单双相重度抑郁临床特征及无抽搐电休克治疗临床疗效的对照研究

目的探讨单双相重度抑郁的临床特征及无抽搐电休克治疗(MECT)的临床疗效差异。方法采用回顾性研究的方法,回顾性地抽取2015年6月～2018年6月于徐州医科大学附属东方医院住院治疗患者中单相重度抑郁患者250例(单相组)及双相重度抑郁症患者92例(双相组)的病案资料,对两组一般资料进行对照分析,以汉密尔顿抑郁量表(HAMD-17)总分、5项因子分及减分率来评定MECT前后两组患者临床症状及临床疗效差异。结果双相组治愈率高于单相组,双相组的HAMD-17总分减分率高于单相组,两组差异显著(P0.01)。单相组阻滞因子减分率更高,双相组躯体焦虑化因子及认知障碍因子减分率更高,差异显著(P0.05)。双相组MECT起效次数及治疗总次数均高于单相组,差异显著(P0.01)。结论 (1)与单相重度抑郁相比,双相重度抑郁患者的发病年龄更早,就诊年龄更小,文化程度更高,家族史阳性率更高,病程更长,阻滞症状更重;(2)单双相抑郁的发病机制可能不同,MECT可能更加适用于阻滞症状更加明显的单相重度抑郁患者和躯体焦虑症状及认知障碍更加明显的双相重度抑郁患者;(3)MECT治疗单双相重度抑郁时均有显著疗效;与单相重度抑郁相比,MECT治疗双相重度抑郁起效更慢,治疗疗程更长,治愈率更高。     

单相与双相抑郁障碍患者临床特征的对照研究

目的比较单相与双相抑郁障碍患者的临床特征,为单相和双相抑郁障碍的鉴别诊断提供参考。方法连续入组2012年6月-2013年11月在广州医科大学附属脑科医院住院、符合《国际疾病分类(第10版)》(ICD-10)诊断标准的单相抑郁障碍(单相组,n=72)和双相抑郁障碍(双相组,n=64)患者,收集并分析两组一般人口学资料和临床特征,采用汉密尔顿抑郁量表17项版(HAMD-17)评定抑郁症状。结果单相组女性及已婚患者比例均高于双相组(χ2=18.74、4.68,P0.05或0.01);双相组平均起病年龄小于单相组(t=-2.13,P=0.035);双相组性格外向者比例高于单相组(χ2=9.74,P=0.002);单相组有病前诱因者比例高于双相组(χ2=18.96,P0.01);双相组伴不典型抑郁症状者比例高于单相组(χ2=24.60,P0.01);双相组既往抑郁发作次数多于单相组(Z=-5.37,P0.01);单相组HAMD-17总评分及躯体化焦虑和食欲减退因子评分均高于双相组,差异均有统计学意义(t=-2.78~-2.06,P0.05或0.01)。结论单相与双相抑郁障碍患者在性别、婚姻状况、发病年龄、是否有病前诱因、是否伴不典型抑郁症状、既往发作次数及HAMD-17评分方面存在差异。     

双相障碍抑郁发作与单相抑郁症患者听觉事件相关电位P300的对照研究

目的:探讨双相障碍I型抑郁发作与单相抑郁患者听觉事件相关电位P300的差异及与各自临床特征相关性。方法:对60例双相障碍I型抑郁发作患者(双相组)、50例单相抑郁患者(单相组)以及50名正常对照者(对照组)进行P300检测;偏相关分析患者组P300与其临床特征及功能相关性。结果:患者组较对照组N1、P2、N2、P3a和P3b潜伏期显著延长(分别F=9.17,F=8.74,F=15.27,F=7.98,F=10.64;P均0.01);3组间N2-P3b潜伏期差异无统计学意义(F=0.46,P0.05);患者组较对照组N1、P2、N2、P3a、P3b和N2-P3b波幅显著降低(分别F=12.23,F=7.27,F=14.16,F=6.96,F=8.58,F=5.36;P均0.01);患者组较对照组按键反应时间显著延长(F=55.37,P0.01);单相组较双相组N1、N2波幅降低、N2潜伏期延长(P均0.05),双相组较单相组按键反应时间延长(P0.01)。双相组N1波幅与其HAMD评分负相关(P0.01),N2潜伏期与其HAMD评分正相关(P0.01),按键反应时间与其病程和HAMD评分正相关(P均0.05);单相组N2波幅与其HAMD评分负相关(P0.01),按键反应时间与其HAMD评分正相关(P0.05)。结论:双相障碍I型抑郁发作与单相抑郁患者听觉事件相关电位P300均存在异常,但损害有差异;P300异常在二者可能均为状态与素质性并存。     

