimental studies. Exclusion criteria were: (1) other study designs (case reports, case series, and reviews); (2) non-original studies including editorials, book reviews and letters to the editor; and (3) studies not specifically designed and focused on SCI-MOODS or MOODS-SR.
RESULTS: The search retrieved 43 papers, including 5 reviews of literature or methodological papers, and 1 case report. After analyzing their titles and abstracts, according to the eligibility criteria, 6 were excluded and 37 were chosen and included. The SCI-MOODS and the MOODS-SR have been tested in published studies involving 52 different samples across 4 countries (Italy, United States, Spain and Japan). The proposed mood spectrum approach has demonstrated its usefulness mainly in 3 different areas: (1) Patients with the so-called “pure” unipolar depression that might manifest hypomanic atypical and/or sub-threshold aspects systematically detectable with the mood questionnaire; (2) Spectrum features not detected by other instruments are clinically relevant, because they might manifest in waves during the lifespan, sometimes together, sometimes alone, sometimes reaching the severity for a full-blown disorder, sometimes interfering with other mental disorders or complicating the course of somatic diseases; and (3) Higher scores on the MOODS-SR factors assessing “psychomotor disturbances”, “mixed instability” and “suicidality” delineate subtypes of patients characterized by the more severe forms of mood disorders, the higher risk for psychotic symptoms, and the lower quality of life after the remission of the full-blown-episode.
CONCLUSION: The mood spectrum model help researchers and clinicians in the systematic assessment of those areas of psychopathology that are still neglected by the Diagnostic and Statistical Manual of Mental Disorders 5 classification.
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Nivoli AMA, Murru A, Pacchiarotti I, Valenti M, Rosa AR, Hidalgo D, Virdis V, Strejilevich S, Vieta E, Colom F. Bipolar disorder in the elderly: a cohort study comparing older and younger patients. Acta Psychiatr Scand 2014; 130:364-373. [PMID: 24702648 DOI: 10.1111/acps.12272] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze differences in clinical and socio-demographic characteristics between older and younger bipolar outpatients paying special attention to depressive symptoms in a large, naturalistic cohort. METHOD Five hundred and ninety-three DSM-IV-TR bipolar outpatients were enrolled. Clinical characteristics were assessed according to DSM-IV-TR (SCID-I). Subjects were categorized into two groups according to current age (older OBD: age > 65 years; younger-YBD: age < 65 years). RESULTS About 80% of patients were younger (N = 470), and a fifth were older (N = 123), with a mean age of 77.30 years in OBD. Older patients were more likely to be married, not qualified, bipolar II, with depressive polarity of first episode, higher age at illness onset, higher age at first hospitalization. They were more likely to present with depressive predominant polarity, with lifetime history of catatonic, psychotic and melancholic features, age at illness onset >40 years, as well as suffering from more medical comorbidities when compared to younger bipolars. CONCLUSION The clinical presentation of bipolar disorder in late life would be defined more frequently by melancholic depressive features and a predominantly depressive polarity. These results suggest that treatment strategies for elderly bipolar patients should focus in the prevention of depressive episodes.
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Affiliation(s)
- A M A Nivoli
- Bipolar Disorders Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Department of Neuroscience, Institute of Psychiatry, University of Sassari, Sassari, Italy
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Noto MN, de Souza Noto C, de Jesus DR, Zugman A, Mansur RB, Berberian AA, Leclerc E, McIntyre RS, Correll CU, Brietzke E. Recognition of bipolar disorder type I before the first manic episode: challenges and developments. Expert Rev Neurother 2014; 13:795-806; quiz 807. [DOI: 10.1586/14737175.2013.811132] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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A Historical Consideration of Psychiatric Diagnostic Systems : Focusing on the Concept of Depression. ACTA ACUST UNITED AC 2014. [DOI: 10.4306/jknpa.2014.53.5.259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Parker G, Graham R, Hadzi-Pavlovic D, McCraw S, Hong M, Friend P. Differentiation of bipolar I and II disorders by examining for differences in severity of manic/hypomanic symptoms and the presence or absence of psychosis during that phase. J Affect Disord 2013; 150:941-7. [PMID: 23774140 DOI: 10.1016/j.jad.2013.05.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/08/2013] [Accepted: 05/08/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND DSM-IV criteria for mania/hypomania overlap considerably. We sought to examine the utility of a model differentiating bipolar I and II disorders by weighting the presence or absence of psychosis during manic/hypomanic episodes as opposed to simply weighting symptom severity. METHODS A set of 632 patients with a so-assigned clinical bipolar I or II disorder diagnosis contributed to the principal analyses, and a subset of 210 was included in a comparative analyses of DSM-assigned diagnoses. We also examined the impact of duration of highs on symptom patterns and the extent to which depressive episodes were psychotic or non-psychotic melancholic in type. RESULTS There were no group differences for bipolar I and II patients (clinical or DSM groups) by age, gender, age of onset or age of formal bipolar diagnosis. Clinically assigned bipolar I patients returned higher severity scores than bipolar II patients on manic/hypomanic symptoms, but such differentiation was limited. Clinically-assigned bipolar I patients were more likely than bipolar II patients to be diagnosed with psychotic depression, and had lower rates of non-melancholic depression. Duration of highs had some impact on the phenomenology of highs, but not on the phenomenology of depression. LIMITATIONS We cannot establish the degree to which clinicians validly differentiated those with bipolar disorder, and accurately judged the lifetime presence of psychotic features and of depressive subtype differentiation. CONCLUSIONS Findings support the utility of an alternative model to DSM-IV in weighting the respective presence or absence of psychotic symptoms during highs in differentiating bipolar I and II disorders.
