Endogenous and exogenous cyclicity and temperament in bipolar disorder: Review, new data and hypotheses
In this special issue dedicated to Falret and the French contributions to the concept of cyclicity in manic depressive illness, we begin with a historical overview of the development of the concept of cyclicity and its fundamental significance in manic-depressive illness and we underscore how the concept fell into neglect only to reemerge in recent years. We then look at the intimate relationship between mania and depression. The hypothesis of the primacy of mania is discussed. The thesis is presented, supported by the examination of 100 consecutive index manias, that in most cases mania is triggered by external factors acting upon hyperthymic patients, determining an exogenous cyclicity. On the other hand, in BPII patients the temperamental mood instability (cyclothymia) is an inherent and decisive factor in determining the cyclic autonomous course of the disorder. Finally, a new distinction of Bipolar Disorders, based on premorbid temperament and course of the illness, is considered.
Available from: Chiara Rapinesi
- "While there is no evidence that oxcarbazepine interferes with CA, topiramate is well-known to inhibit several CA isoenzymes.64,65 It is unknown whether this has to do with a cyclical pattern of CA concentration, as such pattern has not been found to occur in the erythrocytes of healthy women during their menstrual cycle.66 However, acetazolamide proved to be effective in catamenial epilepsy, a condition that shares with PMDD its temporal pattern.49 "
[Show abstract] [Hide abstract]
ABSTRACT: The treatment of premenstrual dysphoric disorder (PMDD) is far from satisfactory, as there is a high proportion of patients who do not respond to conventional treatment. The antidiuretic sulfonamide, acetazolamide, inhibits carbonic anhydrase and potentiates GABAergic transmission; the latter is putatively involved in PMDD. We therefore tried acetazolamide in a series of women with intractable PMDD. Here, we describe a series of eight women diagnosed with DSM-IV-TR PMDD, five of whom had comorbidity with a mood disorder and one with an anxiety disorder, who were resistant to treatment and responded with symptom disappearance after being added-on 125 mg/day acetazolamide for 7-10 days prior to menses each month. Patients were free from premenstrual symptoms at the 12-month follow-up. We suggest that acetazolamide may be used to improve symptoms of PMDD in cases not responding to other treatments. GABAergic mechanisms may be involved in counteracting PMDD symptoms.
Available from: Gianni L Faedda
- "One of Koukopoulos' most important contributions to research on bipolar disorders was his theory of the 'primacy of mania' and excited states in the course of mood disorders. The theory arose in 1973 based on findings suggesting that depression could be avoided by suppressing mania in bipolar disorder patients (Koukopoulos et al. 2006 "
Available from: Michele Fornaro
- "These data are consistent with extensive literature pointing out (mostly on outpatient cases, however) the orthogonal relationship between hyperthymic temperaments and the depressive/cyclothymic/irritable/anxious temperament cluster. Such a dichotomous distribution mainly emerged from the results of the French national multisite collaborative study on the clinical epidemiology of mania (EPIMAN) (Akiskal et al., 2001; Azorin et al., 2008), of the Lebanese-based research groups (Karam et al., 2010), and of other groups worldwide (Aguiar Ferreira et al., 2013; Azorin et al., 2011; Koukopoulos et al., 2006; Lara et al., 2006; Walsh et al., 2012). Our study is the first to demonstrate that the orthogonal subdivision between hyperthymic and depressive/cyclothymic/ irritable/anxious temperaments is maintained also in mood disorder patients in acute relapse. "
[Show abstract] [Hide abstract]
ABSTRACT: The aim of this study was to assess whether different affective temperaments could be related to a specific mood disorder diagnosis and/or to different therapeutic choices in inpatients admitted for an acute relapse of their primary mood disorder.
Hundred and twenty-nine inpatients were consecutively assessed by means of the Structured and Clinical Interview for axis-I disorders/Patient edition and by the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego auto-questionnaire, Young Mania Rating Scale, Hamilton Scale for Depression and for Anxiety, Brief Psychiatry Rating Scale, Clinical Global impression, Drug Attitude Inventory, Barratt Impulsiveness Scale, Toronto Alexithymia Scale, and Symptoms Checklist-90 items version, along with records of clinical and demographic data.
The following prevalence rates for axis-I mood diagnoses were detected: bipolar disorder type I (BD-I, 28%), type II (31%), type not otherwise specified (BD-NOS, 33%), major depressive disorder (4%), and schizoaffective disorder (4%). Mean scores on the hyperthymic temperament scale were significantly higher in BD-I and BD-NOS, and in mixed and manic acute states. Hyperthymic temperament was significantly more frequent in BD-I and BD-NOS patients, whereas depressive temperament in BD-II ones. Hyperthymic and irritable temperaments were found more frequently in mixed episodes, while patients with depressive and mixed episodes more frequently exhibited anxious and depressive temperaments. Affective temperaments were associated with specific symptom and psychopathology clusters, with an orthogonal subdivision between hyperthymic temperament and anxious/cyclothymic/depressive/irritable temperaments. Therapeutic choices were often poorly differentiated among temperaments and mood states.
Cross-sectional design; sample size.
Although replication studies are needed, current results suggest that temperament-specific clusters of symptoms severity and psychopathology domains could be described.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.