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Mitchell, Philip B., Andrew Frankland, Dusan Hadzi-Pavlovic, et al. "Comparison of depressive episodes in bipolar disorder and in major depressive disorder within bipolar disorder pedigrees." British Journal of Psychiatry 199, no. 4 (2011): 303–9. http://dx.doi.org/10.1192/bjp.bp.110.088823.
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BackgroundAlthough genetic epidemiological studies have confirmed increased rates of major depressive disorder among the relatives of people with bipolar affective disorder, no report has compared the clinical characteristics of depression between these two groups.AimsTo compare clinical features of depressive episodes across participants with major depressive disorder and bipolar disorder from within bipolar disorder pedigrees, and assess the utility of a recently proposed probabilistic approach to distinguishing bipolar from unipolar depression. A secondary aim was to identify subgroups within the relatives with major depression potentially indicative of ‘genetic’ and ‘sporadic’ subgroups.MethodPatients with bipolar disorder types 1 and 2 (n = 246) and patients with major depressive disorder from bipolar pedigrees (n = 120) were assessed using the Diagnostic Interview for Genetic Studies. Logistic regression was used to identify distinguishing clinical features and assess the utility of the probabilistic approach. Hierarchical cluster analysis was used to identify subgroups within the major depressive disorder sample.ResultsBipolar depression was characterised by significantly higher rates of psychomotor retardation, difficulty thinking, early morning awakening, morning worsening and psychotic features. Depending on the threshold employed, the probabilistic approach yielded a positive predictive value ranging from 74% to 82%. Two clusters within the major depressive disorder sample were found, one of which demonstrated features characteristic of bipolar depression, suggesting a possible ‘genetic’ subgroup.ConclusionsA number of previously identified clinical differences between unipolar and bipolar depression were confirmed among participants from within bipolar disorder pedigrees. Preliminary validation of the probabilistic approach in differentiating between unipolar and bipolar depression is consistent with dimensional distinctions between the two disorders and offers clinical utility in identifying patients who may warrant further assessment for bipolarity. The major depressive disorder clusters potentially reflect genetic and sporadic subgroups which, if replicated independently, might enable an improved phenotypic definition of underlying bipolarity in genetic analyses.
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Rihmer, Z. "Treatment resistance in bipolar disorder." European Psychiatry 26, S2 (2011): 2025. http://dx.doi.org/10.1016/s0924-9338(11)73728-2.
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Antidepressant-resistant major depression (AD-RD) is a great challenge for the treating clinician. The most widely accepted definition of AD-RD refers that the depressed patient does not show a clinically significant response after at least two adequate trials of different classes of antidepressants. In spite of the fact that there are several causes of AD-RD in general, there is increasing evidence that one of the most common sources of it is the unrecognized bipolar nature of the “unipolar” major depressive episode, when the patients receive antidepressant monotherapy - unprotected by mood stabilizers/atypical antipsychotics. While it is well documented that the optimal clinical response to antidepressants is much rare in bipolar I and II than in unipolar major depression, only the most recent clinical studies have focused on the boundaries between treatment-resistant unipolar major depressive disorder and bipolar disorder. The most widely noted conclusion of the prior studies on AD-RD is that if noncompliance, hypothyreosis, use of “depressiogenic” drugs and pharmacokinetic causes etc, can be excluded, antidepressant-resistance reflects the heterogeneity of depressive disorders and different subgroups of depressed patients respond (or do not respond) to different drugs. However, current psychopathological research on the complex relationship between unipolar depression and bipolar disorders show that the most common source of antidepressant-resistance in DSM-IV diagnosed unipolar major depression is the result of the subthreshold or unrecognized bipolar nature of the depressive episode and antidepressant-induced (hypo)manic switches, antidepressant-resistance and “suicide-inducing” potential of antidepressants seem to be related to the underlying bipolarity of the major depressive episode.
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Perris, Carlo, W. A. Arrindell, Hjördis Perris, Martin Eisemann, J. van der Ende, and Lars von Knorring. "Perceived Depriving Parental Rearing and Depression." British Journal of Psychiatry 148, no. 2 (1986): 170–75. http://dx.doi.org/10.1192/bjp.148.2.170.
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Four groups of depressed patients 47 unipolars, 21 bipolars, 34 with neurotic-reactive depression, and 39 with unspecified depressive disorder completed, after recovery, the EMBU, a Swedish instrument aimed at assessing the experience of parental rearing practices. The results for three factors: “rejection”, “emotional warmth” and “over-protection” and the global judgement scores of “severity” and “consistency” in rearing attitudes were compared with those obtained from 205 healthy individuals. Depressed patients, particularly in the unipolar unspecified groups rated both parents lower than the controls on emotional warmth. Patients tended also to rate their parents as less consistent in their rearing attitudes. The variables emotional warmth and overprotection allowed 64% of the patients and 72 of the unipolar depressives to be classified correctly. These results, like those of previous studies, support the hypothesis that deprivation of love during childhood represents an important psychological risk factor in the background of depressive disorders.
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Jones, Lisa, Jan Scott, Sayeed Haque, et al. "Cognitive style in bipolar disorder." British Journal of Psychiatry 187, no. 5 (2005): 431–37. http://dx.doi.org/10.1192/bjp.187.5.431.
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BackgroundAbnormalities of cognitive style in bipolar disorder are of both clinical and theoretical importance.AimsTo compare cognitive style in people with affective disorders and in healthy controls.MethodSelf-rated questionnaires were administered to 118 individuals with bipolar I disorder, 265 with unipolar major recurrent depression and 268 healthy controls. Those with affective disorder were also interviewed using the Schedules for Clinical Assessment in Neuropsychiatry and case notes were reviewed.ResultsThose with bipolar disorder and those with unipolar depression demonstrated different patterns of cognitive style from controls; negative self-esteem best discriminated between those with affective disorders and controls; measures of cognitive style were substantially affected by current levels of depressive symptomatology; patterns of cognitive style were similar in bipolar and unipolar disorder when current mental state was taken into account.ConclusionsThose with affective disorder significantly differed from controls on measures of cognitive style but there were no differences between unipolar and bipolar disorders when current mental state was taken into account.
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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.
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Suciu, B., R. Paunescu, and I. Miclutia. "Cognitive characteristics of unipolar (major depressive disorder) and bipolar depression." European Psychiatry 33, S1 (2016): S374. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1342.
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IntroductionImpairment in cognitive performance is an important characteristic in many psychiatric illnesses, such as Bipolar Disorder and Major Depressive Disorder. Initially, cognitive dysfunctions were considered to be present only in acute depressive episodes and to improve after symptoms recovered. Reports have described persistent cognitive deficits even after significant improvement of depressive symptoms.Aims/ObjectivesWe wanted to understand the dimension of cognitive impairment in unipolar and bipolar depression and also to underline the differences between cognitive profiles of patients diagnosed within the two mentioned disorders.MethodThis review examined recent literature about unipolar and bipolar depression.ResultsBoth depressed patients presented cognitive deficits in several cognitive domains. Different aspects of attention were altered in both patients but impairment in shifting attention appeared specific to unipolar disorder while impaired sustained attention was particular for bipolar disorder. Both types of patients showed memory deficits that were associated with poor global functioning. Two recent studies described that bipolar depressed subjects were more impaired across all cognitive domains than unipolar depressed subjects on tests assessing verbal memory, verbal fluency, attention and executive functions. The most consistently deficits were displayed on measures of executive functioning – such as tasks requiring problem solving, planning, decision making – suggesting that this cognitive domain is a trait-marker for depression.ConclusionsCognitive deficits are present in both disorders during a depressive episode but they display slightly different patterns of impairment.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Forty, Liz, Daniel Smith, Lisa Jones, et al. "Clinical differences between bipolar and unipolar depression." British Journal of Psychiatry 192, no. 5 (2008): 388–89. http://dx.doi.org/10.1192/bjp.bp.107.045294.