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Affiliation(s)
- Gordon Parker
- School of Psychiatry, University of New South Wales, NSW, Australia.
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Buoli M, Caldiroli A, Altamura AC. Psychotic versus non-psychotic major depressive disorder: a comparative naturalistic study. Asian J Psychiatr 2013; 6:333-7. [PMID: 23810143 DOI: 10.1016/j.ajp.2013.02.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 02/03/2013] [Accepted: 02/09/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Psychotic depressed patients were found to have more severe cognitive deficits, poorer treatment response and higher suicidal risk respect to non-psychotic depressives. Aim of the present research was to compare clinical variables and outcome between psychotic and non-psychotic major depressive patients. METHOD A sample of 36 major depressed patients was divided into two groups according to the presence of psychotic symptoms. Structured Clinical Interview for DSM (SCID-I) and Hamilton Depression Rating Scale (HAM-D) were administered to the patients at baseline by trained raters. One-way analysis of variance (ANOVAs) and chi-square tests were performed to compare the two groups. Binary logistic regression was performed to assess the risk of lack of response/remission in patients with psychotic symptoms and the risk of developing psychotic symptoms in major depressives with a family history of schizophrenia or bipolar disorder. RESULTS Psychotic major depressives presented more severe illness as showed by HAM-D baseline scores (F=17.20, p<0.001), a longer duration of hospitalization (F=7.64, p=0.009) and they were more frequently treated with clomipramine (χ(2)=16.22, p=0.027). Psychotic symptoms were predictive of lack of remission (OR=4.09, p=0.05) and family history of schizophrenia/psychotic bipolar disorder was associated with psychotic major depression (OR=10.81, p=0.04). CONCLUSIONS Patients with psychotic symptoms present a more severe course of illness as showed by long hospitalizations and lower rates of remission. Psychotic depressives show more frequently a family history of "major psychoses" suggesting a continuum in psychotic disorders and a genetic association of major psychotic depression with bipolar disorder and schizophrenia.
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Affiliation(s)
- Massimiliano Buoli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Italy.
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Clinical differences between unipolar and bipolar depression: interest of BDRS (Bipolar Depression Rating Scale). Compr Psychiatry 2013; 54:605-10. [PMID: 23375261 DOI: 10.1016/j.comppsych.2012.12.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 12/17/2012] [Accepted: 12/31/2012] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES It is currently assumed that there are no important differences between the clinical presentations of unipolar and bipolar depression. Failure to distinguish bipolar from unipolar depression may lead to inappropriate treatment and poorer outcomes. We hereby compare unipolar and bipolar depressed subjects, in order to identify distinctive clinical specificities of bipolar depression. METHODS Two independent samples of depressed patients (unipolar and bipolar) were recruited, with 55 patients in one sample, and 49 in the other. In both samples, unipolar and bipolar patients were compared on a broad range of parameters, including sociodemographic characteristics, comorbidities, Montgomery and Asberg Depression Scale (MADRS; assessing depression severity), CORE (assessing psychomotor disturbance) and Bipolar Depression Rating Scale (assessing specific bipolar depression symptoms). RESULTS Results were similar in both samples. MADRS scores were similar in bipolar and unipolar subjects (median score 33 vs 34; p=0.74). On the CORE, there was a trend to higher scores among the bipolar subjects. BDRS scores were higher in bipolar than in unipolar subjects (median score 33 vs 27; p<0.001). The difference was particularly marked on the "mixed" subscale of the BDRS. We tested the ability of the mixed subscale of the BDRS to distinguish bipolar from unipolar depression, using different cut off points: a cut off point of 3 can predict bipolar depression, with a sensibility of 62% and a specificity of 82%. CONCLUSIONS Presence of mixed symptoms during a depressive episode is in favour of bipolar depression. The BDRS scale should be integrated in a probabilistic approach to distinguish bipolar from unipolar depression.
