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Raes, Filip, Ine Ghesquière, and Dinska Van Gucht. "Cognitive Reactivity to Success and Failure Relate Uniquely to Manic and Depression Tendencies and Combine in Bipolar Tendencies." Depression Research and Treatment 2012 (2012): 1–4. http://dx.doi.org/10.1155/2012/753946.
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The present study examined simultaneously the relations between cognitive reactivity to success and failure, on the one hand, and depression, manic, and bipolar tendencies, on the other hand. Participants (161 students) completed measures of success and failure reactivity, current manic and depressive symptoms, and tendencies towards depression, mania, and bipolarity. Results showed that respondents with a greater tendency towards depression evidenced greater (negative) reactivity to failure, whereas those with a greater tendency toward mania evidenced greater (positive) reactivity to success. Depression vulnerability was unrelated to success reactivity, and manic vulnerability was unrelated to failure reactivity. Tendencies toward bipolarity correlated significantly withbothfailure and success reactivity in a negative and positive manner, respectively. These findings add to the growing body of literature, suggesting that different features or cognitive tendencies are related to depression vulnerability versus manic vulnerability and imply that these “mirrored” cognitive features both form part of vulnerability to bipolar disorder.
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MURPHY, F. C., B. J. SAHAKIAN, J. S. RUBINSZTEIN, et al. "Emotional bias and inhibitory control processes in mania and depression." Psychological Medicine 29, no. 6 (1999): 1307–21. http://dx.doi.org/10.1017/s0033291799001233.
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Background. Despite markedly different clinical presentations, few studies have reported differences in neuropsychological functioning between mania and depression. The disinhibited behaviour characteristic of mania and evidence that subgenual prefrontal cortex is differentially activated in mania and depression both suggest that dissociable deficits will emerge on tasks that require inhibitory control and are subserved by ventromedial prefrontal cortex.Methods. Manic patients and controls undertook computerized neuropsychological tests of memory and planning ability. In addition, manic and depressed patients were directly compared with controls on a novel affective shifting task that requires inhibitory control over different components of cognitive and emotional processing.Results. Manic patients were impaired on tests of memory and planning. Importantly, affective shifting performance of manic patients differed from that of depressed patients. Manic patients were impaired in their ability to inhibit behavioural responses and focus attention, but depressed patients were impaired in their ability to shift the focus of attention. Depressed patients exhibited an affective bias for negative stimuli, and we believe this to be the first demonstration of an affective bias for positive stimuli in manic patients.Conclusions. Observed impairments on tests of memory and planning suggest a global pathology for mania consistent with previous profiles for this disorder and similar to established profiles for depression. The results on the affective shifting task demonstrate the presence of mood-congruent bias and dissociable components of inhibitory control in mania and depression. Against a background of memory and planning impairments in the two groups, these findings are consistent with a role for the ventromedial prefrontal cortex in mediating mood–cognition relationships.
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Benazzi, Franco. "Reviewing the diagnostic validity and utility of mixed depression (depressive mixed states)." European Psychiatry 23, no. 1 (2008): 40–48. http://dx.doi.org/10.1016/j.eurpsy.2007.07.003.
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AbstractObjectiveTo review the diagnostic validity and utility of mixed depression, i.e. co-occurrence of depression and manic/hypomanic symptoms.MethodsPubMed search of all English-language papers published between January 1966 and December 2006 using and cross-listing key words: bipolar disorder, mixed states, criteria, utility, validation, gender, temperament, depression-mixed states, mixed depression, depressive mixed state/s, dysphoric hypomania, mixed hypomania, mixed/dysphoric mania, agitated depression, anxiety disorders, neuroimaging, pathophysiology, and genetics. A manual review of paper reference lists was also conducted.ResultsBy classic diagnostic validators, the diagnostic validity of categorically-defined mixed depression (i.e. at least 2–3 manic/hypomanic symptoms) is mainly supported by family history (the current strongest diagnostic validator). Its diagnostic utility is supported by treatment response (negative effects of antidepressants). A dimensionally-defined mixed depression is instead supported by a non-bi-modal distribution of its intradepression manic/hypomanic symptoms.DiscussionCategorically-defined mixed depression may have some diagnostic validity (family history is the current strongest validator). Its diagnostic utility seems supported by treatment response.
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Sharp, Susan L. "Depression and Manic Depression." Journal of Psychosocial Nursing and Mental Health Services 41, no. 11 (2003): 51. http://dx.doi.org/10.3928/0279-3695-20031101-16.
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Lester, David. "Comment on “Manic—Depressiveness and its Correlates”." Psychological Reports 85, no. 3 (1999): 1057–58. http://dx.doi.org/10.2466/pr0.1999.85.3.1057.
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Data from a sample of 612 college students showed that the Depression subscale of the Manic–Depressiveness Scale had greater internal reliability than the Mania subscale. Furthermore, correlates of the total scale score did nor appear to provide as useful information as use of the Depression and Mania subscales separately.
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MURPHY, F. C., J. S. RUBINSZTEIN, A. MICHAEL, et al. "Decision-making cognition in mania and depression." Psychological Medicine 31, no. 4 (2001): 679–93. http://dx.doi.org/10.1017/s0033291701003804.
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Background. Despite markedly different clinical presentations, few studies have reported differences in neuropsychological functioning between mania and depression. Recent work has suggested that differences may emerge on cognitive tasks requiring affective processing, such as decision-making. The present study sought to compare decision-making cognition in mania and depression in order to clarify the current profiles of impairment for these disorders and to contribute to our more general understanding of the relationship between mood and cognition.Methods. Medicated manic patients, depressed patients, and normal healthy controls completed a computerized decision-making task. All subjects were asked to win as many points as possible by choosing outcomes based on variably-weighted probabilities and by placing ‘bets’ on each decision.Results. Both patient groups were impaired on this task, as evidenced by slower deliberation times, a failure to accumulate as many points as controls and suboptimal betting strategies. Manic, but not depressed, patients made suboptimal decisions – an impairment that correlated with the severity of their illness.Conclusions. These findings are consistent with a growing consensus that manic and depressed patients are characterized by significant impairments in cognitive and particularly executive, functioning. Furthermore, the distinct patterns of observed impairment in manic and depressed patients suggests that the nature and extent of cognitive impairment differ between these two groups. Viewed in the context of other recent studies, these findings are consistent with a role for the ventromedial prefrontal cortex in mediating mood–cognition relationships.
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Henry, Chantal, Joel Swendsen, Donatienne Van den Bulke, Frederic Sorbara, Jacques Demotes-Mainard, and Marion Leboyer. "Emotional hyper-reactivity as a fundamental mood characteristic of manic and mixed states." European Psychiatry 18, no. 3 (2003): 124–28. http://dx.doi.org/10.1016/s0924-9338(03)00041-5.