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SummaryIt is commonly – but wrongly – assumed that there are no important differences between the clinical presentations of major depressive disorder and bipolar depression. Here we compare clinical course variables and depressive symptom profiles in a large sample of individuals with major depressive disorder (n=593) and bipolar disorder (n=443). Clinical characteristics associated with a bipolar course included the presence of psychosis, diurnal mood variation and hypersomnia during depressive episodes, and a greater number of shorter depressive episodes. Such features should alert a clinician to a possible bipolar course. This is important because optimal management is not the same for bipolar and unipolar depression.
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Hazarika, Jyoti, Kamal N. Kalita, Mohan Sharma, et al. "Thyroid profile in depression: a cross-sectional study from North-East India." International Journal of Research in Medical Sciences 5, no. 3 (2017): 1066. http://dx.doi.org/10.18203/2320-6012.ijrms20170663.
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Background: Thyroid function disorder is a common feature in depression, with mixed type of response. Some cases are associated with hyperthyroidism and most commonly hypothyroidism. Unipolar and bipolar depressions are also related differently in consideration to thyroid status. This study comprises of assessment of the thyroid disorder prevalence in depressive patients and comparative analysis among unipolar and bipolar groups.Methods: Study consisted of 161 unipolar and 160 bipolar cases of depression as diagnosed by ICD 10 criteria supported by MINI. Thyroid profiling was done against common thyroid hormones TSH, T3, T4 and FT4 by standard method.Results: Gender wise males were dominant with majority in bipolar group in the younger age group. Most of the cases were normal with few hyperthyroid and hypothyroid cases. Bipolar group comprised the majority of overt hyperthyroid, overt hypothyroid and subclinical hyperthyroid cases, whereas unipolars were more in the subclinical hypothyroid category.Conclusions: This study concludes that differences exist in the thyroid response among the unipolar and bipolar depression group, more prominent numbers of hypothyroidism in unipolar group.
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Dervic, K., M. Garcia-Amador, K. Sudol, et al. "Bipolar I and II versus unipolar depression: Clinical differences and impulsivity/aggression traits." European Psychiatry 30, no. 1 (2015): 106–13. http://dx.doi.org/10.1016/j.eurpsy.2014.06.005.
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AbstractObjective:To investigate distinguishing features between bipolar I, II and unipolar depression, and impulsivity/aggression traits in particular.Methods:Six hundred and eighty-five (n = 685) patients in a major depressive episode with lifetime Unipolar (UP) depression (n = 455), Bipolar I (BP-I) disorder (n = 151), and Bipolar II (BP-II) (n = 79) disorder were compared in terms of their socio-demographic and clinical characteristics.Results:Compared to unipolar patients, BP-I and BP-II depressed patients were significantly younger at onset of their first depressive episode, and were more likely to experience their first depressive episode before/at age of 15. They also had more previous affective episodes, more first- and second-degree relatives with history of mania, more current psychotic and subsyndromal manic symptoms, and received psychopharmacological and psychotherapy treatment at an earlier age. Furthermore, BP-I and BP-II depressed patients had higher lifetime impulsivity, aggression, and hostility scores. With regard to bipolar subtypes, BP-I patients had more trait-impulsivity and lifetime aggression than BP-II patients whereas the latter had more hostility than BP-I patients. As for co-morbid disorders, Cluster A and B Personality Disorders, alcohol and substance abuse/dependence and anxiety disorders were more prevalent in BP-I and BP-II than in unipolar patients. Whereas the three groups did not differ on other socio-demographic variables, BP-I patients were significantly more often unemployed that UP patients.Conclusion:Our findings comport with major previous findings on differences between bipolar and unipolar depression. As for trait characteristics, bipolar I and II depressed patients had more life-time impulsivity and aggression/hostility than unipolar patients. In addition, bipolar I and II patients also differed on these trait characteristics.
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Dionisie, Vlad, Gabriela Adriana Filip, Mihnea Costin Manea, et al. "Neutrophil-to-Lymphocyte Ratio, a Novel Inflammatory Marker, as a Predictor of Bipolar Type in Depressed Patients: A Quest for Biological Markers." Journal of Clinical Medicine 10, no. 9 (2021): 1924. http://dx.doi.org/10.3390/jcm10091924.
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(1) Background: Recent research suggests inflammation as a factor involved in the pathophysiology of mood disorders. Neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), platelet-to-lymphocyte (PLR), and systemic immune-inflammatory (SII) index ratios have been studied as peripheral markers of inflammation in bipolar and major depressive disorders. The purpose of this study is to comparatively analyze these inflammatory ratios among manic episodes of bipolar disorder, bipolar depression and unipolar depression. (2) Methods: 182 patients were retrospectively included in the study and divided into three groups: 65 manic patients, 34 patients with bipolar depression, and 83 unipolar depressive patients. White blood cells, neutrophils, monocytes, lymphocytes, and platelets were retrieved from the patients’ database. NLR, MLR, PLR, and SII index were calculated using these parameters. (3) Results: Patients with manic episodes had elevated NLR (p < 0.001), MLR (p < 0.01), PLR (p < 0.05), and SII index (p < 0.001) compared to unipolar depression and increased NLR (p < 0.05) and SII index (p < 0.05) when compared to bipolar depression. NLR (p < 0.01) and SII index (p < 0.05) were higher in the bipolar depression than unipolar depression. NLR is an independent predictor of the bipolar type of depression in depressive patients. (4) Conclusions: The results confirm the role of inflammation in the pathophysiology of mood disorders and suggest the ability of NLR as a marker for the differentiation of bipolar from unipolar depression.
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Solomon, David A., Andrew C. Leon, Timothy I. Mueller, et al. "Tachyphylaxis in Unipolar Major Depressive Disorder." Journal of Clinical Psychiatry 66, no. 03 (2005): 283–90. http://dx.doi.org/10.4088/jcp.v66n0302.
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STĂNESCU, Ana Maria Alexandra, Anca Angela SIMIONESCU, Ioana Veronica GRĂJDEANU, and Mira FLOREA. "Preventive intervention for depression in children, adolescents and adults." Romanian Journal of Medical Practice 16, S4 (2021): 58–61. http://dx.doi.org/10.37897/rjmp.2021.s4.13.
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Depression is a common mental disorder associated with increased morbidity and mortality. Depressive disorders usually occur around the age of 20. However, symptoms may appear earlier, even during childhood. Depressive episodes can be repetitive or chronic, affecting the individual's entire life. Primary prevention of unipolar depressive disorder is a potential strategy to stop or at least reduce the severity or delay the onset of a disorder. Primary preventive interventions are an ideal, modern and future approach that can have many benefits both in terms of population health and economic.