氯胺酮治疗抑郁症抗自杀作用的初步研究

目的探索氯胺酮是否具有独立于其抗抑郁作用的抗自杀作用。方法本研究利用临床研究项目"氯胺酮治疗重度抑郁障碍疗效与安全性的随机对照研究"数据库,进行二次数据分析。纳入13例接受氯胺酮单次注射治疗的抑郁症患者,采用17项汉密尔顿抑郁量表(the 17-item Hamilton depression scale,HAMD-17)、蒙哥马利抑郁评定量表(Montgomery-Asberg depression rating scale,MARDS)、贝克自杀意念问卷(scale for suicide ideation,SSI)评估基线与氯胺酮静滴后4 h的抑郁症状与自杀意念。抗抑郁作用和抗自杀作用的评定分别采用抑郁评分减分值和自杀评分减分值,分析抗自杀作用和抗抑郁作用的相关性。结果 HAMD-17自杀评分减分值与HAMD-17抑郁评分减分值有相关性(r=0.60,P=0.03),决定系数R2=0.36。SSI总分减分值与MARDS抑郁评分减分值有相关性(r=0.59,P=0.03),决定系数R2=0.35。结论氯胺酮抗自杀作用的变异中只有35%～36%可用其抗抑郁作用解释,提示氯胺酮可能具有独立于其抗抑郁作用的抗自杀作用。     

单相与双相抑郁症患者童年虐待、认知偏差及认知情绪调节的比较

目的:探讨单相与双相抑郁症患者在童年虐待经历、认知偏差、认知情绪调节方面的差别。方法:采用认知情绪调节问卷中文版(CERQ-C)、Beck抑郁自评量表(BDI)、功能失调性认知态度问卷(DAS)、儿童期受虐经历问卷(CTQ-SF)对83例发作期双相抑郁障碍患者、76例发作期单相抑郁患者进行评定。结果:双相抑郁组CTQ-SF总分[(41. 34±5. 92) vs.(38. 28±7. 90)]及躯体虐待[(6. 81±1. 93) vs.(6. 08±1. 80)]、性虐待因子[(6. 35±1. 49) vs.(5. 42±0. 94)]分均显著高于单相抑郁组,差异具有统计学意义(t值依次为2. 78、2. 45、4. 66; P 0. 05或P 0. 01)。双相抑郁组DAS强制性因子[(22. 12±3. 55) vs.(20. 82±4. 51)]、依赖性因子[(22. 43±5. 20) vs.(19. 87±5. 18)]、自主性态度因子分[(24. 63±7. 24) vs.(22. 41±5. 95)]及CERQ-C自我责难[(14. 24±2. 47) vs(13. 43±2. 42)]、接受因子分[(13. 98±3. 66) vs (12. 82±2. 94)]显著高于单相抑郁组,而认知哲学因子分[(16. 47±5. 42)vs.(18. 45±4. 00)]低于单相抑郁组,差异具有统计学意义(t值依次为2. 04、3. 11、2. 10、-2. 60,P 0. 05或P 0. 01)。结论:双相抑郁较单相抑郁症患者可能具有更多的童年虐待经历,更为严重的功能失调性认知态度与认知情绪调节问题。     

精神分裂症、双相障碍和单相抑郁障碍患者自知力比较

目的探讨精神分裂症、双相障碍及单相抑郁障碍患者自知力的差异、影响因素及自知力与诊断的关系。方法在广州市惠爱医院连续入组符合《国际疾病分类(第10版)》(ICD-10)精神分裂症、双相躁狂、双相抑郁、单相抑郁诊断标准的住院患者395例,采用症状自评量表(SCL-90)、自知力和治疗态度问卷(ITAQ)分别评定患者的临床症状和自知力水平,通过协方差分析方法进行症状严重程度及自知力水平比较,采用多元逐步线性回归分析比较入院时各因素对自知力的影响。结果入院时精神分裂症组、双相躁狂组、双相抑郁组、单相抑郁组的ITAQ总评分分别为(5.66±0.39)分、(5.95±0.50)分、(9.73±0.95)分、(9.36±0.94)分,四组比较差异有统计学意义(F=8.40,P0.01)。出院时精神分裂症组、双相躁狂组、双相抑郁组、单相抑郁组ITAQ总评分分别为(12.27±0.38)分、(14.46±0.49)分、(13.64±0.94)分、(12.98±0.92)分,四组比较差异有统计学意义(F=4.32,P=0.005)。多元逐步线性回归分析显示,入院时自知力水平、诊断、性别均为自知力变化的影响因素(β=-0.405、2.103、-1.482,P均0.05)。结论住院精神障碍患者在急性期,自知力水平变化与疾病谱系变化存在相关性。随着疾病谱系的发展,抑郁障碍、双相情感障碍、精神分裂症患者的自知力缺损程度逐渐加重。此外,自知力的变化受入院时自知力水平、诊断、性别等诸多因素的影响。     

