Amy M Kilbourne

Publications (6)23.15 Total impact

• Article: Sociodemographic and clinical features of bipolar disorder patients misdiagnosed with major depressive disorder in China.

  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
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  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
• Article: Prescribing patterns of antidepressants, antipsychotics and mood stabilizers in bipolar patients misdiagnosed with major depressive disorder in China.

  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
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  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
• Article: Psychometric properties of the Chinese versions of the Quick Inventory of Depressive Symptomatology - Clinician Rating (C-QIDS-C) and Self-Report (C-QIDS-SR).

  Jia Liu, Yu-Tao Xiang, Gang Wang, Xiong-Zhao Zhu, Gabor S Ungvari, Amy M Kilbourne, Kelly Y C Lai, Bao-Liang Zhong, Ling Zhang, Qinge Zhang, Yu-Chuan Zou, Le Xiao, Qian Zhao, Yang Li, Jiang Wu, Guo-Fu Zhang, Helen F K Chiu
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  ABSTRACT: BACKGROUND: Developing accurate and time-efficient tools to measure depressive symptoms is important for research and clinical practice. This study aimed to test the psychometric properties of the Chinese version of the 16-item Quick Inventory of Depressive Symptomatology - Clinician Rating (C-QIDS-C) and Self-Report (C-QIDS-SR). METHODS: This study included 998 patients with major depressive disorder (MDD) established using the Mini International Neuropsychiatric Interview (MINI). The severity of depressive symptoms was assessed using the Hamilton Rating Scale for Depression (HAMD), C-QIDS-C and C-QIDS-SR at baseline and 6 weeks later. RESULTS: Internal consistency (Cronbach's alpha) ranged from 0.73 to 0.82 for C-QIDS-C and C-QIDS-SR at both the baseline and exit. The involvement and energy domains at baseline, and sad mood, concentration/decision making, self outlook, involvement and agitation/retardation domains at exit had the highest item-total correlations across the two C-QIDS scales. The C-QIDS-C and C-QIDS-SR total scores were highly correlated with the HAMD total score at both baseline (r=0.61, p<0.01 and r=0.54, p<0.01, respectively) and exit (r=0.75, p<0.01 and r=0.72, p<0.01, respectively). The C-QIDS-C, C-QIDS-SR and HAMD were equally sensitive to change of depressive symptoms, suggesting high concurrent validity. The C-QIDS-C and C-QIDS-SR showed uni-dimensional measurement properties in exploratory factor analyses at both baseline and exit. CONCLUSIONS: The C-QIDS-C and C-QIDS-SR have excellent psychometric properties and are sensitive measurement of symptom severity in MDD.
  Journal of affective disorders 09/2012; · 3.76 Impact Factor
• Article: Screening for bipolar disorder with the Mood Disorders Questionnaire in patients diagnosed as major depressive disorder - the experience in China.

  Chen Hu, Yu-Tao Xiang, Gang Wang, Gabor S Ungvari, Faith B Dickerson, Amy M Kilbourne, Kelly Y C Lai, Tian-Mei Si, Yi-Ru Fang, 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: Bipolar disorder (BD) is often misdiagnosed as a major depressive disorder (MDD). This study aimed to test the usefulness of the screening tool, the Mood Disorders Questionnaire (MDQ), to identify BD patients misdiagnosed as MDD in Chinese clinical settings. 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 MDQ was completed by patients to identify symptoms characteristic of BD. DSM-IV diagnoses were established using the Mini International Neuropsychiatric Interview (MINI). Three hundred-nine of the 1487 patients (20.8%) satisfied DSM-IV criteria for BD; 118 (7.9%) for BD-I and 191 (12.8%) for BD-II on the MINI. The optimal cut-off point on the MDQ to differentiate BD from MDD was 3, while cut-off points of 5 and 3 differentiated BD-I and BD-II from MDD, respectively. The maximum sensitivity was 0.31, 0.45 and 0.22 for differentiating BD, BD-I and BD-II from MDD, respectively. The optimal cutoff points of the MDQ for screening BD in Chinese patients originally diagnosed as MDD were considerably lower than those in earlier studies. The routine clinical use of the MDQ as a screening scale for BD in Chinese patients treated for MDD does not seem to be justified.
  Journal of affective disorders 03/2012; 141(1):40-6. · 3.76 Impact Factor
• Article: Undiagnosed bipolar disorder in patients treated for major depression in China.

  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
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  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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  Available from: Yiru Fang

  Article: Demographic and clinical features and prescribing patterns of psychotropic medications in patients with the melancholic subtype of major depressive disorder in China.

  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