DOCSLIB.ORG

Heterogeneity of DSM-IV Major Depressive Disorder As a Consequence of Subthreshold Bipolarity

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Heterogeneity of DSM-IV Major Depressive Disorder As a Consequence of Subthreshold Bipolarity ORIGINAL ARTICLE Heterogeneity of DSM-IV Major Depressive Disorder as a Consequence of Subthreshold Bipolarity Petra Zimmermann, PhD; Tanja Brückl, PhD; Agnes Nocon, MSc; Hildegard Pfister, Dipl-Inf; Roselind Lieb, PhD; Hans-Ulrich Wittchen, PhD; Florian Holsboer, MD, PhD; Jules Angst, MD Context: There is growing evidence that major depres- Results: Among 488 respondents with MDD, 286 (58.6%) sive disorder (MDD) might be overdiagnosed at the ex- had pure MDD and 202 (41.4%) had subthreshold BPD pense of bipolar disorder (BPD). (cumulative incidence, 9.3%). Compared with respon- dents who had pure MDD, respondents with subthresh- Objectives: To identify a subgroup of subthreshold BPD old BPD were found to have a significantly increased fam- among DSM-IV MDD, which is distinct from pure MDD ily history of mania, considerably higher rates of nicotine regarding a range of validators of bipolarity, and to ex- dependence and alcohol use disorders, rates of panic dis- amine the pattern of these validators among different order that were twice as high, and a tendency toward higher groups with affective disorders. rates of criminal acts. Prospective analyses showed that sub- threshold BPD converted more often into BPD during fol- low-up, with DSM-IV criterion D (symptoms observable Design: Ten-year prospective longitudinal and family by others) being of critical predictive relevance. With in- study including 3 follow-up waves. Data were assessed creasing severity of the manic component, rates for di- with the DSM-IV Munich Composite International Di- verse validators accordingly increased (eg, alcohol use dis- agnostic Interview. orders, parental mania) or decreased (harm avoidance). Setting: Community sample in Munich, Germany. Conclusions: Data suggest that MDD is a heteroge- neous concept including a large group with subthreshold Participants: A total of 2210 subjects (aged 14-24 years BPD, which is clinically significant and shares similari- at baseline) who completed the third follow-up. ties with BPD. Findings might support the need for a broader concept and a more comprehensive screening of Main Outcome Measures: Cumulative incidence of bipolarity, which could be substantial for future research pure MDD, BPD, and subthreshold BPD (defined as ful- and adequate treatment of patients with bipolarity. filling criteria for MDD plus having manic symptoms but never having met criteria for [hypo]mania). Arch Gen Psychiatry. 2009;66(12):1341-1352 HE DIAGNOSTIC CONCEPT OF manic episode, and they also noted that major depressive disorder some MDD cases might be better reclassi- (MDD) was adopted in the fied as bipolar.13-18 This could particularly DSM-III1 in 1980 and sub- pertain to young adults, when the disor- sequently refined in the der is in its early stages. Additionally, it must Author Affiliations: Molecular DSM-III-R2 and the DSM-IV.3 Since then, be questioned whether the current DSM- Psychology Unit, Max Planck T Institute of Psychiatry, Munich, MDD has been described as the most fre- IV–based instruments are sufficiently sen- 19,20 Germany (Drs Zimmermann, quent mood disorder, with rates up to 16%, sitive for detecting hypomania. Sup- Brückl, Lieb, Wittchen, and and as highly comorbid with anxiety and port comes from epidemiological and Holsboer and Mss Nocon and substance use disorders (SUDs).4-6 In con- clinical studies dealing with wider con- Pfister); Department of trast as shown by large community stud- cepts of bipolarity, which showed that sub- Epidemiology and Health ies, the prevalence of bipolar disorders threshold BPD not recognized with the cur- Psychology, University of Basel, (BPDs) is 2%, considerably lower.7-10 rent DSM-IV criteria is common and Basel, Switzerland (Dr Lieb); However, concerns about the reliabil- clinically significant.8,14,16,21,22 In the Na- Technische Universität Dresden, ity of the hypomania diagnosis were tional Comorbidity Survey Replication, the Institut für Klinische 11,12 Psychologie und Psychotherapie, raised. Several investigators noted that overall prevalence of BPD increased from Dresden, Germany bipolarity might be underdiagnosed by the 2.1% to 4.4% if subthreshold BPD was con- (Dr Wittchen); and Zurich DSM-IV criteria as the diagnosis of bipolar sidered, and the clinical validity of this sub- University Psychiatric Hospital, II disorder (BP-II) requires the presence of threshold group was clearly demonstrated Zurich, Switzerland (Dr Angst). a major depressive episode plus a hypo- in terms of role impairment or comorbid- (REPRINTED) ARCH GEN PSYCHIATRY/ VOL 66 (NO. 12), DEC 2009 WWW.ARCHGENPSYCHIATRY.COM 1341 ©2009 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/25/2021 ity.8 In the small prospective Zurich Study,14 a stepwise 1.99) and any illegal SUD (OR=1.71; 95% CI, 1.10-2.47), there broadening of the criteria for hypomania allocated almost was no selective attrition