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Abstract
OBJECTIVE There have been no previous factor analytic studies of the Hamilton Depression Rating Scale (HDRS) in samples with bipolar I depression, and no investigations of the utility of any derived factors in determining treatment response in this condition. This study aimed to identify and compare factors of a 31-item version of the HDRS (HDRS-31) in large samples of patients with bipolar depression and Major Depressive Disorder (MDD), then examine the responsiveness of such factors to lamotrigine compared with placebo in the bipolar depressed sample. METHODS This multivariate analytical study was performed on 2 large depressed samples (one bipolar and the other MDD) that had been recruited for separate, contemporaneous, double-blind placebo-controlled trials of lamotrigine. The 2 studies had similar designs and assessment tools, the major measures being the Montgomery-Asberg Depression Rating Scale (MADRS) and HDRS-31. To identify the constructs underlying the scale, exploratory factor analyses were conducted using HDRS-31 baseline scores. Treatment responsiveness in the bipolar depressed sample-as indicated by improvement in the total MADRS and HDRS-31, as well as HDRS factors-were examined using both a mixed-effects analysis and individual time-point t-tests. RESULTS Seven factors of the HDRS-31 were identified: I-"depressive cognitions," II-"psychomotor retardation," III-"insomnia," IV-"hypersomnia," V-"appetite and weight change," VI-"anxiety," and VII-"anergia." A significant therapeutic effect of lamotrigine in bipolar depression was found for the "depressive cognitions" factor (from week 3) and "psychomotor retardation" (from week 4). CONCLUSION This study has identified 7 factors of the HDRS in a large sample of patients with bipolar depression. The results suggest that that the clinical benefits of lamotrigine in acute bipolar depression are primarily upon depressive cognitions and psychomotor slowing.
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Alexandrino-Silva C, Wang YP, Carmen Viana M, Bulhões RS, Martins SS, Andrade LH. Gender differences in symptomatic profiles of depression: results from the São Paulo Megacity Mental Health Survey. J Affect Disord 2013; 147:355-364. [PMID: 23246363 DOI: 10.1016/j.jad.2012.11.041] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 11/20/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Few studies have investigated symptomatic subtypes of depression and their correlates by gender. METHODS Data are from the São Paulo Megacity Mental Health Survey. Symptom profiles of 1207 subjects (864 women; 343 men) based upon symptoms of the worst depressive episode in lifetime were examined through latent class analysis. Correlates of gender-specific latent classes were analyzed by logistic regression. RESULTS For both men and women, a 3-class model was the best solution. A mild class was found in both genders (41.1% in women; 40.1% in men). Gender differences appeared in the most symptomatic classes. In women, they were labeled melancholic (39.3%) and atypical (19.5%), differing among each other in somatic/vegetative symptoms. The melancholic class presented inhibition and eating/sleeping symptoms in the direction of decreasing, whereas the atypical class had increased appetite/weight, and hypersomnia. For men, symptoms that differentiate the two most symptomatic classes were related to psychomotor activity: a melancholic/psychomotor retarded (40.4%) and agitated depression (19.6%). The highest between-class proportion of agitation and racing thoughts was found among men in the agitated class, with similarity to bipolar mixed state. LIMITATIONS Analyses were restricted to those who endorsed questions about their worst lifetime depressive episode; the standardized assessment by lay interviewers; the small male sample size. CONCLUSIONS The construct of depression of current classifications is heterogeneous at the symptom level, where gender different subtypes can be identified. These symptom profiles have potential implications for the nosology and the therapeutics of depression.
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Affiliation(s)
- Clóvis Alexandrino-Silva
- Section of Psychiatric Epidemiology-LIM 23, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
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Terziivanova P, Haralanov S. Epistemological and methodological significance of quantitative studies of psychomotor activity for the explanation of clinical depression. J Eval Clin Pract 2012; 18:1151-5. [PMID: 23009631 DOI: 10.1111/jep.12008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2012] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Psychomotor disturbances have been regarded as cardinal symptoms of depression for centuries and their objective assessment may have predictive value with respect to the severity of clinical depression, treatment outcome and prognosis of the affective disorder. METHODS Montgomery-Åsberg Depression Rating Scale (MADRS) and Hamilton Rating Scale for Anxiety (HAM-A). Psychomotor indicators of activity and reactivity were objectively recorded and measured by means of computerized ultrasonographic craniocorpography. RESULTS We found a statistically significant correlation between disturbances in psychomotor indicators and MADRS total score (r = 0.4; P < 0.0001). The severity of HAM-A total score had no statistically significant correlation with psychomotor indicators (P > 0.05). We found that different items of MADRS and HAM-A correlated with psychomotor disturbances of different strength and significance. Objectively, measured psychomotor retardation was associated with greater severity of depressive symptoms assessed at the clinical level. CONCLUSIONS Integration between different methods is needed in order to improve understanding of the psychopathology and the neurobiology of a disputable diagnosis such as clinical depression.