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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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Ratzke, Roberto, Doris Hupfeld Moreno, Clarice Gorenstein, and Ricardo Alberto Moreno. "Validity and reliability of the Structured Clinical Interview for Mood Spectrum: Brazilian version (SCIMOODS-VB)." Revista Brasileira de Psiquiatria 33, no. 1 (2011): 64–67. http://dx.doi.org/10.1590/s1516-44462011000100013.
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OBJECTIVE: The aim of this study was to translate the Structured Clinical Interview for Mood Spectrum into Brazilian Portuguese, measuring its reliability, validity, and defining scores for bipolar disorders. METHOD: Questionnaire was translated (into Brazilian Portuguese) and back-translated into English. Sample consisted of 47 subjects with bipolar disorder, 47 with major depressive disorder, 18 with schizophrenia and 22 controls. Inter-rater reliability was tested in 20 subjects with bipolar disorder and MDD. Internal consistency was measured using the Kuder Richardson formula. Forward stepwise discriminant analysis was performed. Scores were compared between groups; manic (M), depressive (D) and total (T) threshold scores were calculated through receiver operating characteristic (ROC) curves. RESULTS: Kuder Richardson coefficients were between 0.86 and 0.94. Intraclass correlation coefficient was 0.96 (CI 95 % 0.93-0.97). Subjects with bipolar disorder had higher M and T, and similar D scores, when compared to major depressive disorder (ANOVA, p < 0.001). The sub-domains that best discriminated unipolar and bipolar subjects were manic energy and manic mood. M had the best area under the curve (0.909), and values of M equal to or greater than 30 yielded 91.5% sensitivity and 74.5% specificity. CONCLUSION: Structured Clinical Interview for Mood Spectrum has good reliability and validity. Cut-off of 30 best differentiates subjects with bipolar disorder vs. unipolar depression. A cutoff score of 30 or higher in the mania sub-domain is appropriate to help make a distinction between subjects with bipolar disorder and those with unipolar depression.
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Ball, Roberta, and Robert A. Steer. "Mean Beck Depression Inventory-II Scores of Outpatients with Dysthymic or Recurrent-Episode Major Depressive Disorders." Psychological Reports 93, no. 2 (2003): 507–12. http://dx.doi.org/10.2466/pr0.2003.93.2.507.
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The Beck Depression Inventory-II, published in 1996, was administered to 100 adult outpatients (Age M = 43.1 yr., SD = 15.6) who were diagnosed with a recurrent-episode Major Depressive Disorder and 100 outpatients (Age M = 42.8 yr., SD = 15.7) who were diagnosed with a Dysthymic Disorder. Each diagnostic group was composed of 50 men and 50 women who did not have a comorbid depressive disorder. The mean Beck Depression Inventory-II total score and the mean number of symptoms endorsed by the outpatients with a Major Depressive Disorder were significantly (ps < .001) higher than those for outpatients with a Dysthymic Disorder. The usefulness of the Beck Depression Inventory–II was discussed in helping clinicians discriminate between these two unipolar disorders.
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Bahk, W. M., Y. S. Woo, H. R. Wang, et al. "Determining the cut-off for recurrent depressive episode to predict diagnostic conversion from unipolar depression to bipolar disorder: 5-year retrospective study in one university hospital." European Psychiatry 33, S1 (2016): S120. http://dx.doi.org/10.1016/j.eurpsy.2016.01.141.
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ObjectivesThe aim of this study was to determining the cut-off for recurrent depressive episode to predict diagnostic conversion from unipolar depression to bipolar disorder by means of retrospective reviews of medical records.MethodsThe medical records of 250 patients with a diagnosis of major depressive disorder for at least 5 years were retrospectively reviewed for this study. We reviewed DSM-IV diagnosis and detailed clinical information at the index admission with assessments made every year after discharge to determining the cut-off for recurrent depressive episode to predict diagnostic conversion from unipolar depression to bipolar disorder.ResultsReceiver operating characteristic curve analysis indicated cut-off scores for recurrent depressive episode of more than three times (area under curve = 0.647, sensitivity = 0.435, specificity = 0.819, positive predictive value = 0.351, negative predictive value = 0.865).ConclusionsThese findings suggest that it could predict the best diagnostic conversion from unipolar depression to bipolar disorder when depressive episodes are recurrent more than three times. Based on these findings, it will be able to promote the accuracy of diagnosis and the efficiency of treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Smith, Daniel J., Emily Griffiths, Mark Kelly, Kerry Hood, Nick Craddock, and Sharon A. Simpson. "Unrecognised bipolar disorder in primary care patients with depression." British Journal of Psychiatry 199, no. 1 (2011): 49–56. http://dx.doi.org/10.1192/bjp.bp.110.083840.
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BackgroundBipolar disorder is complex and can be difficult to diagnose. It is often misdiagnosed as recurrent major depressive disorder.AimsWe had three main aims. To estimate the proportion of primary care patients with a working diagnosis of unipolar depression who satisfy DSM–IV criteria for bipolar disorder. To test two screening instruments for bipolar disorder (the Hypomania Checklist (HCL–32) and Bipolar Spectrum Diagnostic Scale (BSDS)) within a primary care sample. To assess whether individuals with major depressive disorder with subthreshold manic symptoms differ from those individuals with major depressive disorder but with no or little history of manic symptoms in terms of clinical course, psychosocial functioning and quality of life.MethodTwo-phase screening study in primary care.ResultsThree estimates of the prevalence of undiagnosed bipolar disorder were obtained: 21.6%, 9.6% and 3.3%. The HCL–32 and BSDS questionnaires had quite low positive predictive values (50.0 and 30.1% respectively). Participants with major depressive disorder and with a history of subthreshold manic symptoms differed from those participants with no or little history of manic symptoms on several clinical features and on measures of both psychosocial functioning and quality of life.ConclusionsBetween 3.3 and 21.6% of primary care patients with unipolar depression may have an undiagnosed bipolar disorder. The HCL–32 and BSDS screening questionnaires may be more useful for detecting broader definitions of bipolar disorder than DSM–IV-defined bipolar disorder. Subdiagnostic features of bipolar disorder are relatively common in primary care patients with unipolar depression and are associated with a more morbid course of illness. Future classifications of recurrent depression should include dimensional measures of bipolar symptoms.
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Cretaz, Eric, André R. Brunoni, and Beny Lafer. "Magnetic Seizure Therapy for Unipolar and Bipolar Depression: A Systematic Review." Neural Plasticity 2015 (2015): 1–9. http://dx.doi.org/10.1155/2015/521398.
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Objective. Magnetic seizure therapy (MST) is a novel, experimental therapeutic intervention, which combines therapeutic aspects of electroconvulsive therapy (ECT) and transcranial magnetic stimulation, in order to achieve the efficacy of the former with the safety of the latter. MST might prove to be a valuable tool in the treatment of mood disorders, such as major depressive disorder (MDD) and bipolar disorder. Our aim is to review current literature on MST.Methods. OVID and MEDLINE databases were used to systematically search for clinical studies on MST. The terms “magnetic seizure therapy,” “depression,” and “bipolar” were employed.Results. Out of 74 studies, 8 met eligibility criteria. There was considerable variability in the methods employed and samples sizes were small, limiting the generalization of the results. All studies focused on depressive episodes, but few included patients with bipolar disorder. The studies found reported significant antidepressant effects, with remission rates ranging from 30% to 40%. No significant cognitive side effects related to MST were found, with a better cognitive profile when compared to ECT. Conclusion. MST was effective in reducing depressive symptoms in mood disorders, with generally less side effects than ECT. No study focused on comparing MST to ECT on bipolar depression specifically.