双相Ⅰ型与双相Ⅱ型障碍临床特征比较分析

目的 对双相I型与双相II型障碍患者人口学与临床特征进行比较,为更好地识别与治疗双相障碍提供临床依据.方法 于2008年11月至2009年10月间,对广州医学院附属精神病医院、暨南大学第一附属医院、广州医学院第二附属医院156例临床诊断为情感性精神障碍的患者进行"DSM-IV轴I障碍用临床定式检查(病人版)"再诊断,对符合DSM-IV双相I型与双相II型障碍标准的患者分别进行自编人口学及临床特征问卷、大体功能评定量表、杨氏躁狂量表、蒙哥马利抑郁量表评定.结果 完成的151例再诊断中,发现双相I型72例、双相II型39例.原诊断为抑郁症的患者中有35.5%符合双相II型诊断,4.8%符合双相I型诊断.双相I型精神病性症状出现率(62.5%vs25.6%,X2=13.75,P<0.001)、情感稳定剂使用率(95.8%vs64.1%,X2=19.64,P<0.001)、超重/肥胖率(38.4%vsl7.9%,X2=5.14,P=0.023)、杨氏躁狂量表评分(15vs2,Z=-5.68,P<0.001)高于双相II型;而后者轻躁狂相(Z=-2.85,P=0.004)、抑郁相次数(3vs1,Z=-4.42,P<0.001)明显多于双相I型.双相II型以抑郁首发为常R,(76.9%vs55.6%,X2=4.96,P=0.026),且抑郁的非典型特征(23.l%vs5.6%,X2=5.91,P=0.015)、既往自杀未遂率(41.0%vsl3.9%,X2=10.39,P=0.001)、蒙哥马利抑郁量表评分(13vs5,Z=-3.64,P<0.001)均高于双相I型.两亚型在性别、年龄、教育水平、婚姻、职业等人口学指标上差异无统计学意义.结论 双相I型与双相II型临床特征间存在较为明显的差异,将它们视为不同障碍更符合疾病本身的特点.双相II型易误诊为单相抑郁,其自杀未遂率高,临床上迫切需要引起足够重视.     

人际社会节奏疗法对首发青少年抑郁障碍的效果

目的探讨人际社会节奏疗法(IPSRT)对首发青少年抑郁障碍的效果,为首发青少年抑郁障碍的治疗提供参考。方法纳入符合《国际疾病分类(第10版)》(ICD-10)诊断标准的首发青少年抑郁障碍患者为研究对象,共310例,采用随机数字表法分为研究组(n=155)和对照组(n=155),研究组接受IPSRT治疗,对照组接受常规心理干预,两组均连续干预2周。分别于干预前和干预2周后,采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表24项版(HAMD-24)和人际交往能力问卷(ICQ)进行评定,采用便携式睡眠监测仪评定两组患者的睡眠质量。结果干预后,研究组HAMA[(5.92±1.04)分vs.(10.23±1.09)分,t=-10.310,P0.01]、入睡时间[(0.26±0.09)h vs.(1.29±0.78)h,t=-4.701,P0.01]和卧床时间[(10.19±0.99)h vs.(11.30±1.38)h,t=-2.353,P=0.027]均低于对照组;研究组ICQ的主动交往[(20.23±1.59)分vs.(17.38±1.33)分,t=4.959,P0.01]、适当拒绝[(14.77±1.17)分vs.(11.77±1.48)分,t=5.740,P0.01]、自我表露[(20.92±1.66)分vs.(16.15±1.46)分,t=7.780,P0.01]、情感支持[(21.00±1.53)分vs.(18.85±1.99)分,t=3.092,P0.01]维度评分均高于对照组,差异均有统计学意义。结论对首发青少年抑郁障碍患者实施IPSRT可能有助于改善其睡眠质量,调整不良心理状态,提高人际交往能力。     