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Moreno C, Hasin DS, Arango C, Oquendo MA, Vieta E, Liu S, Grant BF, Blanco C. Depression in bipolar disorder versus major depressive disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Bipolar Disord 2012; 14:271-82. [PMID: 22548900 PMCID: PMC3349442 DOI: 10.1111/j.1399-5618.2012.01009.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To compare the clinical features and course of major depressive episodes (MDEs) occurring in subjects with bipolar I disorder (BD-I), bipolar II disorder (BD-II), and major depressive disorder (MDD). METHODS Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (2001-2002), a nationally representative face-to-face survey of more than 43000 adults in the USA, including 5695 subjects with lifetime MDD, 935 with BD-I and lifetime MDE, and 494 with BD-II and lifetime MDE. Differences on sociodemographic characteristics and clinical features, course, and treatment patterns of MDE were analyzed. RESULTS Most depressive symptoms, family psychiatric history, anxiety disorders, alcohol and drug use disorders, and personality disorders were more frequent-and number of depressive symptoms per MDE was higher-among subjects with BD-I, followed by BD-II, and MDD. BD-I individuals experienced a higher number of lifetime MDEs, had a poorer quality of life, and received significantly more treatment for MDE than BD-II and MDD subjects. Individuals with BD-I and BD-II experienced their first mood episode about ten years earlier than those with MDD (21.2, 20.5, and 30.4 years, respectively). CONCLUSIONS Our results support the existence of a spectrum of severity of MDE, with highest severity for BD-I, followed by BD-II and MDD, suggesting the utility of dimensional assessments in current categorical classifications.
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Affiliation(s)
- Carmen Moreno
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
| | - Deborah S. Hasin
- Department of Epidemiology, Mailman School of Public Health,New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Celso Arango
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Maria A. Oquendo
- New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Eduard Vieta
- Bipolar Disorders Program, Institute of Neuroscience, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Shangmin Liu
- New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Bridget F. Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Carlos Blanco
- New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Bega S, Schaffer A, Goldstein B, Levitt A. Differentiating between Bipolar Disorder types I and II: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). J Affect Disord 2012; 138:46-53. [PMID: 22284021 DOI: 10.1016/j.jad.2011.12.032] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 12/04/2011] [Accepted: 12/14/2011] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Bipolar Disorder I (BD I) and Bipolar Disorder II (BD II) vary considerably, with differences in symptomatology, management and prognosis. For patients with depression, the distinction between BD I and BD II is not always apparent, and hinges on the differentiation between manic/mixed and hypomanic episodes. Other putative differences between patients with BD I and II exist and may assist in distinguishing between these two conditions. METHODS Data were obtained from the National Epidemiological Survey on Alcohol and Related Conditions. A total of 1429 subjects were included in our analysis based on DSM-IV criteria, 935 with BD I and 494 with BD II. We examined for differences in a number of variables including demographics, clinical features, depressive symptoms, and co-morbid conditions using t-tests and chi-square analyses for a comparison of means as well as a logistic regression for variables found to be significant. RESULTS Key differences between BD I and BD II were identified in all categories in our comparison of means. In the regression analysis, a number of variables were determined to be predictors of BD I, including unemployment (OR=0.6), taking medications for depression (OR=1.7), a history of a suicide attempt (OR=1.8), depressive symptoms such as weight gain (OR=1.7), fidgeting (OR=1.5), feelings of worthlessness (OR=1.6) and difficulties with responsibilities (OR=2.2), as well as the presence of specific phobias (OR=1.8) and Cluster C traits (OR=1.4). CONCLUSIONS Our results indicate that in addition to the differences between manic/mixed and hypomanic episodes, other significant differences exist that may be used to help differentiate BD I from BD II.
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Affiliation(s)
- Sivan Bega
- Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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Abstract
Biopsychosocial eclecticism has led, the authors believe, to a simplistic acceptance of a unitary view of MDD with little scientific solidity. The authors propose a return to careful psychopathology as the basis of all nosology, which has led to identifying four main types of depressive illness, and a method-based, existential approach to understanding depression.
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Affiliation(s)
- S Nassir Ghaemi
- Mood Disorders Program, Department of Psychiatry, Tufts Medical Center, Tufts University School of Medicine, 800 Washington Street #1007, Boston, MA 02111, USA.
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Sung G, Kim BN, Lee EH, Yu BH, Hong KS, Kim JH. Underestimating the severity of bipolar depression: a comparison of the Hamilton Depression Rating Scale items. J Affect Disord 2012; 136:425-9. [PMID: 22178241 DOI: 10.1016/j.jad.2011.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 11/08/2011] [Accepted: 11/08/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Hamilton Depression Rating Scale (HDRS) is a clinician-rated instrument to assess the severity of depressive symptoms that does not account for the differences between bipolar (BP) and unipolar (UP) disorders. This study attempts to evaluate differences in the total scores of the HDRS, Beck Depression Inventory (BDI), and Global Assessment of Functioning (GAF) ratings of patients with bipolar II (BP-II) and UP depression. Each factor and item of the HDRS was compared between the two groups in order to identify specific symptoms. METHODS 588 patients with bipolar II disorder (n=101) and major depressive disorder (n=487) were enrolled in this study. All participants completed the BDI and individually interviewed using HDRS. Each participant was also evaluated with regard to global functioning. RESULTS The BP group scored lower on the total HDRS and all of the factors. The BP and UP groups did not differ in terms of BDI and GAF. With regard to the individual items of HDRS, the BP group scored lower on items associated with 'Depressed mood', 'Work and interest', 'Somatic, gastro', and 'Hypochondriasis'. LIMITATIONS There was a significant age differences between the two groups. CONCLUSIONS The results of this study suggest that the severity of bipolar depression may be less well-recognized by the HDRS due to the different presentations of depressive symptoms. Thus, the clinician should be careful not to underestimate the sincerity of patients' reports when evaluating depression.