between baseline and the third fol- half of the subjects with major depressive episodes to a low-up due to mental syndromes and disorders. broadly defined bipolar group. The frequently reported as- Our investigation is based on the 2210 respondents who com- sociation between alcohol use disorders (AUDs) and MDD pleted the final 10-year follow-up (ie, the third follow-up). The EDSP study was approved by the Ethics Committee of the Medi- disappeared in favor of a high association with BP-II.14,23 19 cal Faculty of the Technische Universität Dresden and the Bay- Benazzi and Akiskal found that 61% of 168 outpatients erische Landesärztekammer Munich. All participants pro- with MDD were classified as bipolar when the strict Struc- vided informed consent. tured Clinical Interview for DSM Disorders criteria for hy- pomania were broadened. DIAGNOSTIC ASSESSMENT Overall, there is still a lack of large-scale epidemio- logical studies that systematically examine the question At each wave participants were interviewed with the computer- of whether DSM-IV MDD might be overdiagnosed at the assisted Munich Composite International Diagnostic Inter- expense of BPD owing to a too restrictive threshold for view (M-CIDI),30 which allows for the standardized assess- DSM-IV hypomania. Taking the considerable burden and ment of symptoms, syndromes, and diagnoses of DSM-IV clinical implications of BPD into account9,10,24-26 as com- disorders along with information about onset, duration, and pared with MDD, the identification of cases with “hid- severity.3 It is supplemented by a respondents’ booklet includ- den” bipolarity might be highly important. ing disorder-specific questionnaires, symptom lists, and cog- Our investigation uses data from the prospective lon- nitive aids. Test-retest reliability and validity have been re- ported elsewhere.31-33 The M-CIDI is highly sensitive for detecting gitudinal Early Developmental Stages of Psychopathol- 32 ogy (EDSP) study and has 3 goals. We examine how many any BPD and MDD (sensitivity, 93%-100%). Clinical inter- viewers, mostly graduated psychologists, who had received the cases previously classified as DSM-IV MDD would be re- standardized M-CIDI training according to the World Health classified as bipolar by broadening the criteria for mania/ Organization protocol carried out face-to-face interviews mainly hypomania and to what degree such subthreshold BPD in the respondents’ homes. All interviewers were regularly su- cases are distinct from pure MDD regarding a broad range pervised. At baseline, lifetime and 12-month disorders were as- of validators that were previously found to differentiate sessed. At the first through third follow-ups, the M-CIDI cov- between BPD and unipolar depression.14,27 Further, we ex- ered the interval since the respective last interview. amine the pattern of these validators among different groups of affective disorders with respect to clinical significance. ASSESSMENT OF MENTAL DISORDERS METHODS Depressive and manic symptoms, syndromes, and disorders were assessed using the DSM-IV M-CIDI sections E (depression) and F (mania). We built 8 mutually exclusive categories. Accord- DESIGN AND SAMPLE ing to the DSM-IV M-CIDI criteria, the spectrum of major mood disorders comprises threshold bipolar I disorder (BP-I), BP-II, Data come from the prospective longitudinal EDSP study28,29 and MDD. To establish a pure depression group, we split MDD comprising a baseline investigation and 3 follow-up waves that into MDD without any manic features (pure MDD) and MDD cover an overall period of about 10 years. The baseline sample with subthreshold hypomania (subthreshold BPD). Subthresh- was drawn randomly from the 1994 government registries of old hypomania means that the person reported a period of at all residents with German nationality aged 14 to 24 years in least 4 days with the following: (1) elated or expansive mood Munich and surrounding counties. The 14- to 15-year-olds were that created troubles or was noticed by others as a change in sampled at twice the probability of the individuals aged 16 to functioning, but DSM-IV hypomania criterion B (meeting the 21 years, and the 22- to 24-year-olds were sampled at half the required minimum number of symptoms) was not fulfilled, or probability of the individuals aged 16 to 21 years. A total of 3021 (2) unusually irritable mood expressed as starting arguments, respondents were interviewed at baseline (response rate, 71.3%), shouting at or hitting people, and having at least 3 manic symp- of whom 36.2% were students at secondary level, 26.4% were toms, but criterion D (symptoms observable by others) was not students at university, and 21.7% were employed. Among the met. Together these syndromes are labeled as the major affec- participants, 62.4% were living with their parents, 22.7% were tive spectrum because in each group DSM-IV criteria for major living alone, and 12.1% were living with their partner or spouse. depressive episodes were fulfilled. The other categories incor- The first follow-up (approximately 20 months after base- porated a subthreshold definition of depressive disorders.
