Pain and rejection sensitivity in bipolar depression

Ehnvall A, Mitchell PB, Hadzi‐Pavlovic D, Loo C, Breakspear M, Wright A, Roberts G, Frankland A, Corry J. Pain and rejection sensitivity in bipolar depression.
Bipolar Disord 2011: 13: 59–66. © 2011 The Authors.
Journal compilation © 2011 John Wiley & Sons A/S. Objectives: Little is known regarding the correlates of pain in bipolar disorder. Recent neuroimaging studies support the contention that depression, as well as pain distress and rejection distress, share the same neurobiological circuits. In a recently published study, we confirmed the hypothesis that perception of increased pain during treatment‐refractory depression, predominantly unipolar, was related to increased rejection sensitivity. In the present study, we aimed to test this same hypothesis for bipolar depression. Methods: The present study analysed data from 67 patients presenting to the Black Dog Institute Bipolar Disorders Clinic in Sydney, Australia. The patients all met DSM‐IV criteria for bipolar disorder and had completed a self‐report questionnaire regarding perceived pain and rejection sensitivity during depression. Results: A significant increase in the experience of headaches (p = 0.003) as well as chest pain (p = 0.004) during bipolar depression was predicted by a major increase in rejection sensitivity when depressed, i.e., state rejection sensitivity. Being rejection sensitive in general, i.e., trait rejection sensitivity, did not predict pain during depression. Conclusions: The experience of increased headaches and chest pain during bipolar depression is related to increased rejection sensitivity during depression. Research to further elucidate this relationship is required.     

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。     

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.     

Prolactin secretion in women with unipolar and bipolar depression

Plasma prolactin levels and prolactin response to thyrotropin releasing hormone (TRH) were studied in 27 unipolar and 24 bipolar depressive female patients before and after tricyclic antidepressant treatment, as well as in 38 normal controls matched for age, sex, and menopausal status. Before antidepressant treatment, basal prolactin levels were significantly lower in both premenopausal and postmenopausal bipolar patients but only in postmenopausal unipolar patients when compared to controls. The prolactin response to TRH was significantly blunted in both unipolar and bipolar postmenopausal subjects but remained normal in all premenopausal (unipolar and bipolar) patients. These data suggest that prolactin pituitary function could be useful in the neuroendocrine study of depressive illness.     

Efficacy of electroconvulsive therapy in bipolar versus unipolar major depression: a meta-analysis

Dierckx B, Heijnen WT, van den Broek WW, Birkenhäger TK. Efficacy of electroconvulsive therapy in bipolar versus unipolar major depression: a meta‐analysis. Bipolar Disord 2012: 14: 146–150. © 2012 The Authors. Journal compilation © 2012 John Wiley & Sons A/S. Objective: Bipolar major depression differs considerably from unipolar major depression with regard to the efficacy of treatment with antidepressants. In bipolar depression, response to treatment with antidepressants is disappointing. Whether response to electroconvulsive therapy (ECT) differs between bipolar and unipolar depression remains unclear. Therefore, this systematic review investigates the relative efficacy of ECT in both forms of depression. Methods: Relevant cohort studies were identified from a systematic search of the PubMed electronic database. Six studies were included in this meta‐analysis. Results: In this meta‐analysis, the overall remission rate was 50.9% (n = 402/790) for patients with unipolar depression and 53.2% (n = 168/316) for patients with bipolar major depression. A pooled odds ratio (OR) and confidence interval (CI) were calculated using random‐effects meta‐analysis with the Mantel–Haenzel method. This analysis shows similar efficacy of ECT in patients with unipolar and bipolar depression (OR = 1.08, 95% CI: 0.75–1.57). Conclusion: ECT appears to be equally effective for both bipolar and unipolar depression and the remission rates are encouraging, especially for bipolar depression.     

