Grey matter volume abnormalities in patients with bipolar I depressive disorder and unipolar depressive disorder:a voxelbased morphometry study

Bipolar disorder and unipolar depressive disorder(UD) may be different in brain structure. In the present study,we performed voxel-based morphometry(VBM) to quantify the grey matter volumes in 23 patients with bipolar I depressive disorder(BP1) and 23 patients with UD,and 23 age-,gender-,and educationmatched healthy controls(HCs) using magnetic resonance imaging. We found that compared with the HC and UD groups,the BP1 group showed reduced grey matter volumes in the right inferior frontal gyrus and middle cingulate gyrus,while the UD group showed reduced volume in the right inferior frontal gyrus compared to HCs. In addition,correlation analyses revealed that the grey matter volumes of these regions were negatively correlated with the Hamilton depression rating scores. Taken together,the results of our study suggest that decreased grey matter volume of the right inferior frontal gyrus is a common abnormality in BP1 and UD,and decreasedgrey matter volume in the right middle cingulate gyrus may be specifi c to BP1.     

双相情感障碍抑郁相与单相抑郁发作临床分析

目的:对双相情感障碍抑郁相和单相抑郁发作进行临床分析。方法:对双相情感障碍抑郁相和单相抑郁发作患者各30例进行临床分析。结果:双相情感障碍抑郁相有如下特点:①发病年龄早;②女性多见;③具有“精力过盛”性人格;④一级亲属中有双相障碍的家族史;⑤症状多为非典型抑郁发作或伴有精神病性症状。结论:如首次抑郁发作的症状符合以上特点,则可能以后发展为双相情感障碍,应使用足量心境稳定剂,谨慎使用抗抑郁剂,以免转为躁狂发作。     

Comparisons of insight in schizophrenia,bipolar I disorder,and depressive disorders with and without comorbid alcohol use disorder

Aims: To compare the level of insight among six groups of patients with psychiatric disorders, including those with schizophrenia (SZ), bipolar I disorder (BP), or depressive disorders (DD) who had or did not have comorbid alcohol use disorder (AUD). Methods: A total of 285 outpatients meeting the aforementioned criteria were recruited into the study. The Schedule of Assessment of Insight–Expanded version (SAI‐E) was used to measure subjects' insight. Analysis of covariance (ancova ) was used to compare the levels of insight among the six groups of subjects. Results: Regardless of whether patients had comorbid AUD or not, patients with DD had higher levels of insight than did patients with SZ. Comorbid AUD had independent effects on the differences in the level of insight between patients with DD and BP and between patients with BP and SZ. No statistically significant difference in insight was found between patients with the same psychiatric diagnosis with and without comorbid AUD. Conclusions: In addition to psychotic features and clinical states, comorbid AUD should be taken into consideration when comparing the level of insight among patients with different psychiatric diagnoses.     

Atypical depressive symptoms and clusters in unipolar and bipolar depression

In order to examine differences in the atypical symptoms of depression between unipolar and bipolar patients, we studied 109 depressed patients (79 unipolar and 30 bipolar subjects) diagnosed with DSM-IV criteria. Patients were assessed using the Atypical Depression Diagnostic Scale (ADDS), a semi-structured interview that rates mood reactivity and other atypical depressive symptoms. Although atypical depression was common in this sample (28% of cases with definite atypical depression), no differences were found between the unipolar and bipolar patients in either the atypical symptom profile or the prevalence of an atypical depression diagnosis. The interrelationships between the atypical symptoms were also examined using a hierarchical cluster analysis. A five-cluster solution maximized differences between groups, with results suggesting that atypical depression may be a heterogeneous diagnosis.     