Load more

Recommended publications
  • Is Your Depressed Patient Bipolar?
    J Am Board Fam Pract: first published as 10.3122/jabfm.18.4.271 on 29 June 2005. Downloaded from EVIDENCE-BASED CLINICAL MEDICINE Is Your Depressed Patient Bipolar? Neil S. Kaye, MD, DFAPA Accurate diagnosis of mood disorders is critical for treatment to be effective. Distinguishing between major depression and bipolar disorders, especially the depressed phase of a bipolar disorder, is essen- tial, because they differ substantially in their genetics, clinical course, outcomes, prognosis, and treat- ment. In current practice, bipolar disorders, especially bipolar II disorder, are underdiagnosed. Misdi- agnosing bipolar disorders deprives patients of timely and potentially lifesaving treatment, particularly considering the development of newer and possibly more effective medications for both depressive fea- tures and the maintenance treatment (prevention of recurrence/relapse). This article focuses specifi- cally on how to recognize the identifying features suggestive of a bipolar disorder in patients who present with depressive symptoms or who have previously been diagnosed with major depression or dysthymia. This task is not especially time-consuming, and the interested primary care or family physi- cian can easily perform this assessment. Tools to assist the physician in daily practice with the evalua- tion and recognition of bipolar disorders and bipolar depression are presented and discussed. (J Am Board Fam Pract 2005;18:271–81.) Studies have demonstrated that a large proportion orders than in major depression, and the psychiat- of patients in primary care settings have both med- ric treatments of the 2 disorders are distinctly dif- ical and psychiatric diagnoses and require dual ferent.3–5 Whereas antidepressants are the treatment.1 It is thus the responsibility of the pri- treatment of choice for major depression, current mary care physician, in many instances, to correctly guidelines recommend that antidepressants not be diagnose mental illnesses and to treat or make ap- used in the absence of mood stabilizers in patients propriate referrals.
    [Show full text]
  • Types of Bipolar Disorder Toms Are Evident
    MOOD DISORDERS ASSOCIATION OF BRITISH COLUmbIA T Y P E S O F b i p o l a r d i s o r d e r Bipolar disorder is a class of mood disorders that is marked by dramatic changes in mood, energy and behaviour. The key characteristic is that people with bipolar disorder alternate be- tween episodes of mania (extreme elevated mood) and depression (extreme sadness). These episodes can last from hours to months. The mood distur- bances are severe enough to cause marked impairment in the person’s func- tioning. The experience of mania is not pleasant and can be very frightening to The Diagnotistic Statisti- the person. It can lead to impulsive behaviour that has serious consequences cal Manual (DSM- IV-TR) is a for the person and their family. A depressive episode makes it difficult or -im manual used by doctors to possible for a person to function in their daily life. determine the specific type of bipolar disorder. People with bipolar disorder vary in how often they experience an episode of either mania or depression. Mood changes with bipolar disorder typically occur gradually. For some individuals there may be periods of wellness between the different mood episodes. Some people may also experience multiple episodes within a 12 month period, a week, or even a single day (referred to as “rapid cycling”). The severity of the mood can also range from mild to severe. Establishing the particular type of bipolar disorder can greatly aid in determin- ing the best type of treatment to manage the symptoms.