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AbstractBackgroundThe relationship between depression and mania remains poorly understood and is responsible for much of the confusion about mixed states. The difficulty in conceptualizing opposite states such as euphoric and depressive moods during the same episode may account for the considerable differences in reported frequencies of mixed states, among acutely manic patients. It is possible that the fundamental mood characteristic of mania is not tonality of mood (e.g. euphoric, irritable or depressed mood), but rather the intensity of emotions.MethodsWe interviewed 30 patients hospitalized for a manic episode, asking about their symptoms during the episode, using the list of symptoms for manic and depressive episode of the DSM-IV criteria. Emotional hyper-reactivity, defined as an increase in the intensity of all emotions, was assessed using the Hardy Scale. Manic symptoms were also assessed by a clinician using the Beck–Rafaelsen Mania Scale.ResultsThis study showed that most of the manic episodes presented many dysphoric symptoms, more particularly depressive mood (33%), irritability (53%), anxiety (76%), and recurrent thoughts of death or suicidal ideation (33%). However, only 10% of our sample met the criteria for mixed state. The other symptoms reported by patients and included in the DSM-IV criteria for depressive mood are common between depressive and manic episodes. All patients (100%) reported that they felt all their emotions with an unusual intensity.ConclusionsWe suggest that the most appropriate way to define mood in manic states is as a function of intensity, and not as a function of tonality. This definition circumvents the arbitrary dichotomy between mania and mixed state. With this definition, manic episodes can be described as being more or less dysphoric, with the actual characteristics of dysphoria encompassing irritability, anxiety, or depressive affect. This point could be extremely helpful in discriminating mixed state or dysphoric mania from depression.
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Pitt, Brice. "Manic depression psychosis." Psychiatric Bulletin 16, no. 2 (1992): 105–6. http://dx.doi.org/10.1192/pb.16.2.105-b.
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Serra, Giulia, Maria Elena Iannoni, Monia Trasolini, et al. "Characteristics Associated with Depression Severity in 270 Juveniles in a Major Depressive Episode." Brain Sciences 11, no. 4 (2021): 440. http://dx.doi.org/10.3390/brainsci11040440.
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Introduction: Severe depression is prevalent in young persons and can lead to disability and elevated suicidal risk. Objectives: To identify clinical and demographic factors associated with the severity of depression in juveniles diagnosed with a major mood disorder, as a contribution to improving clinical treatment and reducing risk of suicide. Methods: We analyzed factors associated with depression severity in 270 juveniles (aged 6–18 years) in a major depressive episode, evaluated and treated at the Bambino Gesù Children’s Hospital of Rome. Depressive symptoms were rated with the revised Children’s Depression Rating Scale (CDRS-R) and manic symptoms with the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) Mania Rating Scale (K-SADS-MRS). Bivariate comparisons were followed by multivariable linear regression modeling. Results: Depression severity was greater among females than males (55.0 vs. 47.2), with the diagnosis of a major depressive disorder (MDD) vs. bipolar disorder (BD; 53.8 vs. 49.3), and tended to increase with age (slope = 1.14). Some symptoms typical of mania were associated with greater depression severity, including mood lability, hallucinations, delusions, and irritability, whereas less likely symptoms were hyperactivity, pressured speech, grandiosity, high energy, and distractibility. Factors independently and significantly associated with greater depression severity in multivariable linear regression modeling were: MDD vs. BD diagnosis, female sex, higher anxiety ratings, mood lability, and irritability. Conclusions: Severe depression was significantly associated with female sex, the presence of some manic or psychotic symptoms, and with apparent unipolar MDD. Manic/psychotic symptoms should be assessed carefully when evaluating a juvenile depressive episode and considered in treatment planning in an effort to balance risks of antidepressants and the potential value of mood-stabilizing and antimanic agents to decrease the severity of acute episodes and reduce suicidal risk.
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Kwok, Cecilia Sze Nga, and Leslie Eng Choon Lim. "Mania following antidepressant discontinuation in depression: two case reports." Australasian Psychiatry 25, no. 6 (2017): 617–21. http://dx.doi.org/10.1177/1039856217732470.
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Objective: Antidepressant-induced mania and an antidepressant discontinuation syndrome are well documented, whereas mania occurring after antidepressant cessation has been infrequently reported. Method: We describe antidepressant discontinuation-related mania in two Chinese patients, as well as a review of the literature on this phenomenon in unipolar depression. Results: A 72-year-old man and a 65-year-old woman had late-onset depression with vascular risk factors, but no personal or family history of mood disorders. Manic symptoms started after stopping escitalopram and venlafaxine during depressive relapse, and resolved with the initiation of olanzapine and valproate. In the literature, 29 episodes of antidepressant discontinuation-related mania were reported. Tricyclic antidepressants were most frequently implicated, followed by selective serotonin reuptake inhibitors. There was spontaneous resolution of manic symptoms in half of the cases. Conclusion: This is the first report of antidepressant discontinuation-related mania in an Asian population, in the setting of late-onset depression. This phenomenon is rare and is amenable to standard treatment.
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Bauer, Mark S., Gregory E. Simon, Evette Ludman, and Jurgen Unützer. "‘Bipolarity’ in bipolar disorder: Distribution of manic and depressive symptoms in a treated population." British Journal of Psychiatry 187, no. 1 (2005): 87–88. http://dx.doi.org/10.1192/bjp.187.1.87.
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SummaryCross-sectional analysis of 441 individuals with bipolar disorder treated at a US health maintenance organisation investigated the distribution of manic and depressive symptoms in that illness. Clinically significant depressive symptoms occurred in 94.1% of those with (hypo)mania, while70.1% inadepressive episode had clinically significant manic symptoms. DSM-unrecognised depression-plus-hypomania was over twice as prevalent as DSM-recognised mixed episodes. Depressive symptoms were unimodally distributed in (hypo)mania. Depressive and manic symptoms were positively, not inversely correlated, and their co-occurrence was associated with worse quality of life. Implications for the DSM and ICD nosological systems are discussed.
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McKeon, Patrick, Patrick Manley, and Gregory Swanwick. "Manic-depressive illness — I: clinical characteristics of bipolar disorder subtypes." Irish Journal of Psychological Medicine 9, no. 1 (1992): 6–9. http://dx.doi.org/10.1017/s0790966700013823.
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AbstractThe clinical and demographic features of 100 bipolar disorder patients, who were categorised into bipolar I, bipolar II, unipolar mania and rapid cycling groups, and who were further classified on the basis of the sequence of occurrence of the manic and depressive episodes within each cycle, are compared. Bipolar I (including unipolar manic) patients, 77% of whom had a sequence of moods where mania preceded depression (Mania-Depression – normothymic Interval: M.D.I.) constituted 69% of the total sample. Six per cent were classified as bipolar II and 25% has a rapid cycling disorder. Patients who had an M.D.I. sequence of moods, whether rapid or non-rapid cycling, had a younger age of onset, a higher male:female ratio and a stronger family history of bipolar disorder than patients whose depression preceded mania (D.M.I.). Unipolar manic patients, 12% of the sample, had a comparable age of onset, a greater family history of bipolarity and more frequent hospitalisations than the bipolar I-M.D.I. group. Rapid cycling patients had a lower mean serum thyroxine concentration than the non-rapid cycling bipolar disorder patients. This study supports the rationale for distinguishing bipolar patients with an M.D.I, sequence from those with a D.M.I, pattern and rapid cyclers from non-rapid cyclers.