运动对抑郁障碍治疗的协同作用

目的探讨运动对抑郁障碍治疗的协同作用,探索抗抑郁治疗新方向。方法连续纳入60例符合《国际疾病分类(第10版)》(ICD-10)抑郁障碍诊断标准并接受规范用药的患者,采用微信监督运动并随访6周,按运动是否达标分为运动组(n=35)和对照组(n=25)。于基线期和干预6周后采用汉密尔顿抑郁量表17项版(HAMD-17)、汉密尔顿焦虑量表(HAMA)、自尊量表(SES)和一般自我效能感量表(GSES)进行评定。结果干预6周后,运动组和对照组HAMA评分差异有统计学意义(t=-6.40,P=0.040),HAMD-17评分差异无统计学意义(t=-0.34,P=0.720);运动组HAMD-17和HAMA评分减分率≥25%的人数比例均高于对照组(χ~2=5.93、6.25,P均0.05);两组GSES评分比较差异有统计学意义(F=0.52,P=0.001);两组腰围比较差异有统计学意义(F=8.22,P=0.006)。结论运动干预联合药物治疗较单用药物治疗可能更有助于改善抑郁障碍患者的抑郁、焦虑症状及自我效能感。     

单相与双相抑郁症患者沉思反应及拖延行为的比较

目的:探讨单相与双相抑郁患者沉思反应及拖延行为的差异。方法:对32例单相抑郁(单相组)及31例双相抑郁(双相组)患者分别评定沉思量表(RRS)、一般拖延行为问卷(GPS)和汉密尔顿抑郁量表(HAMD-17)评定;对26名正常对照者(健康组)给予RRS和GPS评定,然后进行组间比较。结果:抑郁组的RRS总分(55.8±9.5)显著高于健康组[(45.8±8.1),P0.01)],抑郁组的GPS总分(57.2±8.9)也显著高于健康组[(49.3±8.4),P0.05];单相组和双相组的RRS总分及GPS总分与HAMD总分及阻滞、绝望感因子分均呈显著正相关(r=0.368~0.491,P0.05或P0.01);单相组与双相组的RRS总分及各因子分和GPS总分差异无统计学意义(P0.05)。结论:抑郁症患者比健康人更易陷入沉思,且也较易采取拖延方式;单相与双相抑郁症患者的沉思反应及拖延行为未见实质性差别,但在临床上需加以关注。     

Cyclothymia and typus melancholicus: empirical study on personality character of mood disorder]

PURPOSE: 1. To investigate whether depressive, cyclothymic, hyperthymic and irritable temperaments as identified by TEMPS-A are characteristic to monopolar or bipolar disorder. 2. To investigate the independency and to discuss the clinical validity of the temperaments. 3. To replicate the previous studies whether Typus Melancholicus is characteristic to monopolar disorder. 4. To investigate the relationship between Typus Melancholicus and mood dysregulation, and the relationship, if any, is characteristically observed with monopolar disorder. 5. To discuss the difference between monopolar and bipolar disorder in terms of personality character. SAMPLE: Monopolar and bipolar groups were recruited consecutively from the patients who received outpatient treatment at Kanto Medical Center between September and November, 2001. The age is between 18 and 60. The exclusion criteria were psychotic disorder, organic disorder, grave physical illness and non-remitted mood symptoms (HRSD > 11 and MRS > 13). Control group was selected from 1391 company employees who participated in TEMPS-A research project between May 2001 and May 2002, matching gender and age with monopolar and bipolar groups. The exclusion criterion was marked depressive symptom (CES-D > 16). STATISTICAL ANALYSIS: The statistical analyses were done with Kruskal-Wallis test and Mann-Whitney U test with Bonferroni's correction regarding the difference among the groups. Spearman coefficients were examined regarding the independency of temperaments. The relationship between Typus Melancholicus and mood dysregulation was examined by mono-regression analysis. RESULT AND DISCUSSION: Depressive and cyclothymic temperaments scores did not differ significantly between monopolar and bipolar. These scores were significantly higher in monopolar and bipolar than in control. Therefore, these temperaments are evidenced to be characteristic with mood disorder. But between monopolar and bipolar there was no significant difference. Irritable temperament score did not differ significantly among the three groups. This score showed a highly significant correlation with cyclothymic and depressive temperaments. Irritable temperament seems closely related with the personality character of mood disorder, however this temperament itself was not characteristic. Hyperthymic temperament score was mildly significantly lower in bipolar than in control. There was no other significant inter-group difference. This temperament hardly showed a correlation with other temperaments. Though hyperthymic temperament may be hypothesized characteristic with manic patients, the result did not support this hypothesis. Typus Melancholicus score did not differ significantly among three groups. This result contradicts with a number of previous studies. It seems that the prevalence of Typus Melancholicus among the groups should be further investigated. Typus Melancholicus showed a mild correlation with depressive temperament in monopolar and with depressive, cyclothymic and irritable and temperaments in bipolar. Regarding mono-regression analysis, no temperament predicted Typus Melancholicus formation in monopolar. Depressive, cyclothymic and irritable temperaments predicted significantly in bipolar. In control group, hyperthymic temperament predicted midly significantly, but the prediction rate was as small as 7%. These results seem to support the theories of Shimoda and Matussek that Typus Melancholicus characters are related with bipolar disorder. Between monopolar and bipolar, there was not much significant difference in terms of personality characteristics. This seems to suggest no marked personality character difference between these groups and supports Akiskal's concept of Bipolar Spectrum. CONCLUSION: 1. Depressive and Cyclothymic temperaments are characteristic with mood disorder. 2. Hyperthymic temperament is independent, but not characteristic with mood disorder. 3. Irritable temperament may be modifying the personality character of mood disorder. 4. Typus Melancholicus was not characteristic to monopolar disorder. 5. Significant relationship between Typus Melancholicus and mood dysregulation was observed in bipolar group. 6. There seems no substantial difference between monopolar and bipolar disorders in terms of personality character.     