Chronic atypical major depressive episode in private practice: unipolar and bipolar II

OBJECTIVE: The aims of the study were to determine whether chronicity was more common in atypical vs. non-atypical unipolar/bipolar II major depressive episode (MDE), whether atypical unipolar and bipolar II MDE had same chronicity, and to compare chronic with non-chronic atypical MDE. METHOD: A total of 326 unipolar/bipolar II MDE private practice outpatients were interviewed with the DSM-IV Structured Clinical Interview. RESULTS: Chronicity was not significantly different in atypical compared to non-atypical MDE. Unipolar atypical MDE showed more chronicity than bipolar II atypical MDE and unipolar non-atypical MDE. Chronicity was not significantly different in atypical compared to nonatypical bipolar II MDE. Compared to non-atypical MDE, atypical MDE had significantly lower age at onset, more recurrences and more bipolar II patients. Chronic compared to non-chronic atypical MDE had significantly longer duration, more recurrences and more unipolar patients. CONCLUSION: Unipolar atypical MDE is more chronic than unipolar nonatypical MDE. Bipolar II atypical MDE is not more chronic than bipolar II non-atypical MDE.     

Early maladaptive schemas in patients with bipolar and unipolar disorder

Objective: The aim of our study is to determine the difference between the bipolar disorder, unipolar disorder and control groups in terms of maladaptive schemes and childhood trauma.

Methods: Two groups of patients under monitoring with a diagnosis of bipolar or unipolar disorder and one group of healthy controls were enrolled in this study. Each group consisted of 60 subjects. The Young Mania Rating Scale and Beck Depression Inventory were used to confirm that patients were in remission. The Childhood Trauma Questionnaire and Young Schema Questionnaire-Short Form 3 were used to identify childhood traumas and early maladaptive schemas.

Results: In bipolar disorder, a positive, low power correlation was observed between the vulnerability to threats schema and emotional, physical and sexual abuse. In the unipolar disorder group, there was a positive, low power correlation between the emotional inhibition, failure, approval seeking, dependence, abandonment and defectiveness schemas and social isolation, and a positive, moderate correlation between social isolation and emotional abuse.

Conclusions: Individuals with bipolar disorder suffered greater childhood trauma compared to subjects with unipolar disorder and healthy individuals. Greater maladaptive schema activation were present in individuals with bipolar disorder compared to those with unipolar disorder and healthy individuals.     

Unipolar depression with bipolar family history: links with the bipolar spectrum

The aim of the present paper was to find if unipolar major depressive disorder (MDD) with bipolar family history could be included in the bipolar spectrum, by comparing it to unipolar MDD without bipolar family history, and to bipolar II disorder, on typical bipolar variables. A sample of 280 consecutive bipolar II outpatients, and a sample of 135 consecutive unipolar MDD outpatients, presenting for major depressive episode (MDE) treatment, were interviewed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (4th edn). Hypomanic symptoms during the MDE were systematically assessed. Clinical variables used to validate the inclusion of unipolar MDD with bipolar family history in the bipolar spectrum were young age of onset, many MDE recurrences, atypical features, and depressive mixed state (DMX; an MDE plus >2 concurrent hypomanic symptoms), following many previous studies reporting that these variables were typical features of bipolar disorders. Means were compared by t-test and frequencies by chi2 test (stata 7). Two-tailed P < 0.05 was chosen. Unipolar MDD with bipolar family history was present in 20% of MDD patients. Comparisons among unipolar MDD with bipolar family history (UP+BPFH), unipolar MDD without bipolar family history (UP-BPFH), and bipolar II (BPII), found that UP+BPFH versus UP-BPFH had a significantly lower age, lower age of onset, fewer recurrences, and more DMX; that UP+BPFH versus BPII had no significant differences (apart from recurrences); and that UP-BPFH versus BPII had significantly different age, age of onset, recurrences, atypical features, and DMX. Findings suggest that UP+BPFH shows many bipolar signs, and that it could therefore be included in the bipolar spectrum. Unipolar MDD with bipolar family history had a clinically significant 20.0% frequency in the unipolar MDD sample, supporting the clinical usefulness of this depression subtype. The subtyping of MDD based on bipolar family history could have treatment implications.     