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Silva, Rafael de Assis da, Daniel C. Mograbi, Luciana Angélica Silva Silveira, et al. "Mood self-assessment in bipolar disorder: a comparison between patients in mania, depression, and euthymia." Trends in Psychiatry and Psychotherapy 35, no. 2 (2013): 141–45. http://dx.doi.org/10.1590/s2237-60892013000200008.
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BACKGROUND: Some studies indicate that mood self-assessment is more severely impaired in patients with bipolar disorder in a manic episode than in depression. OBJECTIVES: To investigate variations in mood self-assessment in relation to current affective state in a group of individuals with bipolar disorder. METHODS: A total of 165 patients with a diagnosis of bipolar disorder type I or type II had their affective state assessed using the Clinical Global Impressions Scale for use in bipolar illness (CGI-BP), the Positive and Negative Syndrome Scale (PANSS), and the Global Assessment of Functioning (GAF). In addition, participants completed a self-report visual analog mood scale (VAMS). Patients were divided into three groups (euthymia, mania, and depression) and compared with regard to VAMS results. RESULTS: Manic patients rated their mood similarly to patients in euthymia in 14 out of 16 items in the VAMS. By contrast, depressed patients rated only two items similarly to euthymic patients. CONCLUSION: Patients with bipolar disorder in mania, but not those in depression, poorly evaluate their affective state, reinforcing the occurrence of insight impairment in the manic syndrome.
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Coryell, William, Martin Keller, Jean Endicott, Nancy Andreasen, Paula Clayton, and Robert Hirschfeld. "Bipolar II illness: course and outcome over a five-year period." Psychological Medicine 19, no. 1 (1989): 129–41. http://dx.doi.org/10.1017/s0033291700011090.
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SynopsisA five year semi-annual follow-up of patients with non-bipolar (N = 442), bipolar II (N = 64) and bipolar I (N = 53) major depression tracked the courses of prospectively observed major depressive, hypomanic and manic syndromes. In all three groups, depression was much more likely in any given week than was hypomania or mania. However, during the majority of weeks, no full syndrome was present and none of the groups exhibited evidence of continuing psychosocial deterioration. Though all three groups exhibited similar times to recovery from index and subsequent major depressive episodes, both bipolar groups had substantially higher relapse rates and developed more episodes of major depression, hypomania and mania. The two bipolar groups, in turn, differed by the severity of manic-like syndromes and thus remained diagnostically stable; the bipolar II patients were much less likely to develop full manic syndromes or to be hospitalized during follow-up. In conjunction with family study data showing that bipolar II disorder breeds true, these data support the separation of bipolar I and bipolar II affective disorder.
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Bebbington, Paul. "Perspectives on manic depression: a survey of the Manic Depression Fellowship." Psychiatric Bulletin 20, no. 8 (1996): 489. http://dx.doi.org/10.1192/pb.20.8.489.
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Chatterton, Mary Lou, Emily Stockings, Michael Berk, Jan J. Barendregt, Rob Carter, and Cathrine Mihalopoulos. "Psychosocial therapies for the adjunctive treatment of bipolar disorder in adults: Network meta-analysis." British Journal of Psychiatry 210, no. 5 (2017): 333–41. http://dx.doi.org/10.1192/bjp.bp.116.195321.
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BackgroundFew trials have compared psychosocial therapies for people with bipolar affective disorder, and conventional meta-analyses provided limited comparisons between therapies.AimsTo combine evidence for the efficacy of psychosocial interventions used as adjunctive treatment of bipolar disorder in adults, using network meta-analysis (NMA).MethodSystematic review identified studies and NMA was used to pool data on relapse to mania or depression, medication adherence, and symptom scales for mania, depression and Global Assessment of Functioning (GAF).ResultsCarer-focused interventions significantly reduced the risk of depressive or manic relapse. Psychoeducation alone and in combination with cognitive–behavioural therapy (CBT) significantly reduced medication non-adherence. Psychoeducation plus CBT significantly reduced manic symptoms and increased GAF. No intervention was associated with a significant reduction in depression symptom scale scores.ConclusionsOnly interventions for family members affected relapse rates. Psychoeducation plus CBT reduced medication non-adherence, improved mania symptoms and GAF. Novel methods for addressing depressive symptoms are required.
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Van der Gucht, Emma, Richard Morriss, Gill Lancaster, Peter Kinderman, and Richard P. Bentall. "Psychological processes in bipolar affective disorder: negative cognitive style and reward processing." British Journal of Psychiatry 194, no. 2 (2009): 146–51. http://dx.doi.org/10.1192/bjp.bp.107.047894.
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BackgroundPsychological processes in bipolar disorder are of both clinical and theoretical importance.AimsTo examine depressogenic psychological processes and reward responsivity in relation to different mood episodes (mania, depression, remission) and bipolar symptomatology.MethodOne hundred and seven individuals with bipolar disorder (34 in a manic/hypomanic or mixed affective state; 30 in a depressed state and 43 who were euthymic) and 41 healthy controls were interviewed with Structured Clinical Interview for DSM–IV and completed a battery of self-rated and experimental measures assessing negative cognitive styles, coping response to negative affect, self-esteem stability and reward responsiveness.ResultsIndividuals in all episodes differed from controls on most depression-related and reward responsivity measures. However, correlational analyses revealed clear relationships between negative cognitive styles and depressive symptoms, and reward responsivity and manic symptoms.ConclusionsSeparate psychological processes are implicated in depression and mania, but cognitive vulnerability to depression is evident even in patients who are euthymic.
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Uher, R., O. Mantere, K. Suominen, and E. Isometsä. "Typology of clinical course in bipolar disorder based on 18-month naturalistic follow-up." Psychological Medicine 43, no. 4 (2012): 789–99. http://dx.doi.org/10.1017/s0033291712001523.
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BackgroundIndividual variation in the clinical course of bipolar disorder may have prognostic and therapeutic implications but is poorly reflected in current classifications. We aimed to establish a typology of the individual clinical trajectories based on detailed prospective medium-term follow-up.MethodLatent class analysis (LCA) of nine characteristics of clinical course (time depressed, severity of depression, stability of depression, time manic, severity of mania, stability of mania, mixed symptoms, mania-to-depression and depression-to-mania phase switching) derived from life charts prospectively tracking the onsets and offsets of (hypo)manic, depressive, mixed and subsyndromal episodes in a representative sample of 176 patients with bipolar disorder.ResultsThe best-fitting model separated patients with bipolar disorder into large classes of episodic bipolar (47%) and depressive type (32%), moderately sized classes characterized by prolonged hypomanias (10%) and mixed episodes (5%) and five small classes with unusual course characteristics including mania-to-depression and depression-to-mania transitions and chronic mixed affective symptoms. This empirical typology is relatively independent of the distinction between bipolar disorder type I and type II. Lifetime co-morbidity of alcohol use disorders is characteristic of the episodic bipolar course type.ConclusionsThere is potential for a new typology of clinical course based on medium-term naturalistic follow-up of a representative clinical sample of patients with bipolar disorder. Predictive validity and stability over longer follow-up periods remain to be established.