Affective Temperaments in Alcohol and Opiate Addictions

Temperament is considered as a biological disposition reflected by relatively stable features related to mood and reactivity to external and internal stimuli, including variability in emotional reactions. The aim of the present study is to test the hypothesis that affective temperaments might differ according to co-occurring mood disorders among patients with alcohol and/or opiate dependence; to explore the relationship between temperaments and dual substance use disorders (SUDs, alcohol and other drugs). Ninety-two patients attending an alcohol addiction treatment facility and 47 patients in an opiate addiction treatment facility were assessed for SUDs, mood disorders and affective temperaments using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego 39-item auto-questionnaire. Comparison of patients with bipolar disorder, depressive unipolar disorder and no (or substance-induced) mood disorder revealed significant differences for the cyclothymic subscale, with highest scores among patients with bipolar disorder. No difference was observed for the depressive, irritable, hyperthymic and anxious subscales. After adjustment for age, gender and bipolar disorder, irritable temperament was a significant risk factor for past or present history of drug use disorders in patients treated for alcohol addiction (odds ratio [OR] 1.42, 95 % confidence interval [CI] 1.05–1.93). Anxious temperament was a significant risk factor for history of alcohol use disorders in patients treated for opiate addiction (OR 3.30, 95 % CI 1.36–7.99), whereas the hyperthymic subscale appeared as a significant protective factor (OR 0.65, 95 % CI 0.42–0.99). The results highlight the need to consider temperamental aspects in further research to improve the long-term outcome of patient with addictive disorders, who often present complex comorbidity patterns.     

Opposing patterns of neuronal variability in the sensorimotor network mediate cyclothymic and depressive temperaments

Affective temperaments have been described since the early 20th century and may play a central role in psychiatric illnesses, such as bipolar disorder (BD). However, the neuronal basis of temperament is still unclear. We investigated the relationship of temperament with neuronal variability in the resting state signal—measured by fractional standard deviation (fSD) of Blood‐Oxygen‐Level Dependent signal—of the different large‐scale networks, that is, sensorimotor network (SMN), along with default‐mode, salience and central executive networks, in standard frequency band (SFB) and its sub‐frequencies slow4 and slow5, in a large sample of healthy subject (HC, n = 109), as well as in the various temperamental subgroups (i.e., cyclothymic, hyperthymic, depressive, and irritable). A replication study on an independent dataset of 121 HC was then performed. SMN fSD positively correlated with cyclothymic z‐score and was significantly increased in the cyclothymic temperament compared to the depressive temperament subgroups, in both SFB and slow4. We replicated our findings in the independent dataset. A relationship between cyclothymic temperament and neuronal variability, an index of intrinsic neuronal activity, in the SMN was found. Cyclothymic and depressive temperaments were associated with opposite changes in the SMN variability, resembling changes previously described in manic and depressive phases of BD. These findings shed a novel light on the neural basis of affective temperament and also carry important implications for the understanding of a potential dimensional continuum between affective temperaments and BD, on both psychological and neuronal levels.     

