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Yu-Tao Xiang,
Ling Zhang,
Gang Wang,
Chen Hu,
Gabor S Ungvari,
Faith B Dickerson,
Amy M Kilbourne,
Tian-Mei Si,
Yi-Ru Fang,
Zheng Lu, [......],
Kelly Yc Lai,
Edwin Hm Lee,
Jian Hu,
Zhi-Yu Chen,
Yi Huang, Jing Sun,
Xiao-Ping Wang,
Hui-Chun Li,
Jin-Bei Zhang,
Helen Fk Chiu
[show abstract]
[hide abstract]
ABSTRACT: Bipolar disorder (BD) is frequently misdiagnosed as major depressive disorder (MDD), which may lead to inappropriate treatment and poor outcomes. This study aimed to compare demographic and clinical features between patients with MDD and those with BD, but being misdiagnosed as MDD, in China.
A total of 1487 patients diagnosed with MDD were consecutively evaluated in 13 psychiatric hospitals or psychiatric units of general hospitals nationwide in China. The patients' sociodemographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. The Mini-International Neuropsychiatric Interview (MINI) was used to establish DSM-IV diagnoses, and identify patients with MDD and those with BD, but being misdiagnosed with MDD.
The proportions of BD (all types), bipolar I disorder (BD-I), and bipolar II disorder (BD-II) misdiagnosed as MDD in clinical practice were 20.8%, 7.9%, and 12.8%, respectively. Multiple logistic regression analyses revealed that compared to MDD patients, BD-I was characterized by more atypical depressive features (increased appetite, increased sleep, and weight gain) [odds ratio (OR) = 2.0, 95% confidence interval (CI): 1.2-3.2], more psychotic symptoms (OR = 2.1, 95% CI: 1.3-3.5), more lifetime depressive episodes (OR = 1.1, 95% CI: 1.1-1.2), and earlier age of onset (OR = 0.97, 95% CI: 0.9-0.99); BD-II was characterized by more psychotic symptoms (OR = 2.1, 95% CI: 1.4-3.1) and earlier age of onset (OR = 0.96, 95% CI: 0.9-0.97). In addition, compared to BD-II patients, BD-I patients were characterized by more frequent depressive episodes per year (OR = 3.1, 95% CI: 1.5-6.6).
Depressive episodes in the context of BD-I and BD-II, among those who were misclassified as MDD, present some different clinical features compared to MDD. This finding should be taken into account in guiding diagnostic practices in China.
Bipolar Disorders 03/2013; 15(2):199-205. · 5.29 Impact Factor
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Yu-Tao Xiang,
Chen Hu,
Gang Wang,
Qi-Wen Zheng,
Yi-Ru Fang,
Gabor S Ungvari,
Amy M Kilbourne,
Kelly Y C Lai,
Tian-Mei Si,
Da-Fang Chen,
Zheng Lu,
Hai-Chen Yang,
Jian Hu,
Zhi-Yu Chen,
Yi Huang, Jing Sun,
Xiao-Ping Wang,
Hui-Chun Li,
Jin-Bei Zhang,
Helen F K Chiu
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE: Bipolar disorder (BD) is frequently misdiagnosed as major depressive disorder (MDD), which may lead to inappropriate treatment and poor outcomes. This study aimed to examine prescribing patterns of antidepressants, antipsychotics and mood stabilizers in BD patients misdiagnosed with MDD in China. METHODS: A total of 1487 patients originally diagnosed with MDD were consecutively screened for diagnostic revision in 13 psychiatric hospitals or psychiatric units of general hospitals in China nationwide. The patients' sociodemographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. The Mini International Neuropsychiatric Interview (MINI) was used to establish DSM-IV diagnoses. Data on psychotropic prescriptions were collected by a review of medical records. RESULTS: Three hundred and nine of the 1487 patients (20.8%) fulfilled DSM-IV criteria for BD; 118 (7.9%) for BD-I and 191 (12.8%) for BD-II on the MINI. Of the BD patients (n = 309), 227 (73.5%) received any use of antidepressants, 73 (23.6%) antipsychotics and 33 (10.7%) mood stabilizers. In multiple logistic regression analyses, compared with those with MDD, patients with BD-I were more likely to receive antidepressants (OR 1.7, 95% CI 1.1-2.8, p = 0.02), antipsychotics (OR 1.6, 95% CI 1.04-2.5, p = 0.04) and mood stabilizers (OR 3.9, 95% CI 2.1-7.2, p < 0.001), whereas patients with BD-II were more likely to receive mood stabilizers (OR 2.4, 95% CI 1.3-4.4, p = 0.003). There was no difference in the use of antidepressants (OR 1.1, 95% CI 0.8-1.5, p = 0.7) and antipsychotics (OR 1.3, 95% CI 0.9-1.9, p = 0.2) between BD-II and MDD. In addition, there was no difference between BD-I and BD-II in any use of antidepressants, antipsychotics and mood stabilizers. CONCLUSIONS: The prescription of antidepressants for BD patients misdiagnosed with MDD is very common, and only a very small proportion of patients received guideline-concordant treatment. Considering the potentially hazardous effects of inappropriate pharmacotherapy in this population, continuing education and training addressing the correct diagnosis of BD and rational use of psychotropic medications are needed in China. Copyright © 2012 John Wiley & Sons, Ltd.