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Chen, Chih-Ken, Lawrence Shih-Hsin Wu, Ming-Chyi Huang, Chian-Jue Kuo, and Andrew Tai-Ann Cheng. "Antidepressant Treatment and Manic Switch in Bipolar I Disorder: A Clinical and Molecular Genetic Study." Journal of Personalized Medicine 12, no. 4 (2022): 615. http://dx.doi.org/10.3390/jpm12040615.
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Affective switch is an important clinical issue when treating bipolar disorder. Though commonly seen in clinical practice, the benefits of prescribing antidepressants for bipolar depression are still controversial. To date, there have been few genetic studies and no genome-wide association study (GWAS), focusing on manic switch following bipolar depression. This study aims to investigate the effects of individual genomics and antidepressant medication on the risk of manic switch in bipolar I disorder (BPI). A total of 1004 patients with BPI who had at least one depressive episode with complete data on antidepressant treatment and outcome were included. Clinical assessment of mania and depression was performed by trained psychiatric nurses and psychiatrists using the Chinese version of the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), and the diagnosis of BPI was made according to DSM-IV criteria. Manic switch was defined as a manic episode occurring within eight weeks of remission from an acute depressive episode. The age at first depressive episode of the study patients was 30.7 years (SD 12.5) and 56% of all patients were female. GWAS was carried out in a discovery group of 746 patients, followed by replication in an independent group of 255 patients. The top SNP rs10262219 on chromosome 7 showed the strongest allelic association with manic switch (p = 2.21 × 10−7) in GWAS, which was however not significantly replicated. Antidepressant treatment significantly (odds ratio 1.7; 95% CI 1.3–2.2; p < 0.001) increased the risk of manic switch. In logistic regression analysis, the CC genotype of rs10262219 (odds ratio 3.0; 95% CI 1.7–5.2) and antidepressant treatment (odds ratio 2.3; 95% CI 1.4–3.7) significantly increased the risk of manic switch with a joint effect (odds ratio 5.9; 95% CI 3.7–9.4). In conclusion, antidepressant medication and rs10262219 variants jointly increased the risk of manic switch after bipolar depression.
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Prakash, Om, Channaveerachari Naveen Kumar, P. T. Shivakumar, Srikala Bharath, and Mathew Varghese. "Clinical presentation of mania compared with depression: data from a geriatric clinic in India." International Psychogeriatrics 21, no. 4 (2009): 764–67. http://dx.doi.org/10.1017/s1041610209009466.
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ABSTRACTBackground: This retrospective chart review evaluated a comparison of the clinical profiles of older outpatients having mania and those with unipolar depression.Methods: The charts of elderly outpatients with mania and unipolar depression in tertiary care settings were reviewed and relevant information incorporated regarding clinical presentation, past and family history of affective disorder, treatment history and previous psychiatric and neurological history.Results: Charts for 30 patients with mania (23 men and 7 women with mean (±SD) age of 68.5(± 5.75 years) and 92 with depression (47 men and 45 women with mean (±SD) age of 68.18 (±6.0 years) were evaluated. Fifteen patients (50%) with manic episodes had psychotic symptoms in the form of delusions and hallucinations while only 33 (35.8%) depressed patients had psychotic symptoms. One-third of manic patients received mood stabilizers at index visit. More than half (n = 16; 53.3%) of the patients in the mania group were prescribed antipsychotic medications. On cognitive functions, patients with manic episodes scored poorly compared with those with depression.Conclusions: These findings suggest that mania in the elderly is a severe form of affective disorder with respect to psychotic and cognitive symptoms. Conclusions from this study are limited due to its retrospective design. Further studies in this area are warranted.
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Finucane, Lucy, Gabriele Jordan, and Thomas D. Meyer. "Risk for Mania and its Relationship to Implicit and Explicit Achievement Motivation." Journal of Individual Differences 34, no. 4 (2013): 214–21. http://dx.doi.org/10.1027/1614-0001/a000117.
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There is evidence that bipolar disorders are associated with achievement-related cognitions such as setting high goals. A psychodynamic model, the manic defense hypothesis, postulates that a threat to fragile self-esteem triggers grandiosity and manic behaviors in vulnerable people. Vulnerability to bipolar disorders should therefore be positively associated with indicators of explicit hope of success (HS) and implicit fear of failure (FF). Using an online sample (n = 252), we tested these hypotheses using the well-validated Hypomanic Personality Scale as risk indicator for mania, the Multi-Motive Grid for achievement motivation, controlling for current and lifetime depression. Contrary to expectations, we found that vulnerability for mania was significantly and positively related to implicit HS but not to FF after controlling for depression. All measures were self-report tools. Our results contradict the Manic Defense Hypothesis, but they are in line with the idea that achievement-related cognitions are of relevance to vulnerability in bipolar disorders. This is in line with research focusing on the role of the Behavioral Activation System in relation to vulnerability for mania.
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McIntyre, Roger S., Trisha Suppes, Willie Earley, Mehul Patel, and Stephen M. Stahl. "Cariprazine efficacy in bipolar I depression with and without concurrent manic symptoms: post hoc analysis of 3 randomized, placebo-controlled studies." CNS Spectrums 25, no. 4 (2019): 502–10. http://dx.doi.org/10.1017/s1092852919001287.
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AbstractObjective.Mixed presentations, defined by simultaneous occurrence of depressive and manic symptoms, are difficult to treat. Antidepressants, although commonly used, have weak evidence of efficacy and may increase risk of mood destabilization. The aim of this pooled post hoc analysis was to evaluate the efficacy of cariprazine in the treatment of bipolar depression with or without concurrent manic symptoms.Methods.Patients from 3 randomized, double-blind, placebo-controlled studies who met DSM-IV-TR or DSM-5 criteria for bipolar I disorder with a current major depressive episode were identified to have concurrent manic symptoms by baseline Young Mania Rating Scale total score ≥4. Efficacy was assessed in cariprazine 1.5 and 3 mg/day dose groups versus placebo; analyses included the least squares mean change from baseline to week 6 in Montgomery-Åsberg Depression Rating Scale (MADRS) total score.Results.Of 1383 patients randomized to treatment, 808 (58.4%) had concurrent manic symptoms. For patients with manic symptoms, mean reduction in MADRS total score from baseline to week 6 was significantly greater for both cariprazine 1.5 and 3 mg/day compared with placebo, with least squares mean differences (LSMDs) versus placebo of −2.5 (p = .0033) and −2.9 (p = .0010), respectively; for patients without manic symptoms, the LSMD was significant for 1.5 mg/day (−3.3; p = .0008), but not for 3 mg/day (−1.9; p = .0562).Conclusion.The results of this post hoc analysis suggest that cariprazine may be an appropriate treatment option for patients with bipolar I depression with or without manic symptoms, with higher doses potentially more effective in patients with manic symptoms.