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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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Almeida, J. R. C., J. Mourao-Miranda, H. J. Aizenstein, et al. "Pattern recognition analysis of anterior cingulate cortex blood flow to classify depression polarity." British Journal of Psychiatry 203, no. 4 (2013): 310–11. http://dx.doi.org/10.1192/bjp.bp.112.122838.
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SummaryDifferentiating bipolar from recurrent unipolar depression is a major clinical challenge. In 18 healthy females and 36 females in a depressive episode – 18 with bipolar disorder type I, 18 with recurrent unipolar depression – we applied pattern recognition analysis using subdivisions of anterior cingulate cortex (ACC) blood flow at rest, measured with arterial spin labelling. Subgenual ACC blood flow classified unipolar v. bipolar depression with 81% accuracy (83% sensitivity, 78% specificity).
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Solé, Eva, Marina Garriga, Marc Valentí, and Eduard Vieta. "Mixed features in bipolar disorder." CNS Spectrums 22, no. 2 (2016): 134–40. http://dx.doi.org/10.1017/s1092852916000869.
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Mixed affective states, defined as the coexistence of depressive and manic symptoms, are complex presentations of manic-depressive illness that represent a challenge for clinicians at the levels of diagnosis, classification, and pharmacological treatment. The evidence shows that patients with bipolar disorder who have manic/hypomanic or depressive episodes with mixed features tend to have a more severe form of bipolar disorder along with a worse course of illness and higher rates of comorbid conditions than those with non-mixed presentations. In the updated Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5), the definition of “mixed episode” has been removed, and subthreshold nonoverlapping symptoms of the opposite pole are captured using a “with mixed features” specifier applied to manic, hypomanic, and major depressive episodes. However, the list of symptoms proposed in the DSM–5 specifier has been widely criticized, because it includes typical manic symptoms (such as elevated mood and grandiosity) that are rare among patients with mixed depression, while excluding symptoms (such as irritability, psychomotor agitation, and distractibility) that are frequently reported in these patients. With the new classification, mixed depressive episodes are three times more common in bipolar II compared with unipolar depression, which partly contributes to the increased risk of suicide observed in bipolar depression compared to unipolar depression. Therefore, a specific diagnostic category would imply an increased diagnostic sensitivity, would help to foster early identification of symptoms and ensure specific treatment, as well as play a role in suicide prevention in this population.
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Swinnen, Sanne G. H. A., and Jean-Paul Selten. "Mood disorders and migration." British Journal of Psychiatry 190, no. 1 (2007): 6–10. http://dx.doi.org/10.1192/bjp.bp.105.020800.
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BackgroundMigration is a risk factor for the development of schizophrenia.AimsTo examine whether migration is also a risk factor for bipolar affective disorder, unipolar depressive disorder and mood disorders in general.MethodMedline was searched for population-based incidence studies concerning mood disorders among migrants and mean relative risks were computed using a mixed-effects statistical model.ResultsOnly a few studies of unipolar depressive disorder were retrieved. The mean relative risk of developing bipolar affective disorder among migrants was 2.47 (95% C11.33–4.59). However, after excluding people of African-Caribbean origin in the UK this risk was no longer significantly increased. The mean relative risk of mood disorders of unspecified polarity was 1.25 (95% CI 1.04–1.49) and that of any mood disorder was 1.38 (95% CI 1.17–1.62).ConclusionsThere is no conclusive evidence for a large increase in the risk of mood disorders associated with migration.
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Undurraga, Juan, Kang Sim, Leonardo Tondo, et al. "Lithium treatment for unipolar major depressive disorder: Systematic review." Journal of Psychopharmacology 33, no. 2 (2019): 167–76. http://dx.doi.org/10.1177/0269881118822161.
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Background: The potential value of lithium treatment in particular aspects of unipolar major depressive disorder remains uncertain. Methods: With reports of controlled trials identified by systematic searching of Medline, Cochrane Library, and PsycINFO literature databases, we summarized responses with lithium and controls followed by selective random-effects meta-analyses. Results: We identified 36 reports with 39 randomized controlled trials: six for monotherapy and 12 for adding lithium to antidepressants for acute major depression, and 21 for long-term treatment. Data for monotherapy of acute depression were few and inconclusive. As an adjunct to antidepressants, lithium was much more effective than placebo ( p<0.0001). For long-term maintenance treatment, lithium was more effective than placebo in monotherapy ( p=0.011) and to supplement antidepressants ( p=0.038), and indistinguishable from antidepressant monotherapy. Conclusions: The findings indicate efficacy of lithium as a treatment for some aspects of major depressive disorder, especially as an add-on to antidepressants and for long-term prophylaxis. It remains uncertain whether some benefits of lithium treatment occur with many major depressive disorder patients, or if efficacy is particular to a subgroup with bipolar disorder-like characteristics or mixed-features.
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Levitan, Robert D., Caroline Davis, Allan S. Kaplan, Tamara Arenovich, D. I. W. Phillips, and Arun V. Ravindran. "Obesity Comorbidity in Unipolar Major Depressive Disorder." Journal of Clinical Psychiatry 73, no. 08 (2012): 1119–24. http://dx.doi.org/10.4088/jcp.11m07394.
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Klerman, Gerald L. "Treatment of Recurrent Unipolar Major Depressive Disorder." Archives of General Psychiatry 47, no. 12 (1990): 1158. http://dx.doi.org/10.1001/archpsyc.1990.01810240078012.
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Menchon, JM, C. Gasto, J. Vallejo, R. Catalan, A. Otero, and E. Vieta. "Rate and significance of hypomanic switches in unipolar melancholic depression." European Psychiatry 8, no. 3 (1993): 125–29. http://dx.doi.org/10.1017/s0924933800001905.
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SummaryOne hundred and sixteen patients with RDC unipolar recurrent depressive disorder, melancholic subtype, were treated with imipramine or phenelzine and followed-up for six months. None of the patients had a first-degree relative with bipolar I disorder. Twenty-six patients (22.4%) presented an hypomanic episode (‘hypomanic group’). This group of patients, when depressed, had a significantly lower age of onset of the disorder and higher response to antidepressant therapy than patients who did not present an hypomanic episode. Significantly more patients (88%) of the ‘hypomanic group’ had at least one first-degree relative with a history of major depressive disorder. These patients displayed some of the typical features of bipolar II disorder. Overall results support the continuum in clinical phenomena between unipolar and bipolar disorders.
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Elboğa, Gülçin, Muhammet Berkay Özyürek, Zeynel Abidin Sayıner, Şengül Kocamer Şahin, and Abdurrahman Altındağ. "Serum Uric Acid Level in Unipolar and Bipolar Depression." Medical Laboratory Technology Journal 5, no. 1 (2019): 49. http://dx.doi.org/10.31964/mltj.v5i1.202.
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The purinergic system plays a role in the regulation of mood, motor activity, cognitive function, sleep, and behavior. Purinergic mechanisms can also play a role in various neuropsychiatric diseases. The objective of this study is to assess whether uric acid levels in patients with unipolar and bipolar depression are different in comparison to healthy controls and to determine the clinical parameters that can be associated with the uric acid level. This retrospective study consisted of 31 patients with major depressive disorder and 31 patients with bipolar disorder depressive episode and 31 healthy control subjects. The mean serum uric acid levels were found as follows: major depression patient group 4.56 (± 1.53) mg/dL, bipolar depression patient group 5.38 (± 1.43) mg/dL and control group 4.86 (± 1.56) mg/dL. There was no significant difference between patients and the control groups in terms of serum uric acid levels (P=0.075). Serum uric acid levels do not differ significantly in bipolar and unipolar depression. Also, there was no difference between patients and control. Therefore, studying the uric acid metabolism in major depression and bipolar disorder depressive episode according to the symptom severity with larger sample groups is suggested.
