Mania and depression. Mixed, not stirred

Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain.
Journal of Affective Disorders (Impact Factor: 3.38). 04/2011; 133(1-2):105-13. DOI: 10.1016/j.jad.2011.03.037
Source: PubMed


Current criteria for mixed bipolar episode do not allow an adequate understanding of a vast majority of bipolar patients with mixed (hypo) manic-depressive features, keeping the qualification of "mixed episodes" for bipolar type I only. This study was aimed to test the existence of a bipolar-mixed continuum by comparing the characteristics of three groups classified according to patterns of past and current manic or mixed episodes.
134 bipolar I inpatients were divided according to their pattern of excitatory "mixed-like" episodes in three groups: 1) lifetime history of purely manic episodes without mixed features (PMA); 2) lifetime history of both manic and mixed episodes (MIX) and 3) lifetime history exclusively of mixed, but not manic, episodes (PMIX). Differences in clinical and demographic characteristics were analyzed by using chi-square head-to-head for categorical data, one-way ANOVA for continuous variables and Tukey's post-hoc comparison. Logistic regression was used to control for data validity.
PMIX had higher rates of depressive predominant polarity and less lifetime history of psychotic symptoms, and had received more antidepressants both lifetime and during 6 months prior to index episode. PMIX had more suicide attempts and Axis I comorbidity than PMA.
PMIX is likely to have a higher risk for suicide and higher rates of comorbidities; current DSM-IV-TR criteria are not fit for correctly classifying these patients and this may affect treatment appropriateness. The concept of "mixicity" should be extended beyond bipolar I disorder to other bipolar disorder subtypes.

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    • "episodes in three groups: lifetime history of pure manic episodes without mixed features; lifetime history of both manic and mixed episodes and lifetime history of exclusively mixed, but not manic episodes. Following multivariable adjustment for potential confounders , a history of pure mixed episodes was associated with higher proportions of depressive predominant polarity (Pacchiarotti et al., 2011). A principal component analysis of the 24-item brief psychiatric rating scale (BPRS) (Ventura et al., 2000) in a consecutive sample of 187 type I BD inpatients (Pacchiarotti et al., 2013) was performed. "
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    ABSTRACT: Background Predominant polarity (PP) is a proposed course specifier for bipolar disorder, which was not incorporated in the DSM-5 as a descriptor for the nosology of bipolar disorder (BD). Here we perform a systematic review of original studies about PP. Methods A computerized search of MEDLINE/Pubmed, EMBASE and Web of Science databases from inception to October 6th, 2013 was performed with keywords, including ‘bipolar disorder’, ‘polarity’ and ‘predominant polarity’. Results A total of 19 studies met inclusion criteria. A unifying definition and conceptualization for PP is lacking. A PP is found in approximately half of BD patients. Most studies that included type I BD patients found the manic PP to be more prevalent, while studies that included type II BD participants found a higher prevalence of depressive PP. The depressive PP has been consistently associated with a depressive onset of illness, a delayed diagnosis of BD, type II BD and higher rates of suicidal acts. The manic PP is associated with a younger onset of illness, a first episode manic/psychotic and a higher rate of substance abuse. Evidence suggests that PP may influence responses to acute treatment for bipolar depression. Furthermore, evidences indicate that PP should be considered for the selection of maintenance treatments for BD. Limitations There are few prospective studies on PP. There were disparate definitions for PP across studies. Conclusions The concept of PP provides relevant information for clinicians. Future studies should investigate the genetic and biological underpinnings of PP.
    Journal of Affective Disorders 07/2014; 163:56–64. DOI:10.1016/j.jad.2014.03.035 · 3.38 Impact Factor
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    • "Moreover, in that study, lifetime neuropsychiatric history was subdivided into past or current manic episodes only (purely manic), past or current manic and mixed episodes, and past or current mixed episodes only (purely mixed). Second, patients in the present study had an older mean age of onset and a lower rate of previous depressive and hypomanic episodes than did those in the study by Pacchiarotti et al. (2011). These differences may be due to recall bias in that patients and their family members may have had difficulty remembering past depressive or hypomanic episodes. "
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    ABSTRACT: The aim of the present study was to reevaluate the feasibility of diagnosing a mixed features behind bipolar mania and to elucidate the clinical characteristics, treatment response, and course of the illness throughout a 12-month follow-up. The subjects (n=171) were inpatients diagnosed with bipolar I disorder, manic, between 2003 and 2010 and were classified into three groups: "mania" (n=67), "mania with probable mixed features" (n=79), and "mania with definite mixed features" (n=25). Diagnoses were in accordance with the Cincinnati criteria, which include the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision characteristics for a major depressive episode, except for agitation and insomnia. The charts of subjects were retrospectively reviewed for demographic and clinical characteristics prior to the index episode, clinical data regarding the index episode, and treatment courses over a 12-month follow-up period. Subjects in the mania with definite mixed features were more likely to be young at admission, to be female, to have a familial affective loading, and to have a history of suicidality relative to the mania. The results of the present study suggest the need for regular assessment of symptoms associated with both polarities during an episode in routine practice.
    11/2013; 215(2). DOI:10.1016/j.psychres.2013.11.002
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    • "Some known clinical and sociodemographic factor associated with SB in BP include gender (Nivoli et al., 2011), previous suicidal attempt (Hawton et al., 2005), presence of suicidal ideation (Valtonen et al., 2005; Leverich et al., 2003; Oquendo et al., 2000; Roy-Byrne et al., 1988), early age at onset (Slama et al., 2004; Perlis et al., 2004; Lopez et al., 2001; Tsai et al., 1999), BD II diagnosis (Pompili et al., 2009; Rihmer and Pestality, 1999) alcohol abuse/ misuse (Dalton et al., 2003; Lopez et al., 2001), stimulant abuse (Gonzalez-Pinto et al., 2007), depressive episodes, mixed episodes (Dalton et al., 2003; Oquendo et al., 2000; Goodwin and Jamison, 1990; Pacchiarotti et al., 2011a), family history of suicide (Lopez et al., 2001; Romero et al., 2007), illness duration (Oquendo et al., 2000; Roy-Byrne et al., 1988), any comorbidity (Vieta et al., 1999; Vieta et al., 2000), first-episode polarity (Chaudhury et al., 2007; Ryu et al., 2010; Daban et al., 2006), depressive predominant polarity (Colom et al., 2006), rapid cycling (Garcia- Amador et al., 2009; Cruz et al., 2008), atypical depression (Sanchez-Gistau et al., 2009), impulsivity (Swann et al., 2005) (Malloy-Diniz et al., 2011), poor functional outcome (Rosa et al., 2008), affective temperaments (Pompili et al., 2008; Rihmer et al., 2009; Azorin et al., 2009; Serafini et al., 2011), treatment nature (Pacchiarotti et al., 2011b) and adherence (Gonzalez-Pinto et al., 2006). "
    European Neuropsychopharmacology 10/2013; 23:S370-S371. DOI:10.1016/S0924-977X(13)70585-6 · 4.37 Impact Factor
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