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Alger, Ian. "Manic-Depression, Depression, and Adolescent Suicide." Psychiatric Services 40, no. 4 (1989): 347–49. http://dx.doi.org/10.1176/ps.40.4.347.
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Weisberg, Robert W. "Genius and Madness?: A Quasi-Experimental Test of the Hypothesis That Manic-Depression Increases Creativity." Psychological Science 5, no. 6 (1994): 361–67. http://dx.doi.org/10.1111/j.1467-9280.1994.tb00286.x.
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Much evidence has been adduced to support the view, originally proposed by Kraepelin, that mania increases creativity Examples of supporting evidence are findings of similarity in thought between creative persons and manic-depressives and high creativity in normal relatives of manic-depressives However, such data are correlational and are therefore equivocal concerning the hypothesis that mania is a cause of increased creativity The present study analyzed the relationship between mood and productivity in the career of composer Robert Schumann, who has been diagnosed as bipolar Schumann's positive mood was related to increased quantity of his work but not to increased quality, indicating that mania did not increase creativity of thought processes
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Rittmannsberger, H., and G. Malsiner-Walli. "P01-244-Mood-dependent changes of serum lithium concentration in a rapid cycling patient maintained on stable doses of lithium carbonate." European Psychiatry 26, S2 (2011): 245. http://dx.doi.org/10.1016/s0924-9338(11)71955-1.
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IntroductionSerum concentration of lithium may change according to mood states in bipolar patients, leading to reduced serum levels of lithium during manic periods.Objective/aimsDocumentation of mood states and serum lithium levels in a rapid cycling patientMethodsWe report about a 58 year old female patient with rapid cycling disorder whose mood altered every 20 to 30 days. No treatment has been effective until now. The patient is treated with a stable combination of clozapine 200mg, valproate 1500mg and lithium carbonate 450mg. Noncompliance can be ruled out since intake of medication is supervised. For 13 months a mood diary was performed by a relative using a simple scale for mood which rated neutral mood with 0, mania with +1, +2 and +3 (highest mania) and depression from -1 to -3 (deepest depression). Lithium levels were obtained first on a monthly, later on a weekly to two-weekly basis.ResultsOver a period of 13 months 7 depressive and 6 manic phases could be observed. The patient spent 230 (48%) days in depression (8 lithium samples obtained), 137 (29%) in mania (11 samples) and was euthymic on 68 (16%) days (2 samples). Mean lithium serum levels were 0.68mmol/l in depressive states, 0.37 mmol/l in manic states (p = .001, t-test). The lowest value was 0.13 mmol/l (in mania) and the highest 0.93 mmol/l (in depression).ConclusionsIn this patient mood-dependent changes of serum lithium levels during constant medication could be demonstrated. The reasons for this phenomenon are yet to be elucidated.
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Carroll, B. J. "Brain mechanisms in manic depression." Clinical Chemistry 40, no. 2 (1994): 303–8. http://dx.doi.org/10.1093/clinchem/40.2.303.
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Abstract Manic depressive illness (bipolar disorder) is the mood disorder classically considered to have a strong biological basis. During manic depressive cycles, patients show dramatic fluctuations of mood, energy, activity, information processing, and behaviors. Theories of brain function and mood disorders must deal with the case of bipolar disorder, not simply unipolar depression. Shifts in the nosologic concepts of how manic depression is related to other mood disorders are discussed in this overview, and the renewed adoption of the Kraepelinian "spectrum" concept is recommended. The variable clinical presentations of manic depressive illness are emphasized. New genetic mechanisms that must be considered as candidate factors in relation to this phenotypic heterogeneity are discussed. Finally, the correlation of clinical symptom clusters with brain systems is considered in the context of a three-component model of manic depression.
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Nierenberg, A. A., J. Tsai, Y. Mao, A. Pikalov, T. Suppes, and A. Loebel. "Efficacy Of Lurasidone In Major Depression With Mixed Features: Pattern Of Improvement In Depressive And Manic Symptoms." European Psychiatry 33, S1 (2016): S423. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1525.
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IntroductionEvidence indicates that manic symptoms, below the threshold for hypomania (mixed features), are common in individuals with major depressive disorder (MDD).Objectives/aimsTo evaluate the effect of lurasidone on specific depressive and manic symptoms, based on Montgomery Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS) items, in patients with MDD with mixed features.MethodsPatients meeting DSM-IV-TR criteria for MDD, who presented with 2–3 protocol-specified manic symptoms, were randomized to 6 weeks of double-blind treatment with lurasidone monotherapy 20–60 mg/d (n = 109) or placebo (n = 100). Change from baseline in the MADRS total, MADRS-6 core depression subscale, individual MADRS items, and total and individual items of the YMRS were analyzed by MMRM, and Cohen's d effect sizes (d) were calculated for week 6 change scores.ResultsLurasidone improved depressive symptoms at week 6 in the MADRS total score (–20.5 vs. –13.0; P < 0.0001; d = 0.8) and MADRS-6 core depression score (–13.0 vs. –8.5; P < 0.0001; d = 0.7). Significant improvement on lurasidone was observed at week 6 on all ten MADRS items (d = 0.36–0.78). Effect sizes for the MADRS-6 core depression subscale items ranged from 0.36 to 0.78 at week 6. Treatment with lurasidone was associated with significantly greater week 6 improvement on the YMRS (–7.0 vs. –4.9; P < 0.0001). Effect sizes for the 5 YMRS items with baseline item severity ≥ 2 ranged from 0.32 to 0.48.ConclusionsIn this study of MDD with mixed features, lurasidone was effective in treating the range of depressive and manic symptoms that patients presented with.Sponsored by Sunovion Pharmaceuticals Inc.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Hu, Li-Yu, Chen-Jee Hong, Shih-Jen Tsai, and Cheng-Che Shen. "Rechallenge with Amisulpride in a Patient with Schizophrenia following a Manic Episode during Previous Therapy." Case Reports in Psychiatry 2022 (May 16, 2022): 1–3. http://dx.doi.org/10.1155/2022/8732708.
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Amisulpride is an atypical antipsychotic. It is also effective in treating depression. The potential antidepressant effect raises the concern that amisulpride can induce mania. However, reports of amisulpride-induced mania have been rare. Here, we present the case of a Taiwanese woman with a 22-year history of schizophrenia. At the age 57 years, she developed manic symptoms while on treatment with amisulpride for six weeks. She was immediately admitted to the psychiatric in-patient unit. The manic symptoms completely subsided within eight days without the administration of any mood stabilizer. Readministration of a single dose of 200 mg amisulpride during hospitalization induced the same manic symptoms, which remitted completely within 24 hours without any mood stabilizer administration.
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Thalbourne, Michael A., and Darryl L. Bassett. "The Manic Depressiveness Scale: A Preliminary Effort at Replication and Extension." Psychological Reports 83, no. 1 (1998): 75–80. http://dx.doi.org/10.2466/pr0.1998.83.1.75.