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Coryell, William, Jess G. Fiedorowicz, David Solomon, Andrew C. Leon, John P. Rice, and Martin B. Keller. "Effects of anxiety on the long-term course of depressive disorders." British Journal of Psychiatry 200, no. 3 (2012): 210–15. http://dx.doi.org/10.1192/bjp.bp.110.081992.
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BackgroundIt is well established that the presence of prominent anxiety within depressive episodes portends poorer outcomes. Important questions remain as to which anxiety features are important to outcome and how sustained their prognostic effects are over time.AimsTo examine the relative prognostic importance of specific anxiety features and to determine whether their effects persist over decades and apply to both unipolar and bipolar conditions.MethodParticipants with unipolar (n = 476) or bipolar (n = 335) depressive disorders were intensively followed for a mean of 16.7 years (s.d. = 8.5).ResultsThe number and severity of anxiety symptoms, but not the presence of pre-existing anxiety disorders, showed a robust and continuous relationship to the subsequent time spent in depressive episodes in both unipolar and bipolar depressive disorder. The strength of this relationship changed little over five successive 5-year periods.ConclusionsThe severity of current anxiety symptoms within depressive episodes correlates strongly with the persistence of subsequent depressive symptoms and this relationship is stable over decades.
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Cobb, Bryan S., William H. Coryell, Joseph Cavanaugh, et al. "Seasonal variation of depressive symptoms in unipolar major depressive disorder." Comprehensive Psychiatry 55, no. 8 (2014): 1891–99. http://dx.doi.org/10.1016/j.comppsych.2014.07.021.
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PARKER, G., and D. HADZI-PAVLOVIC. "Is the female preponderance in major depression secondary to a gender difference in specific anxiety disorders?" Psychological Medicine 34, no. 3 (2004): 461–70. http://dx.doi.org/10.1017/s0033291703001181.
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Background. While a female preponderance in unipolar depression is a consistent finding in community-based studies, determinants remain speculative. This study aimed to examine whether a female preponderance in certain anxiety disorders drives a gender difference in depression.Method. The relevant data from the National Comorbidity Study (NCS) are analysed.Results. We observed a biphasic pattern in the emergence of a female preponderance in the depressive and anxiety disorders, with an initial pre-pubertal or early adolescent onset, and after attenuation in early to middle adulthood, re-emergence in mid- to late-adulthood. Analyses focused on determinants of the initial female preponderance. Female gender, presence of an anxiety disorder and variable ages of onset in the anxiety disorder all contributed to the increased chance of an initial depressive episode. Some specificity in linking the onset of depressive temporally in early adolescence with two anxiety disorders was demonstrated, specifically generalized anxiety disorder and panic disorder.Conclusions. The separate anxiety disorders and their age of onset had variable links with depression, but female gender remained a significant predictor of depression after accounting for the effects of prior anxiety.
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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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Mehta, Shubham, Pankaj Kumar Mittal, and Mukesh Kumar Swami. "Psychosocial Functioning in Depressive Patients: A Comparative Study between Major Depressive Disorder and Bipolar Affective Disorder." Depression Research and Treatment 2014 (2014): 1–6. http://dx.doi.org/10.1155/2014/302741.
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Introduction. Major depressive disorder (MDD) and bipolar affective disorder (BAD) are among the leading causes of disability. These are often associated with widespread impairments in all domains of functioning including relational, occupational, and social. The main aim of the study was to examine and compare nature and extent of psychosocial impairment of patients with MDD and BAD during depressive phase.Methodology. 96 patients (48 in MDD group and 48 in BAD group) were included in the study. Patients were recruited in depressive phase (moderate to severe depression). Patients having age outside 18–45 years, psychotic symptoms, mental retardation, and current comorbid medical or axis-1 psychiatric disorder were excluded. Psychosocial functioning was assessed using Range of Impaired Functioning Tool (LIFE-RIFT).Results. Domains of work, interpersonal relationship, life satisfaction, and recreation were all affected in both groups, but the groups showed significant difference in global psychosocial functioning score only (P=0.031) with BAD group showing more severe impairment.Conclusion. Bipolar depression causes higher global psychosocial impairment than unipolar depression.
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Rhebergen, D., F. Lamers, J. Spijker, R. de Graaf, A. T. F. Beekman, and B. W. J. H. Penninx. "Course trajectories of unipolar depressive disorders identified by latent class growth analysis." Psychological Medicine 42, no. 7 (2011): 1383–96. http://dx.doi.org/10.1017/s0033291711002509.
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BackgroundCurrent classification of unipolar depression reflects the idea that prognosis is essential. However, do DSM categories of major depressive disorder (MDD), dysthymic disorder (Dysth) and double depression (DD=MDD+Dysth) indeed adequately represent clinically relevant course trajectories of unipolar depression? Our aim was to test DSM categories (MDD, Dysth and DD) in comparison with empirically derived prognostic categories, using a prospectively followed cohort of depressed patients.MethodA large sample (n=804) of out-patients with unipolar depression were derived from a prospective cohort study, the Netherlands Study of Depression and Anxiety (NESDA). Using latent class growth analysis (LCGA), empirically derived 2-year course trajectories were constructed. These were compared with DSM diagnoses and a wider set of putative predictors for class membership.ResultsFive course trajectories were identified, ranging from mild severity and rapid remission to high severity and chronic course trajectory. Contrary to expectations, more than 50% of Dysth and DD were allocated to classes with favorable course trajectories, suggesting that current DSM categories do not adequately represent course trajectories. The class with the most favorable course trajectory differed on several characteristics from other classes (younger age, more females, less childhood adversity, less somatic illnesses, lower neuroticism, higher extraversion). Older age, earlier age of onset and lower extraversion predicted poorest course trajectory.ConclusionsMDD, Dysth and DD did not adequately match empirically derived course trajectories for unipolar depression. For the future classification of unipolar depression, it may be wise to retain the larger, heterogeneous category of unipolar depression, adopting cross-cutting dimensions of severity and duration to further characterize patients.
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Muir, Walter J., David M. St. Clair, and Douglas H. R. Blackwood. "Long-latency auditory event-related potentials in schizophrenia and in bipolar and unipolar affective disorder." Psychological Medicine 21, no. 4 (1991): 867–79. http://dx.doi.org/10.1017/s003329170002986x.
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SYNOPSISLong-latency auditory event-related potentials were examined in 96 subjects with schizophrenia, 99 with bipolar affective disorder and 48 with major depressive (unipolar) disorder, and compared with 32 in-patient and 213 normal controls. The latency of the P3 component was significantly greater in the schizophrenic and bipolar subjects compared to other groups. The difference was stable with respect to clinical state at the time of testing and was not due to age differences or the effect of psychotropic medications. The results support the clinical distinction between bipolar and unipolar affective disorders, but also show that P3 change is not specific to schizophrenia and found in bipolar but not unipolar affective disorder.