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Affiliation(s)
- Gyhye Sung
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
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Ghaznavi S, Deckersbach T. Rumination in bipolar disorder: evidence for an unquiet mind. BIOLOGY OF MOOD & ANXIETY DISORDERS 2012; 2:2. [PMID: 22738363 PMCID: PMC3384231 DOI: 10.1186/2045-5380-2-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 01/23/2012] [Indexed: 01/17/2023]
Abstract
Depression in bipolar disorder has long been thought to be a state characterized by mental inactivity. However, recent research demonstrates that patients with bipolar disorder engage in rumination, a form of self-focused repetitive cognitive activity, in depressed as well as in manic states. While rumination has long been associated with depressed states in major depressive disorder, the finding that patients with bipolar disorder ruminate in manic states is unique to bipolar disorder and challenges explanations put forward for why people ruminate. We review the research on rumination in bipolar disorder and propose that rumination in bipolar disorder, in both manic and depressed states, reflects executive dysfunction. We also review the neurobiology of bipolar disorder and recent neuroimaging studies of rumination, which is consistent with our hypothesis that the tendency to ruminate reflects executive dysfunction in bipolar disorder. Finally, we relate the neurobiology of rumination to the neurobiology of emotion regulation, which is disrupted in bipolar disorder.
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Souery D, Zaninotto L, Calati R, Linotte S, Mendlewicz J, Sentissi O, Serretti A. Depression across mood disorders: review and analysis in a clinical sample. Compr Psychiatry 2012; 53:24-38. [PMID: 21414619 DOI: 10.1016/j.comppsych.2011.01.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 01/20/2011] [Accepted: 01/27/2011] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES In this article we aimed to: (1) review literature concerning the clinical and psychopathologic characteristics of Bipolar (BP) depression; (2) analyze an independent sample of depressed patients to identify any demographic and/or clinical feature that may help in differentiating mood disorder subtypes, with special attention to potential markers of bipolarity. METHODS A sample of 291 depressed subjects, including BP -I (n = 104), BP -II (n = 64), and unipolar (UP) subjects with (n = 53) and without (n = 70) BP family history (BPFH), was examined to evidence potential differences in clinical presentation and to validate literature-derived markers of bipolarity. Demographic and clinical variables and, also, single items from the Hamilton Depression Rating Scale (HDRS), the Montgomery-Asberg Depression Rating Scale (MADRS), and the Young Mania Rating Scale (YMRS) were compared among groups. RESULTS UP subjects had an older age at onset of mood symptoms. A higher number of major depressive episodes and a higher incidence of lifetime psychotic features were found in BP subjects. Items expressing depressed mood, depressive anhedonia, pessimistic thoughts, and neurovegetative symptoms of depression scored higher in UP, whereas depersonalization and paranoid symptoms' scores were higher in BP. When compared with UP, BP I had a significantly higher incidence of intradepressive hypomanic symptoms. Bipolar family history was found to be the strongest predictor of bipolarity in depression. CONCLUSIONS Overall, our findings confirm most of the classical signs of bipolarity in depression and support the view that some features, such as BPFH, together with some specific symptoms may help in detecting depressed subjects at higher risk for BP disorder.
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Affiliation(s)
- Daniel Souery
- Laboratoire de Psychologie Medicale, Université Libre de Bruxelles and Psy Pluriel, Centre Europeén de Psychologie Medicale, Brussels, Belgium
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Souery D, Zaninotto L, Calati R, Linotte S, Sentissi O, Amital D, Moser U, Kasper S, Zohar J, Mendlewicz J, Serretti A. Phenomenology of psychotic mood disorders: lifetime and major depressive episode features. J Affect Disord 2011; 135:241-50. [PMID: 21889213 DOI: 10.1016/j.jad.2011.07.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 07/29/2011] [Accepted: 07/29/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND The nosological and clinical implications of psychotic features in the course of mood disorders have been widely debated. Currently, no specification exists for defining a subgroup of lifetime Psychotic Mood Disorder (PMD) patients. METHODS A total of 2178 patients were examined, including subjects with Bipolar Disorder (BP) type I (n=519) and II (n=207) and Major Depressive Disorder (n=1452). Patients were divided between PMD (n=645) and non-psychotic Mood Disorders (MD) (n=1533) by the lifetime presence of at least one mood episode with psychotic features. Subjects having a depressive episode at the time of assessment were also examined: HAM-D and YMRS scores were compared between MD and PMD subjects, both with and without current psychotic features. RESULTS A diagnosis of BP-I, a higher familial load for BP, a higher number of mood episodes lifetime, and a higher prevalence of OCD and somatic comorbidities were all associated to PMD. A diagnosis of BP (OR=4.48) was the only significant predictor for psychosis. PMD with non-psychotic depression were apparently less severe than MD patients and had a lower rate of "non-responders" to AD treatment. Sub-threshold manic symptoms and suicidal risk were also more pronounced among PMD. LIMITATIONS The lack of information about number and polarity of previous psychotic mood episodes may be the major limitations of our study. CONCLUSIONS BP diagnosis is the most significant predictor for psychosis in mood disorders. Non-psychotic mood episodes in PMD patients may be characterized by a distinctive symptom profile and, possibly, a different response to treatment.