Frequency of manic symptoms during a depressive episode and unipolar 'depressive mixed state' as bipolar spectrum

OBJECTIVE: To report the frequency of intra-episode manic symptoms in depressive episodes, and to evaluate unipolar depressive mixed state (DMS) as bipolar spectrum. METHOD: A total of 958 (863 unipolar, 25 bipolar II, and 70 bipolar I) depressive in-patients were assessed in terms of manic symptoms at admission, and several clinical variables using standardized methods. RESULTS: The frequency of manic symptoms (flight of idea, logorrhea, aggression, excessive social contact, increased drive, irritability, racing thoughts, and distractibility) was significantly higher in bipolar depressives than in unipolar depressives. Unipolar depressives with DMS - defined as having two or more manic symptoms - had more similarities to bipolar depressives than to other unipolar depressives in clinical variables such as onset age, family history of bipolar disorder, and possibly suicidality. CONCLUSION: Depressive mixed state is frequent, particular in bipolar depressives. Unipolar depressives with DMS may be better classified into bipolar spectrum.     

Differences in outcome of DSM-IV bipolar I and II disorders

Objectives:  To investigate whether the course of bipolar disorder (BD) type II is more depressive than that of BD I, and, if so, to explore the underlying factors that cause this difference.
Methods:  In a prospective, naturalistic study of 191 secondary care psychiatric in- and outpatients diagnosed in an acute phase of BD I or II, 160 patients (85.1%) were followed for 18 months. Using a life chart, the exact timing of symptom states in follow-up was examined. Differences between BD I (n = 75) and II (n = 85) in duration of index phase and episode, time to full remission and recurrence, and time in any mood episode were investigated.
Results:  Patients with BD II spent a higher proportion of time ill (47.5% versus 37.7%; p = 0.02) and in depressive symptom states (58.0% versus 41.7%; p = 0.003) than BD I patients. This was a result of the higher proportion (61.7% versus 48.6%; p = 0.03) and mean number (1.69 versus 1.11; p = 0.006) of depressive illness phases in BD II, rather than of differences in the duration of depressive phases. Type of index phase strongly predicted the outcome. In linear regression models, both BD II and type of index phase predicted more time spent in depressive symptom states.
Conclusions:  In medium-term follow-up, BD II patients spend about 40% more time in depressive symptom states than BD I patients because a higher proportion of BD II patients have depressive phases and the frequency of these is higher. Differences in type of index phase may markedly confound differences in outcome between BD I and II.     

Ultra-brief pulse ECT in bipolar and unipolar depressive disorder: differences in speed of response

Objectives:  There is little evidence for differences in response and speed of response to electroconvulsive therapy (ECT) between patients with bipolar and patients with unipolar depressive disorder. In the only prospective study to date, Daly et al. (Bipolar Disord 2001; 3: 95–104) found patients with bipolar depression to show more rapid clinical improvement and require fewer treatments than unipolar patients. In this study, response and speed of response of patients with unipolar and bipolar depression treated with ultra-brief pulse ECT were compared.
Methods:  All patients (n = 64) participated in a randomized trial comparing ultra-brief pulse bifrontal ECT at 1.5 times seizure threshold and unilateral ECT at 6 times seizure threshold. Thirteen patients (20.3%) had DSM-IV-defined bipolar depression. The Hamilton Rating Scale for Depression and Clinical Global Impression scale were administered at baseline and repeated weekly during and after the course of treatment by a blinded rater. At the same time point, the Beck Depression Inventory and the Patient Global Impression scale were administered. Speed of response was analyzed using survival analyses.
Results:  Patients with bipolar and unipolar depression did not differ in rates of response or remission following the ECT course, nor in response to unilateral or bifrontal ECT. Patients with bipolar depression, however, showed a more rapid response than patients with unipolar depression.
Conclusions:  Patients with bipolar depression tend to show more rapid clinical improvement with ECT than patients with unipolar depression.     