Hyperthymic and depressive temperaments study in controls, as a function of their familial loading for mood disorders

SUMMARY: Since the two last decades, many authors have broadened the scope of mood disorders to include a larger bipolar spectrum which encompasses the sub-affective conditions, including temperaments. According to this view, the latter conditions represent milder or alternative expressions of the classic bipolar episodes. In successive elaborations, Akiskal et al. hypothesized a complex multicausal approach to bipolar disorder, and studied temperamental dysregulations, which could serve as risk factors for major episodes. Until recently, there have been several studies of patients populations, little is known in control populations. The aim of this report is to compare the rates of three affective temperaments (hyperthymic: TH; depressive: TD; irritable: TI) in non-ill subjects with different risk for mood disorders. (The cyclothymic temperament is studied as part of another report). METHODS: We recruited 185 individuals from: a) staff hospital; b) sibling of patients suffering from bipolar disorder, type I. Twenty subjects were excluded: 7 suffered from personal affective trouble; 12 exhibited cyclothymic traits; and one had familial schizophrenia. In the 165 remaining subjects, the temperamental characteristics were assessed by mean of the Akiskal and Mallya's criteria (1987, semi-structured interviews for affective temperaments, TH, TD, TI). Then, the population of controls was divided in 3 groups as a function of the familial loading for affective disorder and bipolar disorders: the first subgroup (AFN) was free of any antecedent ("super-normal controls", n=99); the second subgroup (AFP) had familial antecedents at the first or second degree (normal controls but at risk for affective disorder, n=33); the third subgroup (FBP) was composed of the siblings of bipolar I patients (subjects at high risk, n=33). Statistical procedures included standard and non-parametric methods: means standard deviation, Fisher's test, Mann-Whitney' and Kuskall-Wallis' tests, Spearman's correlation coefficient. As described by Placidi and collaborators (12), we also used the Z-score (temperamental score strictly higher than the second positive standard deviation: m + 2 sd). RESULTS: The general demographic characteristics show a higher frequency of women (p=0.02) but a similar mean age (p=0.296, NS) among the groups. The mean scores of the TH and TD are strongly and negatively correlated (Rho coefficient=- 0.397, p=0.01), exhibiting the internal coherence of the responses. The comparison of the temperamental characteristics among the 3 groups exhibits significant differences for the TH and TI (p=0.003). The mean scores are respectively: for the TH, 9.16 4.18 in AFN, 8.33 4.11 in AFP, and 12.16 5.28 in FBP; and for the TI, 8.94 2.25 in AFN, 9.39 2.63 in AFP, and 10.84 2.76 in FBP. Conversely, the TD scores do not significantly differ: 6.01 3.27 in AFN, 6.76 4.34 in AFP, and 7.94 5.28 in FBP. Beyond these first pass results, we also considered the distribution of the subjects as function of the Z-score and the different groups. We found that hyperthymic traits were almost exclusively among the FBP: 15.1% vs 3.0% in the other groups. For the TD, expressed in mean scores, the groups at risk for affective disorders (AFP and FBP) clearly display a percentage of subjects with a more substantial Z-score than the frequencies observed in the AFN: respectively 12.1%, 18.1% and 4.0% for the TD. Concerning traits of all three temperaments, as function of the demographic variables and the Z-score, they are generally predominant in males; however, the TH is more frequent in males only in the AFP and FBP groups (respectively: 8.3% vs none; 21.4% vs 10.5%). The TD is more prevalent among females in AFP and FBP (respectively: 8.3% vs 14.3%; 21.1% vs 14.8%). CONCLUSION: Our results clearly show temperamental dysregulations in the subjects at risk for affective disorders: (1) the levels of all three affective temperaments under study are significantly higher in subjects at risk for affective disorder, as compared to individuals free of a family antecedent; (2) the depressive temperament is prevalent in both AFP and FBP, whereas the hyperthymic is specific for FBP. As for Akiskal's model on the multicausal origin of the mood disorders, our data supports temperamental dysregulation as an important familial genetic factor in the vulnerability to manic depressive episodes. We further posit that such temperaments--more specifically, the hyperthymic--could serve as proximal phenotypes for full-blown bipolar disorder.     

Psychopathology, temperament, and past course in primary major depressions. 1. Review of evidence for a bipolar spectrum

In reviewing recent findings on affective conditions in the interface of unipolar and bipolar disorders, we find evidence favoring a partial return to Kraepelin's broad concept of manic-depressive illness, which included many recurrent depressives and temperamental variants. This review addresses methodologic, clinical, and familial considerations in the definition and characterization of a proposed spectrum of bipolar disorders which subsumes episodic and chronic forms. Episodic bipolar disorders are subclassified into bipolar schizoaffective, and bipolar I and II, and bipolar III or pseudo-unipolar forms. Chronic bipolar disorders could be either intermittent or persistent, and are subclassified into chronic mania, protracted mixed states, and rapid-cycling forms, as well as the classical temperaments (cyclothymic, hyperthymic, irritable and dysthymic).     