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Radaelli, Daniele, Sara Dallaspezia, Sara Poletti, et al. "Different Neural Responses to a Moral Valence Decision Task in Unipolar and Bipolar Depression." ISRN Psychiatry 2013 (December 17, 2013): 1–10. http://dx.doi.org/10.1155/2013/568617.
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Objectives. Patients affected by bipolar disorder (BP) and major depressive disorder (UP) share the susceptibility to experience depression and differ in their susceptibility to mania, but clinical studies suggest that the biological substrates of the two disorders could influence the apparently similar depressive phases. The few brain imaging studies available described different brain metabolic and neural correlates of UP and BP. Methods. We studied the BOLD neural response to a moral valence decision task targeting the depressive biases in information processing in 36 subjects (14 BP, 11 UP, and 11 controls). Results. Main differences between UP and controls and between UP and BP were detected in left ventrolateral prefrontal cortex (PFC, BA 47). Neural responses of BP patients differed from those of control subjects in multiple brain areas, including anterior cingulate cortex (ACC) and medial PFC, bilateral dorsolateral PFC, temporal cortex and insula, and parietal and occipital cortex. Conclusions. Our results are in agreement with hypotheses of dysfunctions in corticolimbic circuitries regulating affects and emotions in mood disorders and suggest that specific abnormalities, particularly in ventrolateral PFC, are not the same in UP and BP depression.
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Holmskov, J., R. W. Licht, K. Andersen, et al. "Diagnostic Conversion to Bipolar Disorder in Unipolar Depressed Patients Participating in Trials on Antidepressants." European Psychiatry 40 (December 18, 2016): 76–81. http://dx.doi.org/10.1016/j.eurpsy.2016.08.006.
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AbstractObjectiveIn unipolar depressed patients participating in trials on antidepressants, we investigated if illness characteristics at baseline could predict conversion to bipolar disorder.MethodA long-term register-based follow-up study of 290 unipolar depressed patients with a mean age of 50.8 years (SD = 11.9) participating in three randomized trials on antidepressants conducted in the period 1985–1994. The independent effects of explanatory variables were examined by applying Cox regression analyses.ResultsThe overall risk of conversion was 20.7%, with a mean follow-up time of 15.2 years per patient. The risk of conversion was associated with an increasing number of previous depressive episodes at baseline, [HR 1.18, 95% CI (1.10–1.26)]. No association with gender, age, age at first depressive episode, duration of baseline episode, subtype of depression or any of the investigated HAM-D subscales included was found.LimitationsThe patients were followed-up through the Danish Psychiatric Central Research Register, which resulted in inherent limitations such as possible misclassification of outcome.ConclusionIn a sample of middle-aged hospitalized unipolar depressed patients participating in trials on antidepressants, the risk of conversion was associated with the number of previous depressive episodes. Therefore, this study emphasizes that unipolar depressed patients experiencing a relatively high number of recurrences should be followed more closely, or at least be informed about the possible increased risk of conversion.
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Pardoen, D., F. Bauwens, A. Tracy, F. Martin, and J. Mendlewicz. "Self-esteem in Recovered Bipolar and Unipolar Out-patients." British Journal of Psychiatry 163, no. 6 (1993): 755–62. http://dx.doi.org/10.1192/bjp.163.6.755.
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The hypothesis of a low self-esteem in depressive patients was tested using the Rosenberg Self-Esteem Scale in 24 recovered unipolar and 27 recovered bipolar patients, compared with a normal control group of 26 subjects matched for age and sex. The hypothesis was confirmed only for unipolars; bipolar patients presented a self-esteem score not significantly different from normal scores. Self-esteem was not related to clinical characteristics of the affective disorder, suggesting that low self-esteem may be a basic component of a depression-prone personality. The investigation of the relationship between self-esteem and social adjustment confirmed the presence of social conformism in bipolar patients and rigidly set low self-esteem in unipolar patients. These results should stimulate the evaluation of different psychotherapeutic treatments in the long-term psychosocial management of affectively ill patients.
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Rucker, James JH, Luke A. Jelen, Sarah Flynn, Kyle D. Frowde, and Allan H. Young. "Psychedelics in the treatment of unipolar mood disorders: a systematic review." Journal of Psychopharmacology 30, no. 12 (2016): 1220–29. http://dx.doi.org/10.1177/0269881116679368.
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Unipolar mood disorders, including major depressive disorder and persistent depressive disorder (dysthymia), confer high rates of disability and mortality and a very high socioeconomic burden. Current treatment is suboptimal in most cases and there is little of note in the pharmaceutical development pipeline. The psychedelic drugs, including lysergic acid diethylamide and psilocybin, were used extensively in the treatment of mood disorders, and other psychiatric conditions, before their prohibition in the late 1960s. They are relatively safe when used in medically controlled environments, with no reported risk of dependence. Here, we present a systematic review of published clinical treatment studies using psychedelics in patients with broadly defined UMD, and consider their place in psychiatry. Whilst all of the included studies have methodological shortcomings, of 423 individuals in 19 studies, 335 (79.2%) showed clinician-judged improvement after treatment with psychedelics. A recently completed pilot study in the UK favours the use of psilocybin with psychological support in treatment resistant depressive disorder. The evidence overall strongly suggests that psychedelics should be re-examined in modern clinical trials for their use in unipolar mood disorders and other non-psychotic mental health conditions.
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Suciu, B., R. Paunescu, and I. Miclutia. "Patterns of Impairment in Executive Functions within Unipolar and Bipolar Depression." European Psychiatry 41, S1 (2017): S212. http://dx.doi.org/10.1016/j.eurpsy.2017.01.2182.
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IntroductionThe majority of studies revealed that cognitive deficits are an important aspect in many psychiatric illnesses, such as bipolar disorder and major depressive disorder. In the past, cognitive impairment was considered part of depression and it was expected to diminish as other mood symptoms improved with treatment.MethodThis study is based on the review of recent literature, performed in order to understand the dimension of executive impairment in unipolar and bipolar depression.ResultsBoth unipolar and bipolar depressed patients display cognitive deficits in several cognitive domains within executive functions. Different subcomponents of executive functions are altered in both types of patients, but impairments in sustained attention appear specific in bipolar depression while dysfunctional divided attention is reported in unipolar disorder. Studies describe deficits in planning strategies and monitoring processes that are characteristically impaired in unipolar depressed patients. Also these subjects tend to make more perseverative responses suggesting set shifting deficits and moreover they require longer time and more cognitive effort in order to accomplish tasks involving inhibitory control or cognitive flexibility. Other findings suggest that bipolar I depressed patients perform worse than bipolar II depressed patients and unipolar depressed patients across all executive functions especially in the decision making process that is considered to be a trait marker for bipolar disorder with no differences between the two types of bipolar subjects.ConclusionsExecutive functions represent a term that includes a higher order of cognitive abilities with deficits that are present in both disorders but display slightly different patterns of impairment.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Pridmore, Saxby, Helen Hornsby, David Hay, and Ivor Jones. "Survival Analysis and Readmission in Mood Disorder." British Journal of Psychiatry 165, no. 6 (1994): 824–27. http://dx.doi.org/10.1192/bjp.165.6.824.