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Affiliation(s)
- Daniel Souery
- Laboratoire de Psychologie Medicale, Université Libre de Bruxelles and Psy Pluriel, Centre Européen de Psychologie Medicale, Brussels, Belgium
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Dumlu K, Orhon Z, Özerdem A, Tural U, Ulaş H, Tunca Z. Treatment-induced manic switch in the course of unipolar depression can predict bipolarity: cluster analysis based evidence. J Affect Disord 2011; 134:91-101. [PMID: 21742381 DOI: 10.1016/j.jad.2011.06.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 06/16/2011] [Accepted: 06/16/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Antidepressants are known to induce manic switch in patients with depression. Treatment-induced mania is not considered as bipolar disorder in DSM IV. The aim of this study was to assess whether clinical characteristics of patients with unipolar depression with a history of treatment-induced mania were similar to those of patients with bipolar disorder. METHOD The study included 217 consecutive patients with DSM-IV mood disorders, diagnosed as: bipolar disorder type I (BP-I, n = 58) or type II (BP-II, n = 18) whose first episodes were depression, recurrent (unipolar) major depressive disorder with a history of antidepressant treatment-induced mania (switchers = sUD; n = 61) and without such an event (rUD; n = 80). First, the groups were compared with regard to clinical features and course specifiers using variance and chi-square analysis. Variables that differed significantly between the four groups were included in two-step cluster analysis to explore naturally occurring subgroups in all diagnoses. Subsequently, the relationship between the naturally occurring clusters and pre-defined DSM-IV diagnoses were investigated. RESULTS Two-step cluster analysis revealed two different naturally occurring groups. Higher severity of depressive episodes, with higher rate of melancholic features, higher number of hospitalization and suicide attempts were represented in one cluster where switchers (77%), bipolar I (94.8%) and II (83.3%) patients clustered together. CONCLUSION The findings of this study confirm that treatment-induced mania is a clinical phenomenon that belongs within the bipolar spectrum rather than a coincidental treatment complication, and that it should be placed under "bipolar disorders" in future classification systems. LIMITATIONS The study includes the limitations of any naturalistic retrospective study.
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Affiliation(s)
- Kemal Dumlu
- Department of Psychiatry, Dokuz Eylul University, School of Medicine, Izmir, Turkey
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Mitchell PB, Frankland A, Hadzi-Pavlovic D, Roberts G, Corry J, Wright A, Loo CK, Breakspear M. Comparison of depressive episodes in bipolar disorder and in major depressive disorder within bipolar disorder pedigrees. Br J Psychiatry 2011; 199:303-9. [PMID: 21508436 DOI: 10.1192/bjp.bp.110.088823] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although genetic epidemiological studies have confirmed increased rates of major depressive disorder among the relatives of people with bipolar affective disorder, no report has compared the clinical characteristics of depression between these two groups. AIMS To compare clinical features of depressive episodes across participants with major depressive disorder and bipolar disorder from within bipolar disorder pedigrees, and assess the utility of a recently proposed probabilistic approach to distinguishing bipolar from unipolar depression. A secondary aim was to identify subgroups within the relatives with major depression potentially indicative of 'genetic' and 'sporadic' subgroups. METHOD Patients with bipolar disorder types 1 and 2 (n = 246) and patients with major depressive disorder from bipolar pedigrees (n = 120) were assessed using the Diagnostic Interview for Genetic Studies. Logistic regression was used to identify distinguishing clinical features and assess the utility of the probabilistic approach. Hierarchical cluster analysis was used to identify subgroups within the major depressive disorder sample. RESULTS Bipolar depression was characterised by significantly higher rates of psychomotor retardation, difficulty thinking, early morning awakening, morning worsening and psychotic features. Depending on the threshold employed, the probabilistic approach yielded a positive predictive value ranging from 74% to 82%. Two clusters within the major depressive disorder sample were found, one of which demonstrated features characteristic of bipolar depression, suggesting a possible 'genetic' subgroup. CONCLUSIONS A number of previously identified clinical differences between unipolar and bipolar depression were confirmed among participants from within bipolar disorder pedigrees. Preliminary validation of the probabilistic approach in differentiating between unipolar and bipolar depression is consistent with dimensional distinctions between the two disorders and offers clinical utility in identifying patients who may warrant further assessment for bipolarity. The major depressive disorder clusters potentially reflect genetic and sporadic subgroups which, if replicated independently, might enable an improved phenotypic definition of underlying bipolarity in genetic analyses.