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In a previous paper, an 18-item scale was presented to measure the extent to which a person had experienced symptoms resembling mania or clinical depression. There was evidence that, within a group of 37 bipolar persons, scores on this Manic Depressiveness Scale correlated significantly positively with number of manic-depression-relevant medications currently being taken by the subject. In the present study, 24 subjects (9 unipolar depressives, 15 bipolars) were administered this scale, and aspects of their clinical history were taken. For the bipolar subjects only, scores on the scale correlated significantly with number of relevant medications ( r = .45, p <.05, one-tailed), with number of hospitalizations ( r = .46, p<.05), and with psychiatrist-rated severity of illness ( r = .45, p<.05). Bipolar patients also scored significantly higher than did unipolar patients on the Manic Experience subscale. The Manic Depressiveness Scale thus appears to have some predictive validity.
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Bower, B. "Gene for Manic Depression?" Science News 131, no. 9 (1987): 132. http://dx.doi.org/10.2307/3971369.
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Hook, Derek. "What is manic-depression?" Psychodynamic Practice 23, no. 3 (2016): 314–16. http://dx.doi.org/10.1080/14753634.2016.1266690.
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&NA;. "Lithium and Manic Depression." International Clinical Psychopharmacology 5, no. 1 (1990): 78–79. http://dx.doi.org/10.1097/00004850-199001000-00021.
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Strober, M. "Manic depression in youth." Biological Psychiatry 42, no. 1 (1997): 81S. http://dx.doi.org/10.1016/s0006-3223(97)87202-2.
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NORTH, C. S. "Manic Depression and Creativity." American Journal of Psychiatry 157, no. 4 (2000): 657. http://dx.doi.org/10.1176/appi.ajp.157.4.657.
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HOLDEN, C. "Manic Depression and Creativity." Science 233, no. 4765 (1986): 725. http://dx.doi.org/10.1126/science.233.4765.725.
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Baron, M. "Genes and manic depression." Psychiatric Genetics 7, no. 1 (1997): 49. http://dx.doi.org/10.1097/00041444-199700710-00009.
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Sclare, Paul, and Francis Creed. "Life Events and the Onset of Mania." British Journal of Psychiatry 156, no. 4 (1990): 508–14. http://dx.doi.org/10.1192/bjp.156.4.508.
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Thirty manic in-patients were interviewed in hospital using the LEDS, and 24 were re-interviewed 6–12 months after discharge. Data for life events were analysed by: comparing events before onset of mania and before re-interview; and comparing these manic patients with patients in other studies which examined life events and the onset of schizophrenia and depression. No relationship was found between life events and the onset of mania in this preliminary study. Previous studies reporting a link between events and the onset of mania have serious methodological flaws, and definitive data have yet to be produced.
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Serra, G., M. P. Casini, V. Maggiore, R. J. Baldessarini, and S. Vicari. "Factors Associated with Depression Severity in Adolescence." European Psychiatry 41, S1 (2017): S224. http://dx.doi.org/10.1016/j.eurpsy.2017.01.2219.
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IntroductionSevere depression is greatly impairing during adolescence and involves a high risk for suicidal behaviors.Objectives and aimsIdentify clinical and demographic factors associated with severity of depression in adolescents diagnosed with a major mood disorder so as to improve clinical treatment and prevent suicidal behaviors.MethodsWe analyzed factors associated with depression severity in 145 severely ill adolescents diagnosed with a major affective disorder using the K-SADS (Kiddie-Schedule for Affective Disorders and Schizophrenia) at the Mood Disorder Outpatient Program of Bambino Gesù Children's Hospital (Rome). Depressive and manic symptoms were rated with the CDRS-R (Children's Depression Rating Scale-Revised) and K-SADS-MRS (Mania Rating Scale), respectively. Bivariate comparisons were followed by multivariable linear regression modeling.ResultsDepression severity was greater among females than males (mean CDRS scores: 53.0 vs. 42.8; P < 0.0001) and with major depressive versus bipolar disorder diagnosis (50.4 vs. 45.4; P = 0.001). Manic symptoms, including irritability, mood lability, crowded thoughts, delusions, and insomnia, were more likely with more severe depression; their number and severity correlated with CDRS-R total score (respectively, β = 1.53 and 5.44;both P < 0.0001). Factors independently and significantly associated with CDRS-R depression score in multivariate modeling were:– presence of suicidal ideation;– absence of ADHD;– female sex;– greater number of manic symptoms.ConclusionsSevere depression was associated with manic symptoms and with suicidal ideation among adolescents diagnosed with either bipolar or major depressive disorders. This relationship should be considered in treatment planning and suicide prevention, including consideration of mood-stabilizing and antimanic agents in the treatment of severe adolescent depression.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Wahi, Monika M., Robert C. Skeate, Steven B. Goldin, and Carlos A. Santana. "A Second Case Report of Lleuprolide Acetate for Depot Suspension-Induced Mania." CNS Spectrums 15, no. 10 (2010): 603–6. http://dx.doi.org/10.1017/s1092852912000041.
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AbstractThis is the second published case report of Lleuprolide acetate for depot suspension (LD)-induced mania. Both reports detail a patient with a prior psychiatric history of both depressive and hypomanic episodes. While depression is a predictable and documented side effect of LD and menopause (especially in those with a previous history of symptoms), manic reactions are rare and unexplained. Possible causative mechanisms behind the LD-induced manic episodes are discussed, and we suggest that patients with a single previous hypomanic episode are at risk for LD-induced mania.
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Amedei, S. Gorini, M. Catena, F. Lejeune, S. Duma, M. A. Scarpato, and C. Faravelli. "Depression and Bipolar Disorder: Is Prevention of Mania Possible? Critical Issues on Diagnostic Criteria." European Psychiatry 24, S1 (2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)70482-1.
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Diagnostic criteria for bipolar disorder in DSM IV require the occurrence of a manic or hypomanic episode. The scant appropriateness of these criteria compared with Kraepelin"s concept of manic depressive insanity has been repeatedly reported and the concept of bipolar spectrum has been proposed for more than 30 years. The negative consequences of pure adherence to operational diagnostic criteria on clinical needs are presented in terms of community epidemiology results and in terms of clinical evidences and the inadequate treatment of depressive and anxiety episodes and the risk of manic switch with antidepressant drugs are discussed.The epidemiological survey conducted in Sesto Fiorentino showed that depressive episodes in patients with subthreshold mania or hypomania were different from the clinical presentation of pure unipolar depressives episodes confirming not only the numeric impact but also qualitative differences between these groups of patients.Our clinical study where predictors of mania have been prospectively evaluated in a trans nosographic sample of outpatients demonstrated that aspects related to bipolarity predicted manic shift regardless of the diagnosis. DSM IV criteria seem not to be able to detect and describe a group of patients relevant both on epidemiological and on clinical level. These findings underline the need of a careful examination of patients treatment and validate the rule of further research in definition of mood disorders boundaries for prevention strategies.