Description and validation of the Affective Temperament Questionnaire

Background

Akiskal and Mallya (Psychopharmacol Bull. 1987;23:68-73) proposed criteria defining 4 affective temperaments—hyperthymic, irritable, cyclothymic, and dysthymic. This study aims to develop and validate, using a 3-point rating scale, a short questionnaire that assesses these temperaments.

Methods

The Affective Temperament Questionnaire (ATQ) was administered to a family-based sample of individuals with major depressive disorder (MDD), bipolar disorder (BP), or no mood disorder (N = 378). Factor analyses, internal consistency, and analysis of variance were undertaken to examine the factorial structure and concurrent validity (relative to Axis I mood disorder diagnosis) of the ATQ. Affective Temperament Questionnaire data were evaluated with respect to raw scores and dominant affective temperament.

Results

Three factors emerged—hyperthymia, cyclothymia, and dysthymia—which had moderate to high internal consistency. Support for the concurrent validity of ATQ was found, whereby temperament scores and rates of dominant affective temperaments differed with respect to mood disorder diagnosis. Hyperthymia and cyclothymia were more prevalent among individuals with BP than among individuals with MDD or no history of a mood disorder. Dysthymia occurred at a relatively similar rate among individuals with MDD or BP.

Conclusions

Our findings support the use of the ATQ for collecting information regarding affective temperaments and for furthering understanding regarding the links between affective temperament and mood disorders.     

Psychopathology, temperament, and past course in primary major depressions. 2. Toward a redefinition of bipolarity with a new semistructured interview for depression

We report on the utility of a new instrument to identify subtypes of major depressive episodes with special reference to pseudo-unipolar conditions. By incorporating reliable measures of depressive and hyperthymic temperamental characteristics in subtype definitions, we achieve the sharpest possible demarcation between unipolar and bipolar disorders. The new procedures also reveal that 1 out of 3 primary depressives in a consecutive series of 405 patients belong to the bipolar spectrum. Furthermore, among bipolars, bipolar II disorder (redefined as major depressions with hypomania or hyperthymic temperament) represents the most common variant. We discuss the nosologic, therapeutic, methodologic and theoretical implications of these considerations on the unipolar-bipolar dichotomy. Given that major depression emerges as the final common clinical expression of a heterogeneous group of disorders, it underscores the importance of focusing on temperament and course of illness in subclassification efforts such as attempted here.     

Faisabilité de l'autoévaluation dans le dépistage de l'hypomanie

The Hypomania Checklist (HC) is a 20-item questionnaire, which is easy to fill in and designed to help clinicians collect data for diagnosing bipolar disorder. This tool could be very useful in primary care where type II bipolar disorder is under-diagnosed, however, to date no suitable cut-off score correlating with a high probability of bipolar II disorder diagnosis has yet been validated.

Method

In a French clinico-epidemiological multi-center survey (EPIDEP) a national sample of patients with DSM-IV major depressive episode (MDE) was recruited and assessed at admittance and four weeks later. Diagnoses of unipolar or bipolar disorder were made according to a semi-structured interview adapted from the DSM-IV. In addition, the HC and questionnaires on affective temperament were administered at the second interview. In the analyses, the diagnostic accuracy was computed in terms of sensitivity, specificity, predictive positive value and predictive negative value, by varying cut-off scores on the HC. The Receiver Operating Characteristic (ROC) statistical technique was used to compare the diagnostic value of HC with the semi-structured interview adapted from the DSM-IV.

Results

Of the 493 patients with a MDE DSM-IV diagnosis, 468 filled in the HC, from which the six following groups were formed: strict unipolar disorder (UP, N = 201), bipolar I disorder (BP-I, n=39), bipolar II disorder (BP-II, N = 141), patients with mania or hypomania secondary to an antidepressant treatment (N = 51), cyclothymia (N = 14) and hyperthymia (N = 22). Comparing the BP-II patient group (N = 141) with the strict UP group (N = 201) the most discriminating HC score was 9, which identified 81% of patients correctly, with a sensitivity of 86.5, a specificity of 77.1, a predictive positive value of 72.6 and a predictive negative value of 89.1. Some cases identified as cyclothymic and hyperthymic temperaments by the affective temperament questionnaire but meeting DSM-IV criteria for major depressive disorder were included in the unipolar group (N = 237). The same score of 9 was validated, identifying a percentage of patients with correct diagnosis of unipolar depression of 78.3%, a sensitivity of 86.5, a specificity of 73.4, a predictive positive value of 66.0 and a predictive negative value of 90.1. If patients with mania or hypomania secondary to an antidepressant treatment were included as a subgroup of BP-II, a score of ten appeared as the most relevant, with a percentage of patients with correct diagnosis of 79.0 %, a sensitivity of 80.2, a specificity of 78.1, a predictive positive value of 74.8 and a predictive negative value of 83.0. ROC curves confirmed these values. Lastly when BP-I patients (N = 39) were compared to the strict UP group (N = 201) the most discriminating HC score was 11, with a percentage of patients with correct diagnosis of 86.3%, a sensitivity of 74.4, a specificity of 88.6, a predictive positive value of 55.8 and a predictive negative value of 94.7, but the BP-I group was too small to validate the score of 11.