ECT in bipolar and unipolar depression: differences in speed of response

Objectives: There is sparse evidence for differences in response to electroconvulsive therapy (ECT) between patients with bipolar or unipolar major depression, with virtually no information on speed of response. We contrasted a large sample of bipolar (BP) and unipolar (UP) depressed patients in likelihood and rapidity of clinical improvement with ECT. Methods: Over three double-blind treatment protocols, 228 patients met Research Diagnostic Criteria for UP (n=162) or BP depression (n=66). Other than lorazepam PRN (3 mg/day), patients were withdrawn from psychotropics prior to the ECT course and until after post-ECT assessments. Patients were randomized to ECT conditions that differed in electrode placement and stimulus intensity. Symptomatic change was evaluated at least twice weekly by a blinded evaluation team, which also determined treatment length. Results: Patients with BP and UP depression did not differ in rates of response or remission following the ECT course, or in response to unilateral or bilateral ECT. Degree of improvement in Hamilton Rating Scale for Depression scores following completion of ECT was also comparable. However, BP patients received significantly fewer ECT treatments than UP patients, and this effect was especially marked among bipolar ECT responders. Both BP I and BP II patients showed especially rapid response to ECT. Conclusions: The BP/UP distinction had no predictive value in determining ECT outcome. In contrast, there was a large effect for BP patients to show more rapid clinical improvement and require fewer treatments than unipolar patients. The reasons for this difference are unknown, but could reflect a more rapid build up of anticonvulsant effects in BP patients.     

Impaired verbal memory in young adults with unipolar and bipolar depression

Aim: Early stages of severe mood disorders may be accompanied by neurocognitive changes. Specifically, deficits in verbal memory have been linked to depression in young people. This study examined whether young adults with unipolar compared with bipolar depression showed similar neurocognitive deficits. Methods: A total of 57 young adults (16–32 years) were assessed in this study. Twenty with unipolar and 20 with bipolar depression, all currently depressed, were compared with 17 healthy controls. Neuropsychological assessment included psychomotor speed, attention for routine mental operations, attentional switching, executive control and verbal learning and memory. Results: Both unipolar and bipolar subjects showed significant impairments in verbal memory and attentional switching compared with controls. Both mood disorder groups showed no impairments in psychomotor speed, attention for routine mental operations and executive control. Effects size calculations show that the unipolar and bipolar groups do not differ from each other across a range of neurocognitive measures. Conclusion: Neurocognitive deficits in young adults with current depressive syndromes appear to differ from those typically seen in older patients. In early adulthood, both unipolar and bipolar depression may be distinguished by poor verbal memory, despite intact speed of processing, attention and executive functions. This study suggests that there is utility in neuropsychological testing for young adults in the early stages of severe mood disorders. In order to prevent neurobiological changes inherent to the disease, pharmacological and non-pharmacological interventions that target verbal memory deficits may be optimally delivered early in the disease course.     

Psychoeducation in bipolar patients with comorbid personality disorders

BACKGROUND: The co-occurrence of personality and bipolar disorders is quite common. Bipolar patients with personality disorders have been described as having poorer outcome than 'pure' bipolar patients. However, from a combined-approach point of view, a little has been done to improve the course of these patients. Psychoeducation has shown its efficacy in the prevention of relapses in the bipolar population but, to date, no data is available on its efficacy in the management of bipolar patients with personality disorders. METHOD: The present study shows a subanalysis from a single-blind randomized prospective clinical trial on the efficacy of group psychoeducation in bipolar I patients. Bipolar patients fulfilling DSM-IV criteria for any personality disorder were randomized to either psychoeducational treatment or a non-structured intervention. There were 22 patients in the control group and 15 in the psychoeducation group. All patients received naturalistic pharmacological treatment as well. The follow-up phase comprised 2 years where all patients continued receiving naturalistic treatment without psychological intervention and were assessed monthly for several outcome measures. RESULTS: At the end of the follow-up phase (2 years), a 100% of control group patients fulfilled criteria for recurrence versus a 67% in the psychoeducation group (p < 0.005). Patients included in the psychoeducation group had a higher time-to-relapse and a significantly lower mean number of total, manic and depressive relapses. No significant differences regarding the number of patients who required hospitalization were found but the mean duration of days spent in the hospitalization room was significantly higher for the patients included in the control group. CONCLUSION: Psychoeducation may be a useful intervention for bipolar patients with comorbid personality disorders. Further studies should address the efficacy of specifically tailored interventions for this common type of patients.     