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Affiliation(s)
- Philip B Mitchell
- UNSW School of Psychiatry, Prince of Wales Hospital, Randwick, Australia.
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Calugi S, Cassano GB, Litta A, Rucci P, Benvenuti A, Miniati M, Lattanzi L, Mantua, Lombardi, Fagiolini A, Frank E. Does psychomotor retardation define a clinically relevant phenotype of unipolar depression? J Affect Disord 2011; 129:296-300. [PMID: 20833434 PMCID: PMC3387566 DOI: 10.1016/j.jad.2010.08.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Revised: 08/03/2010] [Accepted: 08/03/2010] [Indexed: 12/17/2022]
Abstract
BACKGROUND The recognition and assessment of psychomotor retardation may have implications for better definition of the clinical phenotypes of depression. The aim of this study was to assess the clinical correlates of psychomotor retardation endorsed at any time during the patients' lifetime (LPR). METHODS The study sample included 291 patients with non-psychotic major depressive disorder (MDD) participating in the clinical trial, "Depression: The Search for Treatment-Relevant Phenotypes." Psychomotor retardation was measured using a factor derived from the Mood Spectrum Self-Report (MOODS-SR) assessment. Using a pre-defined cut-off score on the lifetime psychomotor retardation (LPR) factor of the MOODS-SR, participants were classified into high and low scorers. Logistic regression analysis was used to evaluate the relationship between LPR and subthreshold bipolarity. RESULTS Compared to low scorers, participants with high scores on the LPR factor had greater severity of depression and more bipolarity indicators. CONCLUSIONS The MOODS-SR appears to be helpful to identify clinical phenotypes of unipolar depression and to highlight the usefulness of a lifetime approach to the assessment of psychopathology in the characterisation of patients with unipolar depression.
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Affiliation(s)
- S Calugi
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa
| | - GB Cassano
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa
| | - A Litta
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa
| | - P Rucci
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - A Benvenuti
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa
| | - M Miniati
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa
| | - L Lattanzi
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa
| | - Mantua
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa
| | - Lombardi
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa
| | - A Fagiolini
- Department of Neuroscience, University of Siena School of Medicine
| | - E Frank
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Kerr CC, Kemp AH, Rennie CJ, Robinson PA. Thalamocortical changes in major depression probed by deconvolution and physiology-based modeling. Neuroimage 2011; 54:2672-82. [PMID: 21073966 DOI: 10.1016/j.neuroimage.2010.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 10/22/2010] [Accepted: 11/01/2010] [Indexed: 10/18/2022] Open
Abstract
Auditory event-related potentials (ERPs) have been extensively studied in patients with depression, but most studies have focused on purely phenomenological analysis methods, such as component scoring. In contrast, this study applies two recently developed physiology-based methods-fitting using a thalamocortical model of neuronal activity and waveform deconvolution - to data from a selective-attention task in four subject groups (49 patients with melancholic depression, 34 patients with non-melancholic depression, 111 participants with subclinical depressed mood, and 98 healthy controls), to yield insight into physiological differences in attentional processing between participants with major depression and controls. This approach found evidence that: participants with depressed mood, regardless of clinical status, shift from excitation in the thalamocortical system towards inhibition; that clinically depressed participants have decreased relative response amplitude between target and standard waveforms; and that patients with melancholic depression also have increased thalamocortical delays. These findings suggest possible physiological mechanisms underlying different depression subtypes, and may eventually prove useful in motivating new physiology-based diagnostic methods.
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Affiliation(s)
- Cliff C Kerr
- School of Physics, University of Sydney, New South Wales, Australia.
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Thuile J, Even C, Guelfi JD. [Bipolar depression: a review of current therapeutic strategies]. Encephale 2011; 32:767-74. [PMID: 17099601 DOI: 10.1016/s0013-7006(06)76229-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
It is now acknowledged that depressive symptoms dominate the natural history of bipolar affective disorder. Treating bipolar depression therefore represents a major therapeutic issue that has paradoxically been understudied compared to the treatment of acute manic or hypomanic episodes. Thanks to a computerized and manual bibliographic search, we reviewed the literature pertaining to the somatic treatments of bipolar depression. It is initially advisable to implement or optimize the thymoregulator treatment by carrying out a blood titration and by adjusting the therapeutic rates as well as possible towards the upper recommended levels. In the second place, the adjunction of another mood stabilizer may be necessary to obtain euthymia while preventing a mood switch to mania. Atypical antipsychotics may have some efficacy in treating bipolar depression, but further evidence is needed. Antidepressants are generally prohibited due to the risk of induction of mania or rapid cycling. Their use is generally limited to severe cases in which the association of at least two mood stabilizers has failed.