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Schwartzmann, Ângela Maria, José Antonio Amaral, Cilly Issler, et al. "A clinical study comparing manic and mixed episodes in patients with bipolar disorder." Revista Brasileira de Psiquiatria 29, no. 2 (2007): 130–33. http://dx.doi.org/10.1590/s1516-44462006005000036.
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OBJECTIVE: Mixed episodes have been described as more severe than manic episodes, especially due to their longer duration and their association with higher rates of suicide attempts, hospitalization and psychotic symptoms. The purpose of this study was to compare the severity between mixed and pure manic episodes according to DSM-IV criteria, through the evaluation of sociodemographic data and clinical characteristics. METHOD: Twenty-nine bipolar I patients presenting acute mixed episodes were compared to 20 bipolar I patients with acute manic episodes according to DSM-IV criteria. We analyzed (cross-sectionally) episode length, presence of psychotic symptoms, frequency of suicide attempts and hospitalization, Young Mania Rating Scale scores, Hamilton Depression Rating Scale scores and the Clinical Global Assessment Scale scores. RESULTS: Young Mania Rating Scale scores were higher in manic episodes than in mixed episodes. There were no differences in gender frequency, CGI scores and rates of hospitalization, suicide attempts and psychotic symptoms, when mixed and manic episodes where compared. Patients with mixed episodes were younger. CONCLUSION: In our sample, mixed states occurred at an earlier age than manic episodes. Contrary to previous reports, we did not find significant differences between manic and mixed episodes regarding severity of symptomatology, except for manic symptoms ratings, which were higher in acute manic patients. In part, this may be explained by the different criteria adopted on previous studies.
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Filgueiras, A., A. L. S. Nunes, L. A. S. Silveira, et al. "Latent structure of the symptomatology of hospitalized patients with bipolar mania." European Psychiatry 29, no. 7 (2014): 431–36. http://dx.doi.org/10.1016/j.eurpsy.2014.02.003.
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AbstractSeveral studies have attempted to understand the dimensions of psychiatric symptoms in manic episodes, but only a few have been able to model the latent structure of mania in bipolar disorder patients using confirmatory factor analysis. The objective of the present study was to search for the best model of the symptomatology of hospitalized manic patients. To achieve this goal, 117 manic inpatients during a manic crisis participated in this research. Exploratory factor analysis was conducted followed by confirmatory factor analysis using an exploratory factor analysis solution and three other theory-based models. The exploratory factor analysis results revealed a six-factor structure: depression, suicide, insomnia, mania, psychosis, and anxiety. This solution also presented the best fit to the data when tested with confirmatory factor analysis. A five-factor solution, without suicide as a separate dimension, appeared to be more theoretically suitable. Another important finding was that anxiety was an independent dimension in mania. Some hypotheses are discussed in light of contemporary theories, and future studies should investigate this aspect further.
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McGuffin, Peter, and Randy Katz. "The Genetics of Depression and Manic-Depressive Disorder." British Journal of Psychiatry 155, no. 3 (1989): 294–304. http://dx.doi.org/10.1192/bjp.155.3.294.
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Depressive disorders are more common in the relatives of depressed probands than in the population at large, and there is compelling evidence that the familial aggregation of bipolar disorder and severe unipolar depression is at least partly due to genetic factors. However, the evidence concerning ‘non-endogenous' depression is less clear, and family environment probably plays a stronger role. Much current research is focused on two areas: firstly, the mode of inheritance of manic-depressive illness, with the use of molecular biological techniques to detect and localise major genes; and secondly, the ways in which familial predisposition and environmental insults combine to produce depressive disorder.
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Thalbourne, Michael A., and James Houran. "Preliminary Validity Data on the Rasch Manic-Depressiveness Scale." Psychological Reports 90, no. 3 (2002): 817–20. http://dx.doi.org/10.2466/pr0.2002.90.3.817.
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The 18-item Manic-Depressiveness Scale was revised via a Rasch ‘top-down purification’ procedure to provide a new 12-item scale with no significant age or sex bias. Application of this scale to previously collected data indicated that patients with manic-depression and schizophrenia receive comparable scores, which are significantly higher than those of a control group of students. Moreover, for a subgroup of patients with manic-depression, scores correlated .55 ( p < 001) with number of manic-depression-relevant medications being taken. These findings lend support to the validity of the Rasch Manic-Depressiveness Scale as a general measure of psychoticism and psychiatric status.
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Sánchez-Rivero, I. "Lurasidone in treatment of manic episode." European Psychiatry 65, S1 (2022): S400. http://dx.doi.org/10.1192/j.eurpsy.2022.1013.
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Introduction Lurasidone is an atypical antipsychotic used in the treatment of schizophrenia and bipolar depression. Both indications are approved by the FDA nowadays, whereas in Europe it is only approved for schizophrenia. Lurasidone has been barely studied for the treatment of acute mania, nonetheless it is sometimes used off-label. Objectives A case of a patient with a manic episode treated with lurasidone is presented, in order to provide further evidence on this topic. Methods The patient is a 43 year-old-woman with diagnosis of type I bipolar disorder, personality disorder and borderline intellectual functioning, resident in our Hospital’s long-stay psychiatric rehabilitation unit. She was previously under treatment with venlafaxine 75 mg/day, valproate 1500 mg/day and levomepromazine 25 mg on demand; remaining stable for months. The patient presented an episode consisting on agitation, irritability, verbiage, tachyphase, verbal aggressiveness and behavioral disturbances. Psysical restraint was needed for one day long and zuclopenthixol acetate 50 mg IM was administered twice within 5 days for the acute agitation. Venlafaxine was immediately withdrawn and lurasidone was progressively introduced up to 111 mg daily. Results Approximately 3 weeks after the treatment adjustment, the patient reached the psychopatological stabilty. Conclusions Antidepressive withdrawal and introduction of Lurasidone were effective to treat the acute manic episode in this patient. It has been previosuly suggested that lurasidone caused improvement in emergent manic symptoms in patients with bipolar depression, and in subsyndromal hypomanic symptoms in patients with mixed features of depression. However, no studies have been made yet to evaluate the efficacy of lurasidone in acute mania. Disclosure I received financing from Angelini Pharma, Casen Recordati, Janssen, Exeltis and Otsuka.
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Koukopoulos, Athanasios, and S. Nassir Ghaemi. "The primacy of mania: A reconsideration of mood disorders." European Psychiatry 24, no. 2 (2009): 125–34. http://dx.doi.org/10.1016/j.eurpsy.2008.07.006.