    [Show full text]
  • Pharmacogenomic Characterization in Bipolar Spectrum Disorders
    pharmaceutics Review Pharmacogenomic Characterization in Bipolar Spectrum Disorders Stefano Fortinguerra 1,2 , Vincenzo Sorrenti 1,2,3 , Pietro Giusti 2, Morena Zusso 2 and Alessandro Buriani 1,2,* 1 Maria Paola Belloni Center for Personalized Medicine, Data Medica Group (Synlab Limited), 35131 Padova, Italy; [email protected] (S.F.); [email protected] (V.S.) 2 Department of Pharmaceutical & Pharmacological Sciences, University of Padova, 35131 Padova, Italy; [email protected] (P.G.); [email protected] (M.Z.) 3 Bendessere™ Study Center, Solgar Italia Multinutrient S.p.A., 35131 Padova, Italy * Correspondence: [email protected] Received: 25 November 2019; Accepted: 19 December 2019; Published: 21 December 2019 Abstract: The holistic approach of personalized medicine, merging clinical and molecular characteristics to tailor the diagnostic and therapeutic path to each individual, is steadily spreading in clinical practice. Psychiatric disorders represent one of the most difficult diagnostic challenges, given their frequent mixed nature and intrinsic variability, as in bipolar disorders and depression. Patients misdiagnosed as depressed are often initially prescribed serotonergic antidepressants, a treatment that can exacerbate a previously unrecognized bipolar condition. Thanks to the use of the patient’s genomic profile, it is possible to recognize such risk and at the same time characterize specific genetic assets specifically associated with bipolar spectrum disorder, as well as with the individual response to the various therapeutic options. This provides the basis for molecular diagnosis and the definition of pharmacogenomic profiles, thus guiding therapeutic choices and allowing a safer and more effective use of psychotropic drugs. Here, we report the pharmacogenomics state of the art in bipolar disorders and suggest an algorithm for therapeutic regimen choice.
    [Show full text]
  • Specificity of Psychosis, Mania and Major Depression in A
    Molecular Psychiatry (2014) 19, 209–213 & 2014 Macmillan Publishers Limited All rights reserved 1359-4184/14 www.nature.com/mp ORIGINAL ARTICLE Specificity of psychosis, mania and major depression in a contemporary family study CL Vandeleur1, KR Merikangas2, M-PF Strippoli1, E Castelao1 and M Preisig1 There has been increasing attention to the subgroups of mood disorders and their boundaries with other mental disorders, particularly psychoses. The goals of the present paper were (1) to assess the familial aggregation and co-aggregation patterns of the full spectrum of mood disorders (that is, bipolar, schizoaffective (SAF), major depression) based on contemporary diagnostic criteria; and (2) to evaluate the familial specificity of the major subgroups of mood disorders, including psychotic, manic and major depressive episodes (MDEs). The sample included 293 patients with a lifetime diagnosis of SAF disorder, bipolar disorder and major depressive disorder (MDD), 110 orthopedic controls, and 1734 adult first-degree relatives. The diagnostic assignment was based on all available information, including direct diagnostic interviews, family history reports and medical records. Our findings revealed specificity of the familial aggregation of psychosis (odds ratio (OR) ¼ 2.9, confidence interval (CI): 1.1–7.7), mania (OR ¼ 6.4, CI: 2.2–18.7) and MDEs (OR ¼ 2.0, CI: 1.5–2.7) but not hypomania (OR ¼ 1.3, CI: 0.5–3.6). There was no evidence for cross-transmission of mania and MDEs (OR ¼ .7, CI:.5–1.1), psychosis and mania (OR ¼ 1.0, CI:.4–2.7) or psychosis and MDEs (OR ¼ 1.0, CI:.7–1.4).