Human Psychopharmacology Clinical and Experimental 10/2012; · 2.48 Impact Factor
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Hai-Chen Yang,
Yu-Tao Xiang,
Tie-Bang Liu,
Rong Han,
Gang Wang,
Chen Hu,
Ling-Jiang Li,
Xiao-Ping Wang,
Hong-Jun Peng,
Tian-Mei Si,
Yi-Ru Fang,
Cheng-Mei Yuan,
Zheng Lu,
Jian Hu,
Zhi-Yu Chen,
Yi Huang, Jing Sun,
Hui-Chun Li,
Jin-Bei Zhang,
Jules Angst
[show abstract]
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ABSTRACT: AIM: To investigate the results of the Hypomania Checklist-32 (HCL-32) administered as a screening instrument in clinical settings to mood disorders patients in the depressive phase. METHODS: A total of 1487 patients diagnosed and being treated for major depressive disorder (MDD) in 13 mental health centers across China were self-rated by the HCL-32 and independently examined by the Mini International Neuropsychiatric Interview (MINI). RESULTS: After examination by the MINI, 309 (20.8%) of the 1487 patients clinically diagnosed as having MDD satisfied DSM-IV criteria for bipolar disorder (BD): 118 (7.9%) for bipolar I disorder (BD-I) and 191 (12.8%) for bipolar II disorder (BD-II). The mean HCL-32 score of the BD patients was statistically higher than that of patients with unipolar depression (UD, major depressive disorder), BD-II higher than UD, while no significant difference between BD-I and BD-II. The HCL-32 distinguished between BD and UD (best cutoff score 14), between BD-II and UD (best cutoff 12). At the optimum cutoff of 12 between BD and UD, the sensitivity was 0.86, specificity 0.69. LIMITATIONS: No standardized instruments were used to measure the severity of depressive symptoms. Depressed patients with a previous history of BD were excluded from this study. CONCLUSIONS: The HCL-32 results in this multicenter study of patients in the depressive phase were similar to those of earlier, generally smaller-scale studies which subjects could be in any mood phases. A score of 12 could be used as the optimum cutoff between BD and UD to improve screening for BD-II if the HCL-32 was applied in clinical settings in China.
Journal of affective disorders 07/2012; · 3.76 Impact Factor
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Chen Hu,
Yu-Tao Xiang,
Gabor S Ungvari,
Faith B Dickerson,
Amy M Kilbourne,
Tian-Mei Si,
Yi-Ru Fang,
Zheng Lu,
Hai-Chen Yang,
Helen F K Chiu,
Kelly Y C Lai,
Jian Hu,
Zhi-Yu Chen,
Yi Huang, Jing Sun,
Xiao-Ping Wang,
Hui-Chun Li,
Jin-Bei Zhang,
Gang Wang
[show abstract]
[hide abstract]
ABSTRACT: Bipolar disorder (BD) is a recurrent, complex illness and often misdiagnosed and treated as a major depressive disorder (MDD). This study set out (1) to investigate the proportion of BD in patients treated for MDD using DSM-IV diagnostic criteria; (2) to test the usefulness of the screening tool - the 32-item Hypomania Checklist (HCL-32) in Chinese patients; and (3) to assess whether MDD patients with subthreshold manic features (patients who screened positive for BD on the HCL-32, but did not meet the diagnostic criteria for DSM-IV BD as measured by Mini International Neuropsychiatric Interview (MINI)) differ from those with BD, and from those suffering from MDD without manic features in terms of basic demographic and clinical variables.