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AbstractIn contemporary psychiatry, depression and mania are conceived as different entities. They may occur together, as in bipolar disorder, or they may occur separately, as in unipolar depression. This view is partly based on a narrow definition of mania and a rather broad definition of depression. Generally, depression is seen as more prominent, common, and problematic; while mania appears uncommon and treatment-responsive. We suggest a reversal: mania viewed broadly, not as simply episodic euphoria plus hyperactivity, but a wide range of excitatory behaviors; and depression seen more narrowly. Further, using pharmacological and clinical evidence, and in contrast to previous theories of mania interpreted as a flight from depression, we propose the primacy of mania hypothesis (PM): depression is a consequence of the excitatory processes of mania. If correct, current treatment of depressive illness needs revision. Rather than directly lifting mood with antidepressants, the aim would be to suppress manic-like excitation, with depression being secondarily prevented. Potential objections to, and empirical tests of, the PM hypothesis are discussed.
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Bolge, Susan C., Thomas Thompson, Eric Bourne, and Kevin Nanry. "Characteristics and Symptomatology of Patients Diagnosed with Unipolar Depression at Risk for Undiagnosed Bipolar Disorder: A Bipolar Survey." CNS Spectrums 13, no. 3 (2008): 216–24. http://dx.doi.org/10.1017/s1092852900028467.
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ABSTRACTObjective: To identify characteristics of patients diagnosed with unipolar depression who may have undiagnosed bipolar disorder.Methods: Patients diagnosed with unipolar depression by a healthcare provider were identified through the Consumer Health Sciences National Health and Wellness Survey. Manic symptoms, comorbid conditions, psychiatric symptomatology, use of healthcare resources, and patient demographics were identified through Internet-based questionnaires. A self-report adapted version of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision criteria identified symptoms consistent with a manic episode. Psychological well-being was measured by the Psychological General Well-Being Index.Results: Of the 1,602 respondents who met inclusion criteria, 219 (14% or ~1 out of 7) reported symptoms consistent with a manic episode and were considered at risk for undiagnosed bipolar disorder. These respondents were younger and had a lower socioeconomic status. At-risk patients rated their depression as more severe and experienced greater impairment of psychological well-being. More than 70% of those at risk reported speaking with a healthcare provider about their mania symptoms. Comorbid mental disorders, especially anxiety-related conditions, were common in these patients.Conclusion: These findings underscore the importance of evaluating unipolar patients for bipolar disorder and may help clinicians identify symptoms and comorbidities associated with patients with unipolar depression at risk for undiagnosed bipolar disorder.
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Russo, Daniel, Matteo Martino, Paola Magioncalda, Matilde Inglese, Mario Amore, and Georg Northoff. "Opposing Changes in the Functional Architecture of Large-Scale Networks in Bipolar Mania and Depression." Schizophrenia Bulletin 46, no. 4 (2020): 971–80. http://dx.doi.org/10.1093/schbul/sbaa004.
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Abstract Objective Manic and depressive phases of bipolar disorder (BD) show opposite symptoms in psychomotor, thought, and affective dimensions. Neuronally, these may depend on distinct patterns of alterations in the functional architecture of brain intrinsic activity. Therefore, the study aimed to characterize the spatial and temporal changes of resting-state activity in mania and depression, by investigating the regional homogeneity (ReHo) and degree of centrality (DC), in different frequency bands. Methods Using resting-state functional magnetic resonance imaging (fMRI), voxel-wise ReHo and DC were calculated—in the standard frequency band (SFB: 0.01–0.10 Hz), as well as in Slow5 (0.01–0.027 Hz) and Slow4 (0.027–0.073 Hz)—and compared between manic (n = 36), depressed (n = 43), euthymic (n = 29) patients, and healthy controls (n = 112). Finally, clinical correlations were investigated. Results Mania was mainly characterized by decreased ReHo and DC in Slow4 in the medial prefrontal cortex (as part of the default-mode network [DMN]), which in turn correlated with manic symptomatology. Conversely, depression was mainly characterized by decreased ReHo in SFB in the primary sensory-motor cortex (as part of the sensorimotor network [SMN]), which in turn correlated with depressive symptomatology. Conclusions Our data show a functional reconfiguration of the spatiotemporal structure of intrinsic brain activity to occur in BD. Mania might be characterized by a predominance of sensorimotor over associative networks, possibly driven by a deficit of the DMN (reflecting in internal thought deficit). Conversely, depression might be characterized by a predominance of associative over sensorimotor networks, possibly driven by a deficit of the SMN (reflecting in psychomotor inhibition).
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McElroy, Susan L., Anna I. Guerdjikova, and Francisco Romo-Nava. "Diagnosing and treating major depressive episodes that lie along the mood disorders spectrum: focus on depression with mixed features." CNS Spectrums 26, no. 2 (2021): 133–39. http://dx.doi.org/10.1017/s1092852921000262.
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AbstractGrowing evidence indicates that historical descriptions of mixed depression—broadly defined as major depressive episodes with subthreshold manic or hypomanic (hypo/manic) symptoms—are incredibly clinically relevant in this day-and-age. However, the first operational definition of mixed depression did not occur in the modern nomenclature until 2013 with publication of Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), and there has not been enough time to evaluate these criteria empirically. Thus, the most valid operational definition of a mixed depressive episode is still unknown, widely accepted treatment guidelines are not available, and no treatment has regulatory approval for mixed depression—whether associated with bipolar I disorder, bipolar II disorder, or major depressive disorder. This is despite seven drugs having regulatory indications for mixed episodes, defined as the co-occurrence of syndromal depression and syndromal mania, and now recognized as mania with mixed features by DSM-5. Indeed, we found only two randomized, placebo-controlled trials in patients with protocol defined mixed depression, one with ziprasidone and one with lurasidone. Both studies were positive, suggesting treatment with second-generation antipsychotics may be helpful for mixed depressive episodes associated with bipolar II or unipolar disorder. We found no randomized control trial of antidepressant monotherapy in mixed depression and many clinical reports that such treatment may worsen mixed depression Randomized, placebo-controlled trials of antidepressants, antipsychotics, and mood stabilizers—alone and in combination—in individuals with carefully defined mixed depression are needed before firm treatment guidelines can be produced.
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Stanton, Kasey, Shereen Khoo, David Watson, June Gruber, Mark Zimmerman, and Lauren M. Weinstock. "Unique and Transdiagnostic Symptoms of Hypomania/Mania and Unipolar Depression." Clinical Psychological Science 7, no. 3 (2018): 471–87. http://dx.doi.org/10.1177/2167702618812725.
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Extensive research has been conducted to isolate features that distinguish bipolar spectrum disorders from unipolar depression. Therefore, we identified latent symptom dimensions that are unique versus shared across these disorders by examining the joint structure of hypomanic/manic and depressive symptoms in two large samples (i.e., 647 community adults; 1,370 outpatients with unipolar depression or bipolar disorder history). Results across studies suggested that (a) many hypomanic/manic and depressive symptoms (e.g., irritability) are transdiagnostic, but also that (b) symptoms such as increased energy and euphoric mood define a latent specific positive activation dimension that appears more specific to bipolar disorder. We discuss how these results indicate that some symptoms may be more optimal to target than others when trying to distinguish bipolar disorder from unipolar depression, as well as how the identification of relatively disorder-specific symptom types may optimally guide future research on key mechanisms linked to hypomania/mania and depression.