    [Show full text]
  • Bordering on the Bipolar: a Review of Criteria for ICD-11 and DSM-5 Persistent Mood Disorders Jason Luty
    BJPsych Advances (2020), vol. 26, 50–57 doi: 10.1192/bja.2019.54 ARTICLE Bordering on the bipolar: a review of criteria for ICD-11 and DSM-5 persistent mood disorders Jason Luty Jason Luty, MB, ChB, PhD, SUMMARY MRCPsych, is a consultant in addic- Persistent low mood with lack of enjoyment (‘anhe- tions, liaison and general psychiatry The principal manuals for psychiatric diagnosis donia’) is common and often hard to treat in psychi- in south-east England. He trained at have recently been updated (ICD-11 was released atric practice. Recent changes in the two major the Maudsley Hospital, London, and in June 2018 and DSM-5 was published in 2013). spent 8 years as a consultant in diagnostic classification systems – ICD-11 released A common diagnostic quandary is the classification addictions with the South Essex in June 2018 (World Health Organization 2018) Partnership NHS Trust. He has a PhD of people with chronic low mood, especially those in pharmacology, following a study of with repeated self-harm (‘emotionally unstable’ or and DSM-5 (American Psychiatric Association the molecular mechanisms of recep- ‘borderline’ personality disorder). There has been 2013) – make the time apposite to review the diag- tor desensitisation and tolerance, and a great interest in use of type II bipolar affective dis- nostic categories relevant to persistent mood has published in the addictions field. order (‘bipolar II disorder’) as a less pejorative diag- disorders. Correspondence Dr Jason Luty, nostic alternative to ‘personality disorder’,despite fi Consultant Psychiatrist, Athona There is signi cant diagnostic overlap with emo- Recruitment Ltd, 1st Floor, Juniper the radically different treatment options for these tionally unstable/borderline personality disorder, House, Warley Hill Business Park, disorders.
    [Show full text]
  • Depression and Anxiety: a Review
    DEPRESSION AND ANXIETY: A REVIEW Clifton Titcomb, MD OTR Medical Consultant Medical Director Hannover Life Reassurance Company of America Denver, CO [email protected] epression and anxiety are common problems Executive Summary This article reviews the in the population and are frequently encoun- overall spectrum of depressive and anxiety disor- tered in the underwriting environment. What D ders including major depressive disorder, chronic makes these conditions diffi cult to evaluate is the wide depression, minor depression, dysthymia and the range of fi ndings associated with the conditions and variety of anxiety disorders, with some special at- the signifi cant number of comorbid factors that come tention to post-traumatic stress disorder (PTSD). into play in assessing the mortality risk associated It includes a review of the epidemiology and risk with them. Thus, more than with many other medical factors for each condition. Some of the rating conditions, there is a true “art” to evaluating the risk scales that can be used to assess the severity of associated with anxiety and depression. Underwriters depression are discussed. The various forms of really need to understand and synthesize all of the therapy for depression are reviewed, including key elements contributing to outcomes and develop the overall therapeutic philosophy, rationale a composite picture for each individual to adequately for the choice of different medications, the usual assess the mortality risk. duration of treatment, causes for resistance to therapy, and the alternative approaches that The Spectrum of Depression may be employed in those situations where re- Depression represents a spectrum from dysthymia to sistance occurs.
    [Show full text]
  • Guidance on the Use of Mood Stabilizers for the Treatment of Bipolar Affective Disorder Version 2
    Guidance on the use of mood stabilizers for the treatment of bipolar affective disorder Version 2 RATIFYING COMMITTEE DRUGS AND THERAPEUTICS GROUP DATE RATIFIED July 2015 REPLACES Version 1 dated July 2013 NEXT REVIEW DATE July 2017 POLICY AUTHORS Jules Haste, Lead Pharmacist, Brighton and Hove Members of the Pharmacy Team (contributors are listed overleaf) If you require this document in an alternative format, i.e. easy read, large text, audio or Braille please contact the pharmacy team on 01243 623349 Page 1 of 49 Contributors Jed Hewitt, Chief Pharmacist - Governance & Professional Practice James Atkinson, Pharmacist Team Leader Mental Health and Community Services Miguel Gomez, Lead Pharmacist, Worthing. Hilary Garforth, Lead Pharmacist, Chichester. Pauline Daw, Lead Pharmacist (CRHTs & AOT), East Sussex. Iftekhar Khan, Lead Pharmacist (S&F Service), East Sussex. Graham Brown, Lead Pharmacist CAMHS & EIS. Gus Fernandez, Specialist Pharmacist MI and MH Lisa Stanton, Specialist Pharmacist Early Intervention Services & Learning Disabilities. Nana Tomova, Specialist Pharmacist, Crawley. Page 2 of 49 Section Title Page Number Introduction and Key Points 4 1. General principles in the treatment of acute mania 6 2. General principles in the treatment of bipolar depression 8 3. General principles in long term treatment 10 4. Rapid cycling 13 5. Physical health 13 6. Treatment in special situations 6.1 Pregnancy 15 6.2 Breast-feeding 17 6.3 Older adults 19 6.4 Children and adolescents 22 6.5 Learning disabilities 29 6.6 Cardiac dysfunction 30 6.7 Renal dysfunction 34 6.8 Hepatic dysfunction 37 6.9 Epilepsy 41 7. The risk of switching to mania with antidepressants 43 8.