A total of 1487 patients treated for MDD were consecutively examined in 13 mental health centers in China. The patients' socio-demographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. The HCL-32 was self-completed by patients to identify hypomanic symptoms, and the MINI was used by clinicians to establish DSM-IV diagnoses.
The proportions of undiagnosed BD (all types), BD-I and BD-II were 20.8%, 7.9% and 12.8%, respectively. The HCL-32 had low positive predictive value (0.43). Compared to MDD patients without subthreshold manic features, MDD patients with subthreshold manic features were younger at onset, less likely to be married and had more depressive episodes on a seasonal basis, and more frequent depressive episodes overall. Compared to BD patients, MDD patients with subthreshold manic features had an older age at onset and less frequent depressive episodes and less family history of psychiatric disorders, appetite, weight gain and time spent sleeping, suicide ideation and attempts and psychotic symptoms.
At least one fifth of Chinese patients treated for MDD may have an undiagnosed BD. The HCL-32 is useful to identify broader subthreshold bipolar features. The findings need to be confirmed by longitudinal studies using more comprehensive, standardized instruments.
Journal of affective disorders 03/2012; 140(2):181-6. · 3.76 Impact Factor
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Yu-Tao Xiang,
Gang Wang,
Chen Hu,
Tong Guo,
Gabor S Ungvari,
Amy M Kilbourne,
Kelly Y C Lai,
Tian-Mei Si,
Qi-Wen Zheng,
Da-Fang Chen, [......],
Zheng Lu,
Hai-Chen Yang,
Jian Hu,
Zhi-Yu Chen,
Yi Huang, Jing Sun,
Xiao-Ping Wang,
Hui-Chun Li,
Jin-Bei Zhang,
Helen F K Chiu
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ABSTRACT: Little has been known about the demographic and clinical features of the melancholic subtype of major depressive disorder (MDD) in Chinese patients. This study examined the frequency of melancholia in Chinese MDD patients and explored its demographic and clinical correlates and prescribing patterns of psychotropic drugs.
A consecutively collected sample of 1,178 patients with MDD were examined in 13 psychiatric hospitals or psychiatric units of general hospitals in China nationwide. The cross-sectional data of patients' demographic and clinical characteristics and prescriptions of psychotropic drugs were recorded using a standardized protocol and data collection procedure. The diagnosis of the melancholic subtype was established using the Mini International Neuropsychiatric Interview (MINI). Medications ascertained included antidepressants, mood stabilizers, antipsychotics and benzodiazepines.
Six hundred and twenty nine (53.4%) of the 1,178 patients fulfilled criteria for melancholia. In multiple logistic regression analyses, compared to non-melancholic counterparts, melancholic MDD patients were more likely to be male and receive benzodiazepines, had more frequent suicide ideations and attempts and seasonal depressive episodes, while they were less likely to be employed and receive antidepressants and had less family history of psychiatric disorders and lifetime depressive episodes.
The demographic and clinical features of melancholic MDD in Chinese patients were not entirely consistent with those found in Western populations. Compared to non-melancholic MDD patients, melancholic patients presented with different demographic and clinical features, which have implications for treatment decisions.
PLoS ONE 01/2012; 7(6):e39840. · 4.09 Impact Factor
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Ning Sun,
Yihan Li,
Yiyun Cai,
Jing Chen,
Yuan Shen, Jing Sun,
Zheng Zhang,
Jiulong Zhang,
Lina Wang,
Liyang Guo, [......],
Guixing Jin,
Yutang Zhang,
Lixin Sun,
Yunchun Chen,
Haiying Zhao,
Yamei Dang,
Shenxun Shi,
Kenneth S Kendler,
Jonathan Flint,
Kerang Zhang
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ABSTRACT: Although the diagnosis of melancholia has had a long history, the validity of the current DSM-IV definition remains contentious. We report here the first detailed comparison of melancholic and nonmelancholic major depression (MD) in a Chinese population examining in particular whether these two forms of MD differ quantitatively or qualitatively.