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Affiliation(s)
- J Thuile
- Clinique des Maladies Mentales et de l'Encéphale, service du Professeur Guelfi, Centre Hospitalier Sainte-Anne, Université Paris V-René Descartes, Paris
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Perlis RH, Uher R, Ostacher M, Goldberg JF, Trivedi MH, Rush AJ, Fava M. Association between bipolar spectrum features and treatment outcomes in outpatients with major depressive disorder. ACTA ACUST UNITED AC 2010; 68:351-60. [PMID: 21135313 DOI: 10.1001/archgenpsychiatry.2010.179] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
CONTEXT It has been suggested that patients with major depressive disorder (MDD) who display pretreatment features suggestive of bipolar disorder or bipolar spectrum features might have poorer treatment outcomes. OBJECTIVE To assess the association between bipolar spectrum features and antidepressant treatment outcome in MDD. DESIGN Open treatment followed by sequential randomized controlled trials. SETTING Primary and specialty psychiatric outpatient centers in the United States. PARTICIPANTS Male and female outpatients aged 18 to 75 years with a DSM-IV diagnosis of nonpsychotic MDD who participated in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. INTERVENTIONS Open treatment with citalopram followed by up to 3 sequential next-step treatments. MAIN OUTCOME MEASURES Number of treatment levels required to reach protocol-defined remission, as well as failure to return for the postbaseline visit, loss to follow-up, and psychiatric adverse events. For this secondary analysis, putative bipolar spectrum features, including items on the mania and psychosis subscales of the Psychiatric Diagnosis Screening Questionnaire, were examined for association with treatment outcomes. RESULTS Of the 4041 subjects who entered the study, 1198 (30.0%) endorsed at least 1 item on the psychosis scale and 1524 (38.1%) described at least 1 recent maniclike/hypomaniclike symptom. Irritability and psychoticlike symptoms at entry were significantly associated with poorer outcomes across up to 4 treatment levels, as were shorter episodes and some neurovegetative symptoms of depression. However, other indicators of bipolar diathesis including recent maniclike symptoms and family history of bipolar disorder as well as summary measures of bipolar spectrum features were not associated with treatment resistance. CONCLUSION Self-reported psychoticlike symptoms were common in a community sample of outpatients with MDD and strongly associated with poorer outcomes. Overall, the data do not support the hypothesis that unrecognized bipolar spectrum illness contributes substantially to antidepressant treatment resistance.
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Affiliation(s)
- Roy H Perlis
- Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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Weinstock LM, Strong D, Uebelacker LA, Miller IW. DSM-IV depressive symptom expression among individuals with a history of hypomania: a comparison to those with or without a history of mania. J Psychiatr Res 2010; 44:979-85. [PMID: 20398907 PMCID: PMC2908735 DOI: 10.1016/j.jpsychires.2010.03.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 03/08/2010] [Accepted: 03/16/2010] [Indexed: 11/30/2022]
Abstract
In an effort to advance an understanding of the phenomenology of bipolar II depression, the current study used methods based in item response theory to evaluate differences in DSM-IV depression symptom endorsement in an epidemiological sample of individuals with a history of hypomania (i.e., bipolar II depression) in comparison to: a) individuals with a history of mania (i.e., bipolar I depression), and b) individuals without a history of hypomania or mania (i.e., unipolar depression). Clinical interview data were drawn from a subsample (n = 13,753) of individuals with bipolar II, bipolar I, or unipolar depression who had participated in the National Epidemiologic Survey on Alcohol and Related Conditions. A two-parameter item response model was used to estimate differential item functioning (DIF) between these groups. Differences in severity parameter estimates revealed that suicidal ideation/attempt was less likely to be endorsed across most levels of depression severity in bipolar II versus bipolar I disorder. There were no significant differences between groups on the remaining DSM-IV symptoms. Although preliminary, current study data are consistent with recent assertions that depression may be understood as a clinical phenomenon that is consistent across the major affective disorders. An exception to this conclusion may be in the area of suicidal ideation, which requires additional attention.
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Affiliation(s)
- Lauren M Weinstock
- Psychosocial Research Program, Warren Alpert Medical School of Brown University and Butler Hospital, 345 Blackstone Boulevard, Providence, RI 02906, United States.
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Abstract
OBJECTIVE We examine the depressive symptom profile of bipolar II disorder patients compared with a comparator (composite) group of those with unipolar depression, with stratification by melancholic and non-melancholic subtypes. METHOD Out-patients (n = 394) attending a specialist depression clinic comprised the sample. Data on severity and prototypic status of depressive symptoms were analysed. RESULTS Age-matched analyses revealed minimal differentiation between bipolar II and composite unipolar groups. Stratified analyses suggested that 'bipolar II depression' more closely approximated melancholic depression in terms of psychomotor and cognitive slowing. Severity-based analyses and prototypic symptom patterns yielded differing results, suggesting that definition of bipolar II depression is influenced by rating strategies, and age. CONCLUSION We found limited differentiation of bipolar II depression from unipolar, melancholic and non-melancholic depression. Differences suggested previously may reflect age, gender and severity differences, highlighting the need for appropriately matched groups in defining bipolar II depression.
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Affiliation(s)
- G B Parker
- School of Psychiatry, University of New South Wales and Black Dog Institute, Prince of Wales Hospital, Randwick 2031, Sydney, Australia.
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