A different depression: Clinical distinctions between bipolar and unipolar depression [Electronic version]

Department of Psychiatry, University of Texas Health Science Center, 7703 Floyd Curl Drive, 7th Floor (Mail Code 7792), San Antonio, TX 78229-3900, USA.
Journal of Affective Disorders (Impact Factor: 3.38). 03/2005; 84(2-3):117-25. DOI: 10.1016/S0165-0327(03)00194-0
Source: PubMed

ABSTRACT Delayed diagnosis or misdiagnosis can prolong the suffering of patients with bipolar disorder. Accurate early diagnosis is sometimes difficult, however, particularly because patients often present in the depressive phase, which can easily be mistaken for unipolar depression. Unfortunately, therapy appropriate for unipolar depression can increase the risk of manic switch or cycle acceleration in bipolar disorder, especially in those with a family history of bipolarity and suicide, although some antidepressants may be useful in some bipolar patients. In addition, most currently available mood stabilizers, though effective in managing mania, do not effectively resolve depression. In contrast, lamotrigine has shown activity in bipolar depression and has a very low risk of manic switch. Bipolar depression, compared with unipolar depression, is more likely to be associated with hypersomnia, motor retardation, mood lability, early onset, and a family history of bipolar disorder. Awareness of these distinctions can greatly improve diagnosis of bipolar disorder and provide an opportunity for effective therapeutic intervention.

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    • "Although the cognitive model of unipolar depression is extensively studied [1] [10] [11], little is known about the distinctive features of the cognitive model of bipolar depression [12] [13] [14] [15]. Clinical and demographic variables may be helpful to some extent in the distinction between these two different phenomenological syndromes [16] [17] [18], but there still is a high rate of misdiagnosis [19] [20] [21]. "
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    ABSTRACT: Introduction: Clinicians need to make the differential diagnosis of unipolar and bipolar depression to guide their treatment choices. Looking at the differences observed in the metacognitions, and the emotional schemas, might help with this differentiation, and might provide information about the distinct psychotherapeutical targets. Methods: Three groups of subjects (166 unipolar depressed, 140 bipolar depressed, and 151 healthy controls) were asked to fill out the Metacognitions Questionnaire-30 (MCQ-30), and the Leahy Emotional Schema Scale (LESS). The clinicians diagnosed the volunteers according to the criteria of DSM-IV-TR with a structured clinical interview (MINI), and rated the moods of the subjects with the Montgomery Asberg Depression Rating Scale (MADRS), and the Young Mania Rating Scale (YMRS). Statistical analyses were undertaken to identify the group differences on the MCQ-30, and the LESS. Results: The bipolar and unipolar depressed patients' scores on the MCQ-30 were significantly different from the healthy controls, but not from each other. On the LESS dimensions of guilt, duration, blame, validation, and acceptance of feelings, all three groups significantly differed from each other. There were no statistically different results on the LESS dimensions of comprehensibility, consensus, and expression. The mood disordered groups scored significantly different than the healthy controls on the LESS dimensions of simplistic view of emotions, numbness, rationality, rumination, higher values, and control. Conclusions: These results suggest that the metacognitive model of unipolar depression might be extrapolated for patients with bipolar depression. These results are also compatible to a great extent with the emotional schema theory of depression.
    Comprehensive Psychiatry 06/2014; 55(7). DOI:10.1016/j.comppsych.2014.05.016 · 2.25 Impact Factor
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    • "Differentiating BD from disorders with similar symptoms, such as UPD and ADHD, is particularly difficult (Galanter & Leibenluft, 2008; Geller et al., 2001; Sala et al., 2009). BD and UPD are challenging to differentiate (Akiskal, 1995; Bowden, 2005; Ghaemi et al., 2000). Many individuals with BD are initially appropriately diagnosed with major depression because the onset of a depressive episode precedes the onset of a (hypo)manic episode (Ghaemi et al., 1999), particularly for individuals with early-onset BD (Bowden, 2001; Lish et al., 1994). "
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    ABSTRACT: Adolescence and early adulthood are the peak ages for the onset of unipolar and bipolar mood disorders. Moreover, for most individuals with attention-deficit/hyperactivity disorder (ADHD), symptoms and impairment begin in childhood but persist well into adolescence and adulthood (e.g., Barkley, 2010). Thus, adolescence and early adulthood represent a developmental window wherein individuals can be affected by mood disorders, ADHD, or both. Because treatment protocols for unipolar depression (UPD), bipolar disorder (BD), and ADHD are quite different, it is crucial that assessment instruments used among adolescents and young adults differentiate between these disorders. The primary objectives of this study were to evaluate the predictive and diagnostic validity of General Behavior Inventory (GBI; Depue et al., 1981) scores in discriminating BD from UPD and ADHD. Participants were drawn from adolescent (n = 361) and young adult (n = 614) samples. Based on findings from logistic regression and receiver-operating characteristics analyses, the diagnostic efficiency of the GBI scales range from fair (discriminating UPD from BD) to good (discriminating BD participants from nonclinical controls). Multilevel diagnostic likelihood ratios are also provided to facilitate individual decision making. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Psychological Assessment 12/2013; 26(1). DOI:10.1037/a0035138 · 2.99 Impact Factor
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    • "Consequently, the time lag between initial help seeking and the correct diagnosis is often more than ten years (Lish et al., 1994; Hirschfeld et al., 2003a). This is problematic as bipolar disorder requires specific interventions (Forty et al., 2008) and inappropriate treatment may worsen its course (Baldessarini et al., 2010; Ghaemi et al., 2000; Matza et al., 2005; Bowden, 2005). "
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    ABSTRACT: Bipolar disorders often remain unrecognized in clinical practice, which may be a consequence of imprecise recall of manic symptoms earlier in life. This study will therefore examine the validity of the widely-used Mood Disorder Questionnaire (MDQ) in detecting a (hypo)manic episode and explore the impact of recall bias. As an indication of impairments in recalling manic symptoms, we examined the long-term reliability of the MDQ after two years of follow-up in a sample of 2087 persons. Then, the validity of the MDQ was tested against the gold standard of a CIDI-based DSM-IV (hypo)manic episode. Its performance was compared for detecting a lifetime episode (at T1) versus a recent episode in the past two years (at T2). The long-term reliability of the MDQ was limited as the correct recall of individual items ranged from 44.6% to 68.8% after two years. The overall validity of the MDQ in detecting a lifetime (hypo)manic episode was limited and no adequate cut-off point with acceptable sensitivity and specificity could be identified. However, the MDQ accurately detected a recent episode with a sensitivity of 0.83 and a specificity of 0.82 for the standard and optimal cut-off point of ≥7. Taking into account two additional MDQ questions on clustering in time and severity of problems decreased its validity. Patients with a primary, clinical diagnosis of bipolar disorder were excluded. The MDQ accurately detected recent (hypo)manic episodes, but imprecise recall may result in a limited performance for episodes earlier in life.
    Journal of Affective Disorders 06/2013; 151(1). DOI:10.1016/j.jad.2013.05.078 · 3.38 Impact Factor
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