    [Show full text]
  • What Is Bipolar Disorder?
    Bipolar Disorder Fact Sheet For more information about bipolar or other mental health disorders, call 513-563-HOPE or visit our website at www.lindnercenterofhope.com. What Is Bipolar Disorder? What does your mood Each year, nearly 6 million adults (or approximately 5% of the population) in the U.S. are affected by bipolar disorder, according to the Depression and Bipolar Support say about you? Alliance. While the condition is treatable, unfortunately bipolar disorder is frequently misdiagnosed and may be present an average of 10 years before it is correctly identified. Go to My Mood Monitor™, a three minute assessment Bipolar disorder (also known as bipolar depression or manic depression) is identified for anxiety, depression, PTSD by extreme shifts in mood, energy, and functioning that can be subtle or dramatic. The characteristics can vary greatly among individuals and even throughout the and bipolar disorder, at course of one individual’s life. www.mymoodmonitor.com to see if you may need a Bipolar disorder is usually a life-long condition that begins in adolescence or early professional evaluation. adulthood with recurring episodes of mania (highs) and depression (lows) that can continue for days, months or even years. My Mood Monitor™ Copyright © 2002-2010 by M3 Information™ Phases of Bipolar Disorder • Mania is the activated phase of bipolar disorder and is characterized by extreme moods, increased or impulsive mental and physical activities, and risk taking. • Hypomania describes a mild-to-moderate level of mania. Because it may feel good to the individual experiencing it, this condition can be difficult for someone with bipolar illness to recognize as a concern.
    [Show full text]
  • Empirical Redefinition of Delusional Disorder and Its Phenomenology: the DELIREMP Study ⁎ Enrique De Portugala, , Nieves Gonzálezb, Victoria Del Amoc, Josep M
    Available online at www.sciencedirect.com Comprehensive Psychiatry 54 (2013) 243–255 www.elsevier.com/locate/comppsych Empirical redefinition of delusional disorder and its phenomenology: the DELIREMP study ⁎ Enrique de Portugala, , Nieves Gonzálezb, Victoria del Amoc, Josep M. Harod, Covadonga M. Díaz-Caneja e, Juan de Dios Luna del Castillof, Jorge A. Cervillag aDepartment of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Hospital General Universitario Gregorio Marañón, Madrid, Spain bResearch and Development Unit, Sant-Joan de Déu-SSM, Barcelona, Spain cDepartment of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain dParc Sanitari Sant Joan de Déu, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Sant Boi de Llobregat, Barcelona, Spain eChild and Adolescent Psychiatry Department. Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain fDepartment of Psychiatry & Institute of Neurosciences, University of Granada, Spain gCentro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Hospital Universitario San Cecilio, Granada, Spain Abstract Aims: Since Kraepelin, the controversy has persisted surrounding the nature of delusional disorder (DD) as a separate nosological entity or its clinical subtypes. Nevertheless, there has been no systematic study of its psychopathological structure based on patient interviews. Our goal was to empirically explore syndromic subentities in DD. Methods: A cross-sectional study was conducted in 86 outpatients with DSM-IV-confirmed DD using SCID-I. Psychopathological factors were identified by factor analysis of PANSS scores. The association between these factors and clinical variables (as per standardized instruments) was analyzed using uni- and multivariate techniques.
