Continuous Distribution of Atypical Depressive Symptoms between Major Depressive and Bipolar II Disorders: Dose-Response Relationship with Bipolar Family History

International Mood Center, University of California at San Diego, San Diego, CA, USA.
Psychopathology (Impact Factor: 2.08). 02/2008; 41(1):39-42. DOI: 10.1159/000109954
Source: PubMed


Despite the categorical position of formal diagnostic approaches (i.e. ICD-10 and DSM-IV) to mood disorders, atypical depression (AD) occupies an ambiguous position between major depressive (MDD) and bipolar II (BP-II) disorders.
Three hundred and eighty-nine and 261 consecutive BP-II and MDD patients, respectively, presenting for treatment of depression in an Italian private practice, were interviewed by a mood specialist psychiatrist using the Structured Clinical Interview for DSM-IV Axis I Disorders - Clinician Version as modified by the authors to improve the probing for hypomania. Familial bipolarity was measured by the Family History Screen. AD was defined, according to DSM-IV, as a major depressive episode with the 'atypical features' specifier.
BP-II, versus MDD, had the usual distinguishing features (i.e. earlier age at onset, higher rate of depressive recurrences, AD symptoms, and bipolar family history). Such categorical distinction notwithstanding, the distribution of the number of AD symptoms between BP-II and MDD depressions, studied by Kernel estimate, was continuous, showing no bimodality. Furthermore, there was a dose-response relationship between such symptoms and bipolar family history.
The continuous distribution of a distinct clinical feature (i.e. atypical symptoms) between BP-II and MDD supports a dimensional view of depressive disorders. Our data could also be interpreted as providing further support for the subclassification of AD within the bipolar spectrum.

8 Reads
  • Source
    • "Psychotic features were also found to be a significant predictor in univariate, but not multivariate analyses, conducted by Holma et al. (2008). In addition, a number of studies have found that atypical features were more common in patients with BP than in patients with MDD (Quitkin et al., 2003; Angst et al., 2006; Akiskal and Benazzi, 2008), but these features were not predictive of a diagnostic conversion in the present study. For instance, Gan et al. (2011) found that some atypical features, such as hypersomnia and irritability, were associated with BP, but others, such as weight gain, were not. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The major aims of this study were to identify factors that may predict the diagnostic conversion from major depressive disorder (MDD) to bipolar disorder (BP) and to evaluate the predictive performance of the bipolar spectrum disorder (BPSD) diagnostic criteria. The medical records of 250 patients with a diagnosis of MDD for at least 5 years were retrospectively reviewed for this study. The diagnostic conversion from MDD to BP was observed in 18.4% of 250 MDD patients, and the diagnostic criteria for BPSD predicted this conversion with high sensitivity (0.870) and specificity (0.917). A family history of BP, antidepressant-induced mania/hypomania, brief major depressive episodes, early age of onset, antidepressant wear-off, and antidepressant resistance were also independent predictors of this conversion. This study was conducted using a retrospective design and did not include structured diagnostic interviews. The diagnostic criteria for BPSD were highly predictive of the conversion from MDD to BP, and conversion was associated with several clinical features of BPSD. Thus, the BPSD diagnostic criteria may be useful for the prediction of bipolar diathesis in MDD patients. Copyright © 2014 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 11/2014; 174C:83-88. DOI:10.1016/j.jad.2014.11.034 · 3.38 Impact Factor
  • Source
    • "A major depressive episode diagnosed according to the DSM-IV-criteria can be accompanied by symptoms or psychopathological phenomena that DSM-IV does not include [1]. The classification of these symptoms is often difficult; some specialists speak of an atypical depression or of a comorbidity [2–4]. Possible examples of such symptoms could be anger attacks, distress symptoms like a sudden and periodical reduction of stress tolerance, impulsive-aggressive behavior, and suddenly occurring endorphin- or serotonin-related behavior such as alcohol or drug abuse or abusive equivalents (behavior typical for workaholics, those who jog excessively, etc.). "
    [Show abstract] [Hide abstract]
    ABSTRACT: A major depressive episode diagnosed according to DSM-IV criteria can be accompanied by symptoms that DSM-IV does not include. These symptoms are sometimes classified as comorbidities. Our study assessed altered behavioral modes during a major depressive episode; ie, if 1 or more modes of behavior operated less or even not at all ("never"), or if the operation of others was more frequent or even constant ("always"). We hypothesize that these altered behavioral modes, especially the extreme positions "never" (hypomodes) and "always" (hypermodes) might correlate with depression scores and thus represent a typical symptom of depression. We used the 35-item Salzburg Subjective Behavioral Analysis (SSBA) questionnaire to measure altered behavioral modes in 63 depressed patients and 87 non-depressed controls. Depression was assessed using the Hamilton Depression Scale. In our test group (n=63) we found a total of 888 extreme positions. The mean number of extreme positions per patient was 11.15±5.173 (SD). Extreme positions were found in all 35 behavioral modes. The mean Hamilton score was 22.08±7.35 (SD). The association of the incidence of extreme positions and the Hamilton score in our test group was highly significant (Spearman's Rho=0.41; p=.001). In the control group (n=87), only 11 persons were found to display extreme positions, with a total of only 25. Although this study has several limitations, such as the small sample or the use of a questionnaire in the validation procedure, the significant correlation of extreme positions and the Hamilton score indicate that altered modes of behavior as detected with the SSBA might be typical symptoms in a major depressive episode.
    Medical science monitor: international medical journal of experimental and clinical research 05/2011; 17(5):CR259-64. DOI:10.12659/MSM.881765 · 1.43 Impact Factor
  • Source
    • "Delusions are relatively more common than hallucinations. However, it is reported that unipolar-depressed patients who later 'convert' to BD over time, as well as bipolar depressives, manifest more frequently psychotic features and pathological (psychotic) guilt [8,9]. Additionally, within the BD patient group it has been suggested (but not proven) that those patients with a history of psychotic symptoms suffer from a greater impairment regarding the neuropsychological performance especially concerning verbal memory and executive function [10,11]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: We present a systematic review and meta-analysis of the available clinical trials concerning the usefulness of aripiprazole in the treatment of the psychotic symptoms in bipolar disorder. A systematic MEDLINE and repository search concerning clinical trials for aripiprazole in bipolar disorder was conducted. The meta-analysis of four randomised controlled trials (RCTs) on acute mania suggests that the effect size of aripiprazole versus placebo was equal to 0.14 but a more reliable and accurate estimation is 0.18 for the total Positive and Negative Syndrome Scale (PANSS) score. The effect was higher for the PANSS-positive subscale (0.28), PANSS-hostility subscale (0.24) and PANSS-cognitive subscale (0.20), and lower for the PANSS-negative subscale (0.12). No data on the depressive phase of bipolar illness exist, while there are some data in favour of aripiprazole concerning the maintenance phase, where at week 26 all except the total PANSS score showed a significant superiority of aripiprazole over placebo (d = 0.28 for positive, d = 0.38 for the cognitive and d = 0.71 for the hostility subscales) and at week 100 the results were similar (d = 0.42, 0.63 and 0.48, respectively). The data analysed for the current study support the usefulness of aripiprazole against psychotic symptoms during the acute manic and maintenance phases of bipolar illness.
    Annals of General Psychiatry 12/2009; 8(Suppl 1):27. DOI:10.1186/1744-859X-8-27 · 1.40 Impact Factor
Show more