Mental disorders in offspring of parents with bipolar and major depressive disorders

Vandeleur C, Rothen S, Gholam‐Rezaee M, Castelao E, Vidal S, Favre S, Ferrero F, Halfon O, Fumeaux P, Merikangas KR, Aubry J‐M, Burstein M, Preisig M. Mental disorders in offspring of parents with bipolar and major depressive disorders. Bipolar Disord 2012: 14: 641–653. © 2012 The Authors. Journal compilation © 2012 John Wiley & Sons A/S. Objectives: There is limited information on the specificity of associations between parental bipolar disorder (BPD) and major depressive disorder (MDD) and the risk of psychopathology in offspring. The chief aim of the present study was to investigate the association between mood disorder subtypes in the two parents and mental disorders in the offspring. Methods: A total of 376 offspring (aged 6.0–17.9 years; mean = 11.5 years) of 72 patients with BPD (139 offspring), 56 patients with MDD (110 offspring), and 66 controls (127 offspring) participated in a family study conducted in two university hospital centers in Switzerland. Probands, offspring, and biological co‐parents were interviewed by psychologists blind to proband diagnoses, using a semi‐structured diagnostic interview. Results: Rates of mood and anxiety disorders were elevated among offspring of BPD probands (34.5% any mood; 42.5% any anxiety) and MDD probands (25.5% any mood; 44.6% any anxiety) as compared to those of controls (12.6% any mood; 22.8% any anxiety). Moreover, recurrent MDD was more frequent among offspring of BPD probands (7.9%) than those of controls (1.6%). Parental concordance for bipolar spectrum disorders was associated with a further elevation in the rates of mood disorders in offspring (64.3% both parents versus 27.2% one parent). Conclusions: These findings provide unique information on the broad manifestations of parental mood disorders in their offspring. The earlier onset and increased risk of recurrent MDD in the offspring of parents with BPD compared to those of controls suggests that the episodicity characterizing BPD may emerge in childhood and adolescence.     

Differences in incidence of suicide attempts during phases of bipolar I and II disorders

Background:  Differences in the incidence of suicide attempts during various phases of bipolar disorder (BD), or the relative importance of static versus time-varying risk factors for overall risk for suicide attempts, are unknown.
Methods:  We investigated the incidence of suicide attempts in different phases of BD as a part of the Jorvi Bipolar Study (JoBS), a naturalistic, prospective, 18-month study representing psychiatric in- and outpatients with DSM-IV BD in three Finnish cities. Life charts were used to classify time spent in follow-up in the different phases of illness among the 81 BD I and 95 BD II patients.
Results:  Compared to the other phases of the illness, the incidence of suicide attempts was 37-fold higher [95% confidence interval (CI) for relative risk (RR): 11.8–120.3] during combined mixed and depressive mixed states, and 18-fold higher (95% CI: 6.5–50.8) during major depressive phases. In Cox's proportional hazards regression models, combined mixed (mixed or depressive mixed) or major depressive phases and prior suicide attempts independently predicted suicide attempts. No other factor significantly modified the risks related to these time-varying risk factors; their population-attributable fraction was 86%.
Conclusions:  The incidence of suicide attempts varies remarkably between illness phases, with mixed and depressive phases involving the highest risk by time. Time spent in high-risk illness phases is likely the major determinant of overall risk for suicide attempts among BD patients. Studies of suicidal behavior should investigate the role of both static and time-varying risk factors in overall risk; clinically, management of mixed and depressive phases may be crucial in reducing risk.