Conclusions

These results indicate that a score of 9 on the HC is highly correlated with a BP-II diagnosis (and a score of 10 if patients with mania induced by antidepressants are considered as BP-II), and suggest that a wider use of the HC in primary care associated with strong GP/Psychiatrist networks could improve the detection, and with appropriate treatment, the prognosis of Bipolar II disorder.     

Clinical characteristics of patients with major affective disorders and comorbid migraine.

The present study was undertaken to examine the clinical characteristics of patients with major affective disorders and comorbid migraine. Patients (n = 102) with an index episode of either major depression or mania were interviewed with a semi-structured interview based partly on DSM-IV criteria and partly on Akiskal's criteria for affective temperaments. Compared to the patients without migraine (n = 49), the patients with comorbid migraine (n = 53) had a higher frequency of bipolar II disorder (43% vs. 10%), a lower frequency of bipolar I disorder (11% vs. 33%), an approximately equal frequency of unipolar depressive disorder (45% vs. 57%) and a higher frequency of affective temperaments (45% vs. 22%). The migraine patients also had a greater number of anxiety disorders (3.0 vs. 1.9) and a higher frequency of panic disorder and agoraphobia. Gender distribution, age, age at onset of first affective episode, number of previous episodes and symptoms during depressive episodes were similar in both groups. Based on these findings it is suggested that the presence of migraine may be used to delineate a distinct subgroup of the major affective disorders.     

Tempéraments affectifs prébipolaires dans les dépressions récurrentes : vers un dépistage de « fausse unipolarité »

IntroductionThe current categorical split of mood disorders into bipolar disorders and depressive disorders has recently been questioned after the widening of the bipolar spectrum. Recent studies have suggested that clinicians may under-diagnose bipolarity in a substantial proportion of depressed patients, and have proposed the existence of a “pseudo-unipolar” depression. On the other hand, many studies were made to identify factors correlated to bipolarity in depressive disorders. They have shown that the main clinical factors correlated to bipolarity are: pharmacological hypomania, puerperal depression, early age of onset, psychotic features, hypersomnia and psychomotor inhibition. In this context, it should be interesting to study temperaments as predictive factors of bipolarity in depression and to explore their correlation with those clinical predictors.ObjectivesThe aims of this study were to assess affective temperaments in patients with recurrent depressive disorders, and to explore the correlations between these temperaments and clinical features of depressive disorders.MethodsThe study was a cross-sectional one bearing on 91 recurrent depressive patients (40 men and 51 women, mean age: 46.8 ± 10.1 years), who were interviewed using the DSM-IV Structured Clinical Interview during the partial or total recovery period. Data was collected using available medical records. The evaluation of affective temperaments consisted in filling in the Akiskal and Mallya semi-structured questionnaire.ResultsThe depressive temperament obtained the higher mean score (12.3 ± 4.74), followed by the hyperthymic temperament (7.8 ± 4.5), the cyclothymic temperament (5.9 ± 5.8) and the irritable temperament (4.9 ± 3.3). A significant association was found between the onset of the first depressive episode during the postpartum period and the cyclothymic temperament score (7.4 ± 6.9 versus 3.3 ± 3.6, p = 0.04). The psychotic features in the last depressive episode were significantly associated with the hyperthymic (p = 0,001), the cyclothymic (p < 10^?3) and the irritable temperament scores (p < 10^?3). A significant link was found between suicide attempts during the last depressive episode and the cyclothymic temperament on the one hand (p < 10^?3) and the irritable temperament on the other hand (p = 0.01).ConclusionsThe recurrent depressive disorders with hyperthymic, cyclothymic and the irritable temperaments seem to have clinical features similar to those of bipolar disorders. These results point to the importance of evaluating these temperaments in depressed patients, considering the risk of polarity change and of misdiagnoses of unipolar depression.