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BackgroundThis is an exploratory study of readmission in mood disorder.MethodThe study is naturalistic and employs survival analysis. We identified 821 individuals with ICD–9 diagnoses, drawn from the Tasmanian Mental Health Register.ResultsNo demographic variables influence the time to readmission. Two groups emerge: those with affective psychoses, and those with neurotic depression, brief depressive reaction and depressive disorders not elsewhere classified. The former group demonstrated shorter times to readmission than the latter. There was no support for a unipolar–bipolar distinction.ConclusionsAffective psychoses have a less favourable outcome than expected. There was support for an endogenous-neurotic distinction.
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Kessing, Lars Vedel, Tom Gert Bolwig, Per Kragh Andersen, and Preben Bo Mortensen. "Recurrence in affective disorder." British Journal of Psychiatry 172, no. 1 (1998): 23–28. http://dx.doi.org/10.1192/bjp.172.1.23.
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BackgroundIn recent years, studies of the risk of recurrence in affective disorder in relation to the number of prior episodes have given contradictory results.MethodSurvival analysis was used to calculate the rate of recurrence after successive episodes in a case register study including all hospital admissions with primary affective disorder in Denmark during 1971–1993. A total of 20 350 first-admission patients were discharged with a diagnosis of affective disorder, depressive or manic/cyclic type.ResultsThe rate of recurrence increased with the number of previous episodes in both unipolar and bipolar disorder. Initially, the two types of disorders followed markedly different courses, but later in the course of the illness the rate of recurrence was the same for the two disorders.ConclusionsThe course of severe unipolar and bipolar disorder seems to be progressive in nature despite the effect of treatment.
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OLDEHINKEL, A. J., H. U. WITTCHEN, and P. SCHUSTER. "Prevalence, 20-month incidence and outcome of unipolar depressive disorders in a community sample of adolescents." Psychological Medicine 29, no. 3 (1999): 655–68. http://dx.doi.org/10.1017/s0033291799008454.
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Background. This article presents prospective longitudinal findings on prevalence, incidence, patterns of change and stability of depressive disorders in a community sample of 1228 adolescents.Methods. Data were collected at baseline and follow-up (20 months later) in a representative population sample of 1228 adolescents, aged 14–17 at baseline. Diagnostic assessment was based on the Munich Composite International Diagnostic Interview (M-CIDI).Results. The overall cumulative lifetime incidence of any depressive condition was 20·0% (major depressive disorder (MDD), 12·2%; dysthymia, 3·5%; subthreshold MDD, 6·3%), of which about one-third were incident depressions in the period between baseline and follow-up. Depressive disorders rarely started before the age of 13. Females were about twice as likely as males to develop a depressive disorder. Overall, the 20-month outcome of baseline depression was unfavourable. Dysthymia had the poorest outcome of all, with a complete remission rate of only 33% versus 43% for MDD and 54% for subthreshold MDD. Dysthymia also had the highest number of depressive episodes, and most psychosocial impairment and suicidal behavioural during follow-up. Treatment rates were low (8–23%). Subthreshold MDD associated with considerable impairment had an almost identical course and outcome as threshold MDD.Conclusions. DSM-IV MDD and dysthymia are rare before the age of 13, but frequent during adolescence, with an estimated lifetime cumulative incidence of 14%. Only a minority of these disorders in adolescence is treated, and more than half of them persist or remit only partly.
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Maes, M. "Effects of age and gender on the classification and phenomenology of unipolar depression." Acta Neuropsychiatrica 14, no. 1 (2002): 29–35. http://dx.doi.org/10.1034/j.1601-5215.2002.140104.x.
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Aim:The aim of the present study was to examine the effects of age and gender on depressive classification and phenomenology in unipolar depressed in-patients.Methods:The authors have assessed 14 items relevant to depressive symptomatology from the Structured Clinical Interview for DSM-III (SCID) and the Hamilton Depression Rating Scale (HDRS) in 180 depressed in-patients.Results:Melancholia was significantly more prominent in older depressed patients (≥ 55 years), whereas minor depression (i.e. adjustment disorder with depressed mood and dysthymic disorder) in younger (< 55 years) depressed subjects. Older depressed subjects exhibited significantly more anorexia/weight loss, non-reactivity, depressed mood, loss of interest, early morning awakening, loss of energy, somatic anxiety, loss of insight, psychotic symptoms and retardation than younger depressed people. Male depressed subjects showed significantly more loss of interest, suicidal ideation and agitation than their female counterparts. Psychomotor disorders, a distinct quality of mood and early morning awakening were characteristics of older depressed males, while diurnal variation occurred more frequently in older depressed females.Conclusion:It is concluded that increasing age in unipolar depression may be accompanied by an increase in severity of illness, increased frequency of some melancholic symptoms, particularly in men and a higher frequency of major depression in women and of melancholia in men.
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Clark, David A., and Robert A. Steer. "Use of Nonsomatic Symptoms to Differentiate Clinically Depressed and Nondepressed Hospitalized Patients with Chronic Medical Illnesses." Psychological Reports 75, no. 3 (1994): 1089–90. http://dx.doi.org/10.2466/pr0.1994.75.3.1089.
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The differential sensitivity of the Depression subscale scores of the Hospital Anxiety and Depression Scale and the Cognitive-Affective subscale scores of the revised Beck Depression Inventory were compared for 21 chronic medically ill hospitalized patients with DSM-III—R unipolar depressive disorders and 54 hospitalized medically ill patients without a comorbid psychiatric disorder. Both subscales significantly differentiated these two types of patients beyond the .001 level and yielded comparable effect sizes. The Cognitive-Affective subscale detected clinical depression as well as a specialized self-report measure.
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Alnæs, Randolf, and Svenn Torgersen. "Mood Disorders: Developmental and Precipitating Events." Canadian Journal of Psychiatry 38, no. 3 (1993): 217–24. http://dx.doi.org/10.1177/070674379303800311.
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A consecutive sample of 298 mainly non psychotic outpatients was classified according to DSM-III criteria. The differences in the reports from childhood and the precipitating events among the various subgroups of mood disorders (bipolar disorder, major depression, cyclothymic disorder, dysthymic disorder) and a residual group of patients with other mental disorders were examined. The patients in the non bipolar group reported more traumatic childhood experiences than the patients in the bipolar group. Precipitating events among patients in the group with major depression consisted more often of acute external stressors. Developmental factors and precipitating events in adulthood seem to be relevant in differentiating between the depressive disorders. The study supports the validity of the unipolar-bipolar distinction. The cyclothymic group seem to be a special variant of the major mood disorders.
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Akiskal, H. S., and K. Akiskal. "Reassessing the prevalence of bipolar disorders : clinical significance and artistic creativity." Psychiatry and Psychobiology 3, S1 (1988): 29s—36s. http://dx.doi.org/10.1017/s0767399x00002625.
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SummaryKraepelin's broad concept of manic-depressive illness was challenged in the 1960s by several European and American investigators. This led to the unipolar-bipolar distinction, with considerable restriction of the boundaries of bipolar disorder in favor of unipolar depressions. This concept has now been implicity adopted by official systems of classification worldwide. This review summarizes recent research data that suggest that a partial return to Kraepelin's broad concept of manic-depressive illness is in order. In reassessing the unipolar-bipolar dichotomy, the authors propose that the classification of depressions should incorporate such nonsymptomatologic considerations as family history, temperament, abruptness of onset, recurrence (periodicity and seasonality), and Pharmacologie response.Depending on the definitions used, the unipolar-bipolar ratio has ranged from 10:1 to 4:1. Recent American and European investigations, including studies by the authors and their Italian collaborators, suggest that this ratio may be closer to 2:1 and even as low as 1:1. This conclusion is further supported by genetic data, prospective follow-up studies, pharmacologie response, and examination of interepisodic temperaments. Thus, many depressives with premorbid or intermorbid hyperthymie, irritable or cyclothymie temperaments can now be classified as bipolar. Variously referred to as pseudo-unipolar, unipolar II, bipolar III, bipolar II, or the “ soft” bipolar speetrum, these depressive conditions present diagnostic and therapeutic challenges to the clinician. Special subgroups may be at risk for rapid cycling when overexposed to tricyclic antidepressants. Finally, a significant minority of soft bipolars uppear to be prominent in leadership positions and artistic domains.