    [Show full text]
  • Differentiating Schizoaffective and Bipolar Disorder: a Dimensional Approach
    ECNP Berlin 2014 Differentiating schizoaffective and bipolar disorder: a dimensional approach Heinz Grunze Newcastle University, Institute of Neuroscience, Academic Psychiatry, Newcastle upon Tyne, UK http://www.ncl.ac.uk/ion/staff/profile/heinz.grunze http://www.ntw.nhs.uk/sd.php?l=2&d=9&sm=15&id=237 Disclosures o I have received grants/research support, consulting fees and honoraria within the last three years from BMS, Desitin, Eli Lilly, Gedeon Richter, Hoffmann-La Roche,Lundbeck, Otsuka, and Servier o Research grants: NHS National Institute for Health Research/Medical Research Council UK o Neither I nor any member of my family have shares in any pharmaceutical company or could benefit financially from increases or decreases in the sales of any psychotropic medication. During this presentation, some medication may be mentioned which are off-label and not or not yet licensed for the specified indication!! The content of the talk represents solely the opinion of the speaker, not of the sponsor. SCZ and BD means impairment at multiple levels- and we assume SAD, too Machado-Vieira et al, 2013 The polymorphic course of Schizoaffective Disorder Schizophrenic Depressive Manic syndrome syndrome syndrome Marneros et al. 1995. Dimensional view of Schizoaffective Disorder (SAD) vs Bipolar Disorder (BD) Genes Brain morphology and Function Symptomatology Outcome Dimension SAD AND GENES Bipolar and schizophrenia are not so different….. 100% Non-shared environmental 90% effects 80% 70% Shared environmental 60% effects 50% 40% 30% Unique genetic effects 20% 10% 0% Shared genetic effects Schizophrenia Bipolar Disorder Variance accounted for by genetic, shared environmental, and non-shared environmental effects for schizophrenia and bipolar disorder.
    [Show full text]
  • Diagnosis and Management of Post-Traumatic Stress Disorder BRADLEY D
    Diagnosis and Management of Post-traumatic Stress Disorder BRADLEY D. GRINAGE, M.D., University of Kansas School of Medicine–Wichita, Wichita, Kansas Although post-traumatic stress disorder (PTSD) is a debilitating anxiety disorder that may cause significant distress and increased use of health resources, the condition O A patient informa- often goes undiagnosed. The lifetime prevalence of PTSD in the United States is 8 to tion handout on post- traumatic stress disor- 9 percent, and approximately 25 to 30 percent of victims of significant trauma der, written by the develop PTSD. The emotional and physical symptoms of PTSD occur in three clusters: author of this article, re-experiencing the trauma, marked avoidance of usual activities, and increased is provided on page symptoms of arousal. Before a diagnosis of PTSD can be made, the patient’s symp- 2409. toms must significantly disrupt normal activities and last for more than one month. Approximately 80 percent of patients with PTSD have at least one comorbid psychi- atric disorder. The most common comorbid disorders include depression, alcohol and drug abuse, and other anxiety disorders. Treatment relies on a multidimensional approach, including supportive patient education, cognitive behavior therapy, and psychopharmacology. Selective serotonin reuptake inhibitors are the mainstay of pharmacologic treatment. (Am Fam Physician 2003;68:2401-8,2409. Copyright© 2003 American Academy of Family Physicians) ost-traumatic stress disorder Background (PTSD) is an anxiety disorder The psychologic effects of trauma have that occurs following exposure to been described throughout military history. a traumatic event. The disorder Da Costa syndrome (“soldier’s heart”), which has not been extensively studied is characterized by cardiac symptoms associ- Pin primary care; however, the events of Sep- ated with irritability and increased arousal, tember 11, 2001, raised both public and pro- was described in veterans of the American fessional awareness of PTSD.
    [Show full text]
  • Education Session One-Bipolar II D/O
    Education session one-Bipolar II D/o I know from interviewing you both previously that you both are familiar with the dx that ________has been given, and that is bipolar II disorder. What does Bipolar II disorder mean to you? What kind of effect has it had on you? Go over common myths Look at myths page Explain the diagnosis Prevalence for Bipolar disorder in the general population About one in every 200 hundred people (0.5 percent) develops bipolar II disorder some time during his or her life. Course of Disorder Bipolar disorder often develops in late adolescence or early adulthood, but is can also develop later in life, in an individual's 40s or even 50s. Bipolar is a lifelong disorder, with symptoms varying over time in severity. In most cases, clients with the disorder are able to function between episodes; for instance, they can work, maintain household responsibilities, and raise children. Many famous people have struggled with bipolar disorder (such as Vincent Van Gogh, Patty Duke, Samuel Coleridge, Edgar Allan Poe, Carrier Fisher and Robert Schumann), but have been able to make significant contributions to society. Roughly 60%-70% of the hypomanic episodes in Bipolar II disorder occur immediately before or after a Major Depressive episode. Completed suicide (usually during Major Depressive Episodes) is a significant risk, occurring in 10% -15% of persons with Bipolar II Disorder. How diagnosis is established Bipolar II disorder can only be diagnosed by a clinical interview. The purpose of this interview is to determine whether the client has experienced specific "symptoms" of the disorder for a sufficiently long period of time (4 days for hypomania).
    [Show full text]