Continuous distribution of atypical depressive symptoms between major depressive and bipolar II disorders: dose-response relationship with bipolar family history.
ABSTRACT 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.
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ABSTRACT: Objectives: The loudness dependence of auditory evoked potentials (LDAEP) has been proposed as a useful biomarker of serotonin activity, and the LDAEP value is low in patients with melancholic depression. In this study, we evaluated LDAEP levels in patients with atypical depression. Methods: We recruited 53 patients with atypical depression and 68 patients with non-atypical depression. Subjects were evaluated by the Atypical Depression Diagnostic Scale (ADDS), Hamilton Rating Scale for Depression (HAMD), Hamilton Rating Scale for Anxiety (HAMA), Beck Scale for Suicidal Ideation (BSI), Behavioral Inhibition System and Behavioral Activation System (BIS/BAS) scales, and Hypomanic Personality Scale (HPS). To determine LDAEP, the peak-to-peak N1/P2 was measured at five stimulus intensities and the LDAEP was calculated as the linear-regression slope. Results: Patients with atypical depression had stronger LDAEP values and higher BAS and HPS scores than those with non-atypical depression. LDAEP showed a pattern of gradual decrease according to ADDS score hierarchy in patients with major depressive disorder. In the atypical depression group, LDAEP showed significant negative correlation with the BSI score and significant positive correlation with BAS score. In the non-atypical depression group, LDAEP did not show any significant correlations with the scores of psychological scales. Conclusions: Our results suggest that there is a relatively deficient serotonergic activity in patients with atypical depression and that LDAEP reflects mood reactivity. The transient drop of serotonergic activity induced by mood vulnerability might contribute to suicidal tendencies in patients with atypical depression.Progress in Neuro-Psychopharmacology and Biological Psychiatry 05/2014; 54. DOI:10.1016/j.pnpbp.2014.05.010 · 4.03 Impact Factor
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ABSTRACT: Objective To investigate distinguishing features between bipolar I, II and unipolar depression, and impulsivity/aggression traits in particular. Methods Six hundred and eighty-five (n = 685) patients in a major depressive episode with lifetime Unipolar (UP) depression (n = 455), Bipolar I (BP-I) disorder (n = 151), and Bipolar II (BP-II) (n = 79) disorder were compared in terms of their socio-demographic and clinical characteristics. Results Compared to unipolar patients, BP-I and BP-II depressed patients were significantly younger at onset of their first depressive episode, and were more likely to experience their first depressive episode before/at age of 15. They also had more previous affective episodes, more first- and second-degree relatives with history of mania, more current psychotic and subsyndromal manic symptoms, and received psychopharmacological and psychotherapy treatment at an earlier age. Furthermore, BP-I and BP-II depressed patients had higher lifetime impulsivity, aggression, and hostility scores. With regard to bipolar subtypes, BP-I patients had more trait-impulsivity and lifetime aggression than BP-II patients whereas the latter had more hostility than BP-I patients. As for co-morbid disorders, Cluster A and B Personality Disorders, alcohol and substance abuse/dependence and anxiety disorders were more prevalent in BP-I and BP-II than in unipolar patients. Whereas the three groups did not differ on other socio-demographic variables, BP-I patients were significantly more often unemployed that UP patients. Conclusion Our findings comport with major previous findings on differences between bipolar and unipolar depression. As for trait characteristics, bipolar I and II depressed patients had more life-time impulsivity and aggression/hostility than unipolar patients. In addition, bipolar I and II patients also differed on these trait characteristics.European Psychiatry 09/2014; 30(1). DOI:10.1016/j.eurpsy.2014.06.005 · 3.21 Impact Factor
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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 · 3.71 Impact Factor