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Li, Cheng-Ta, Ya-Mei Bai, Yu-Lin Huang, et al. "Association between antidepressant resistance in unipolar depression and subsequent bipolar disorder: cohort study." British Journal of Psychiatry 200, no. 1 (2012): 45–51. http://dx.doi.org/10.1192/bjp.bp.110.086983.
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BackgroundPeople with major depressive disorder who fail to respond to adequate trials of antidepressant treatment may harbour hidden bipolar disorder.AimsWe aimed to compare the rates of a change in diagnosis to bipolar disorder among people with major depressive disorder with stratified responses to antidepressants during an 8-year follow-up period.MethodInformation on individuals with major depressive disorder identified during 2000 (cohort 2000, n = 1485) and 2003 (cohort 2003, n = 2459) were collected from a nationally representative cohort of 1 000 000 health service users in Taiwan. Participants responding well to antidepressants were compared with those showing poor responses to adequate trials of antidepressants.ResultsIn 7.6–12.1% of those with a diagnosis of unipolar major depressive disorder this diagnosis was subsequently changed to bipolar disorder, with a mean time to change of 1.89–2.98 years. Difficult-to-treat participants presented higher rates of change to a bipolar diagnosis (25.6% in cohort 2000; 26.6% in cohort 2003) than easy-to-treat participants (8.8–8.9% in cohort 2000; 6.8–8.6% in cohort 2003; P<0.0001). Regression analysis showed that the variable most strongly associated with the change in diagnosis was antidepressant use history. The difficult-to-treat participants were associated most with diagnostic changing (cohort 2000: odds ratio (OR) = 1.88 (95% CI 1.12–3.16); cohort 2003: OR = 4.94 (95% CI 2.81–8.68)).ConclusionsThis is the first large-scale study to report an association between antidepressant response history and subsequent change in diagnosis from major depressive disorder to bipolar disorder. Our findings support the view that a history of poor response to antidepressants in unipolar depression could be a useful predictor for bipolar diathesis.
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Morin, Anna K. "Triiodothyronine (T3) supplementation in major depressive disorder." Mental Health Clinician 5, no. 6 (2015): 253–59. http://dx.doi.org/10.9740/mhc.2015.11.253.
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Abstract Introduction The use of thyroid hormones to enhance the effects of antidepressants is based on evidence supporting a link between thyroid function and Major Depressive Disorder. Thyroid abnormalities have been found in patients with Major Depressive Disorder and have been correlated with depression severity. Symptoms associated with clinical hypothyroidism include mood disturbances, primarily depression. In addition, an increase in antidepressant treatment resistance has been associated with thyroid abnormalities. This article reviews the existing data regarding triiodothyronine (T3) supplementation of antidepressants in the treatment of major depressive disorder. Methods Medline and EMBASE were searched from 1996 to November 2014 using the key terms triiodothyronine, T3, and treatment-resistant depression. Results T3 may increase serotonergic neurotransmission and has been studied as an add-on agent in patients with unipolar depression with and without thyroid dysfunction to accelerate, enhance, and augment the effects of tricyclic antidepressants and selective serotonin reuptake inhibitors. Discussion Data support the use of T3 augmentation (25-50 μg/d) for the treatment of depressive symptoms in some patient populations without thyroid hormone abnormalities who do not respond to an adequate trial of a tricyclic antidepressant or a selective serotonin reuptake inhibitor. Monitoring for adverse effects and conditions that may be exacerbated by T3 augmentation is recommended.
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Piacentino, D., P. Girardi, K. G. D. Md, et al. "Sensitivity and specificity of the Italian version of the bipolar spectrum diagnostic scale. Different scores in distinct populations with unipolar depression." European Psychiatry 41, S1 (2017): S333. http://dx.doi.org/10.1016/j.eurpsy.2017.02.279.
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IntroductionTo date, the proposition of recurrence as a subclinical bipolar disorder feature has not received adequate testing.Objectives/AimsWe used the Italian version of the bipolar spectrum diagnostic scale (BSDS), a self-rated questionnaire of bipolar risk, in a sample of patients with mood disorders to test its specificity and sensitivity in identifying cases and discriminating between high risk for bipolar disorder major depressive patients (HRU) and low risk (LRU) adopting as a high recurrence cut-off five or more lifetime major depressive episodes.MethodsWe included 115 patients with DSM-5 bipolar disorder (69 type I, 41 type II, and 5 NOS) and 58 with major depressive disorder (29 HRU and 29 LRU, based on the recurrence criterion). Patients filled-out the Italian version of the BSDS, which is currently undergoing a validation process.ResultsThe BSDS, adopting a threshold of 14, had 84% sensitivity and 76% specificity. HRU, as predicted, scored on the BSDS intermediate between LRU and bipolar disorder. Clinical characteristics of HRU were more similar to bipolar disorder than to LRU; HRU, like bipolar disorder patients, had more lifetime hospitalizations, higher suicidal ideation and attempt numbers, and higher rates of family history of suicide.ConclusionsThe BSDS showed satisfactory sensitivity and sensitivity. Splitting the unipolar sample into HRU and LRU, on the basis of the at least 5 lifetime major depressive episodes criterion, yielded distinct unipolar subpopulations that differ on outcome measures and BSDS scores.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Nivoli, A., L. Floris, M. Antonioli, et al. "Personality disorders and affective temperament in unipolar and bipolar mood disorder." European Psychiatry 41, S1 (2017): S536. http://dx.doi.org/10.1016/j.eurpsy.2017.01.735.
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IntroductionPersonality disorders (PD) and Affective temperaments (AT) have been considered vulnerability factors for the development of mood disorder (MD).ObjectiveTo study the simultaneous presence of PD and AT in patients with DU and differences between unipolar depression (DD) and bipolar disorder BD.MethodsAn observational study was conducted. Patients were administered the Temperament Evaluation of Memphis, Pisa, Paris and San Diego questionnaire (TEMPS-A) for AT and the Structured Clinical Interview for DSM IV Axis II Disorders (SCID-II) for PD. The interrelationships of the different PD and AT were studied by factor analysis (principal component analysis, PCA) (orthogonal rotation, Varimax).ResultsParticipants were 156 adult patients with MD, 37.1% with DD and 62.9% with BD. DD patients presented with significantly more paranoid PD (P = 0.009), depressive (P = 0.029), anxious (P = 0.009) and irritable temperament (P = 0.006) compared to BD. PCA results showed four significant factors, explaining the 63.1% of total variance, corresponding to four potential groups of patients with specific PD and AT associations.ConclusionThe comorbidity between MD and PD and AT may differentiate DD from BD. Specific patterns of comorbidity may be useful as they may substantially influence the course of the mood disorders and how patients respond to treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.