Electroconvulsive therapy is equally effective in unipolar and bipolar depression

Bailine S, Fink M, Knapp R, Petrides G, Husain MM, Rasmussen K, Sampson S, Mueller M, McClintock SM, Tobias KG, Kellner CH. Electroconvulsive therapy is equally effective in unipolar and bipolar depression. Objective: To determine the relative efficacy of electroconvulsive therapy (ECT) in the treatment of bipolar (BP) and unipolar (UP) depressive illness and clarify its role in BP depression. Method: Patients referred for ECT with both UP and BP depressions. [classified by Structured Clinical Interview for DSM (SCID‐I) criteria for history of mania] were included in a multi‐site collaborative, double‐masked, randomized controlled trial of three electrode placements – right unilateral, bifrontal or bitemporal – in a permutated block randomization scheme. Results: Of 220 patients, 170 patients (77.3%) were classified as UP and 50 (22.7%) as BP depression in the intent‐to‐treat sample. The remission and response rates and numbers of ECT for both groups were equivalent. Conclusion: Both UP and BP depressions remit with ECT. Polarity is not a factor in the response rate. In this sample ECT did not precipitate mania in depressed patients. Treatment algorithms for UP and BP depression warrant re‐evaluation.     

Laterality of pain in migraine with comorbid unipolar depressive and bipolar II disorders

Objectives:  The purpose of the present study has been to examine differences in the laterality of pain in patients with migraine and comorbid unipolar depressive (UP) and bipolar II (BP II) disorders.
Methods:  Semi-structured interviews of 102 patients with major affective disorders were conducted, using DSM-IV criteria for affective disorders combined with Akiskal's criteria for affective temperaments and International Headache Society criteria for migraine. The group of patients reported on in the present study encompass 47 subjects with UP (n=24) or BP II (n=23) disorders. Fifteen of the bipolar II patients fulfilled DSM-IV criteria while eight were diagnosed according to the broader criteria of Akiskal.
Results:  Sixteen of the 38 patients with migraine headaches had bilateral pain or pain equally often on the left or right side while 22 had pain predominantly located on one side. Among the UP patients the pain was most often on the right side (8/10) while among the BP II patients the pain was most often on the left (9/12, p = 0.01). Apart from the presence of hypomanic symptoms in the BP II group there were no clinical or demographic characteristics that distinguished these two sub-groups of affective disorders.
Conclusions:  These results indicate that there may be a differential affection of the cerebral hemispheres in patients with migraine and comorbid unipolar depressive disorder versus patients with migraine and comorbid bipolar II disorder.     

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.     

Psychotic features in bipolar and unipolar depression

BACKGROUND: While some prior studies have found higher rates of psychotic depression in those with bipolar disorder or a bipolar relative, others have failed to confirm these observations. We examined the relationship of psychotic depression to polarity in several large familial samples of mood disorder. METHODS: A total of 4,724 subjects with major mood disorder in three family studies on the genetics of bipolar I disorder (BPI) or recurrent major depressive disorder (MDDR) were administered semi-structured interviews by clinicians. Determination of psychotic features was based on a report of hallucinations and/or delusions during the most severe depressive episode in the Schedule for Affective Disorders and Schizophrenia-Lifetime Version or the Diagnostic Interview for Genetic Studies interview. Rates of psychotic depression were calculated by diagnostic category and comparisons were made between diagnoses within and across studies using the generalized estimating equation. RESULTS: A diagnosis of BPI disorder was strongly predictive of psychotic features during depression compared to MDDR [odds ratio (OR) = 4.61, p < 0.0005]. Having bipolar II compared to MDDR was not predictive of psychosis (OR = 1.05, p = 0.260), nor was having a family history of BPI in MDDR subjects (OR = 1.20, p = 0.840). CONCLUSIONS: Psychotic features during a depressive episode increased the likelihood of a BPI diagnosis. Prospective studies are needed to confirm these findings. The potential genetic underpinnings of psychotic depression warrant further study.     

基于DSM-5的单双相抑郁住院患者的临床特征比较

目的采用《美国精神障碍诊断与统计手册(第5版)》(DSM-5)诊断标准,比较单相复发性抑郁障碍及双相障碍抑郁发作患者的临床特征,探讨DSM-5特征标准在中国住院患者中的适用情况。方法根据DSM-5标准自编抑郁发作临床特征调查问卷,对2015年8月-12月在北京安定医院抑郁症治疗中心住院的复发性抑郁障碍112例及双相障碍抑郁发作136例进行访谈,比较差异。结果双相抑郁起病年龄更早、抑郁发作次数更多、家族史阳性及伴精神病性特征的比例更高(P0.05)。复发性抑郁一次抑郁发作持续时间更长,伴焦虑痛苦及伴忧郁特征的比例更高(P0.05)。结论单双相抑郁具有不同的临床特征,DSM-5特征标准在中国人群中的信效度需要进一步验证。     

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.