DSM-IV criteria for melancholia were applied to 1,970 Han Chinese women with recurrent MD recruited from 53 provincial mental health centers and psychiatric departments of general medical hospitals in 41 cities. Statistical analyses, utilizing Student's t-tests and Pearson's χ(2) , were calculated using SPSS 13.0.
Melancholic patients with MD were distinguished from nonmelancholic by being older, having a later age at onset, more episodes of illness and meeting more A criteria. They also had higher levels of neuroticism and rates of lifetime generalized anxiety disorder, panic disorder, and social and agoraphobia. They had significantly lower rates of childhood sexual abuse but did not differ on other stressful life events or rates of MD in their families.
Consistent with most prior findings in European and US populations, we find that melancholia is a more clinically severe syndrome than nonmelancholic depression with higher rates of comorbidity. The evidence that it is a more "biological" or qualitatively distinct syndrome, however, is mixed.
Depression and Anxiety 11/2011; 29(1):4-9. · 4.18 Impact Factor
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Lina Wang,
Dongdong Qiao,
Yihan Li,
Liwei Wang,
Jianer Ren,
Kangmei He, Jing Sun,
Zhoubing Wang,
Tian Tian,
Ce Chen, [......],
Xueyi Wang,
Lanxian Ye,
Wei Liang,
Yunchun Chen,
Qingjun Tang,
Jing Guan,
Shenxun Shi,
Kenneth S Kendler,
Jonathan Flint,
Lanfen Liu
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ABSTRACT: A number of clinical features potentially reflect an individual's familial vulnerability to major depression (MD), including early age at onset, recurrence, impairment, episode duration, and the number and pattern of depressive symptoms. However, these results are drawn from studies that have exclusively examined individuals from a European ethnic background. We investigated which clinical features of depressive illness index familial vulnerability in Han Chinese females with MD.
We used lifetime MD and associated clinical features assessed at personal interview in 1,970 Han Chinese women with DSM-IV MD between 30-60 years of age. Odds Ratios were calculated by logistic regression.
Individuals with a high familial risk for MD are characterized by severe episodes of MD without known precipitants (such as stress life events) and are less likely to feel irritable/angry or anxious/nervous.
The association between family history of MD and the lack of a precipitating stressor, traditionally a characteristic of endogenous or biological depression, may reflect the association seen in other samples between recurrent MD and a positive family history. The symptomatic associations we have seen may reflect a familial predisposition to other dimensions of psychopathology, such as externalizing disorders or anxiety states.
Depression and Anxiety 11/2011; 29(1):10-5. · 4.18 Impact Factor
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Ming Tao,
Yihan Li,
Dong Xie,
Zhiyang Wang,
Jianying Qiu,
Wenyuan Wu, Jing Sun,
Zhoubing Wang,
Danhong Tao,
Hongsu Zhao, [......],
Ling Li,
Ruiling Zhang,
Qingrong Tan,
Jun Zhang,
Jing Guan,
Shenxun Shi,
Yiping Chen,
Kenneth S Kendler,
Jonathan Flint,
Jingfang Gao
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ABSTRACT: In European and US studies, patients with major depressive disorder (MDD) report more stressful life events (SLEs) than controls, but this relationship has rarely been studied in Chinese populations.
Sixteen lifetime SLEs were assessed at interview in two groups of Han Chinese women: 1970 clinically ascertained with recurrent MDD and 2597 matched controls. Diagnostic and other risk factor information was assessed at personal interview. Odds ratios (ORs) were calculated by logistic regression.
60% of controls and 72% of cases reported at least one lifetime SLE. Fourteen of the sixteen SLEs occurred significantly more frequently in those with MDD (median odds ratio of 1.6). The three SLEs most strongly associated with risk for MDD (OR>3.0) preceded the onset of MDD the majority of the time: rape (82%), physical abuse (100%) and serious neglect (99%).
Our results may apply to females only. SLEs were rated retrospectively and are subject to biases in recollection. We did not assess contextual information for each life event.
More severe SLEs are more strongly associated with MDD. These results support the involvement of psychosocial adversity in the etiology of MDD in China.
Journal of affective disorders 08/2011; 135(1-3):95-9. · 3.76 Impact Factor
