Toward a validation of a new definition of agitated depression as a bipolar mixed state (mixed depression)

2004 ◽  
Vol 19 (2) ◽  
pp. 85-90 ◽  
Author(s):  
F. Benazzi ◽  
A. Koukopoulos ◽  
H.S. Akiskal
Keyword(s):  
Mixed State ◽  
Age At Onset ◽  
Signs And Symptoms ◽  
Mood Stabilizers ◽  
Major Depressive ◽  
Cross Sectional ◽  
History Of ◽  
Dsm Iv ◽  
Major Depressive Episodes ◽  
Depressive Episodes

AbstractPurposeAs psychotic agitated depression is now a well-described form of mixed state during the course of bipolar I disorder, we sought to investigate the diagnostic validity of a new definition for agitated (mixed) depression in bipolar II (BP-II) and major depressive disorder (MDD).Materials and methodsThree hundred and thirty six consecutive outpatients presenting with major depressive episodes (MDE) but without history of mania were evaluated with the Structured Clinical Interview for DSM-IV when presenting for the treatment of MDE. On the basis of history of hypomania they were assigned to BP-II (n = 206) vs. MDD (n = 130). All patients were also examined for hypomania during the current MDE. Mixed depression was operationally defined by the coexistence of a MDE and at least two of the following excitatory signs and symptoms as described by Koukopoulos and Koukopoulos (Koukopoulos A, Koukopoulos A. Agitated depression as a mixed state and the problem of melancholia. In: Akiskal HS, editor. Bipolarity: beyond classic mania. Psychiatr Clin North Am 1999;22:547–64): inner psychic tension (irritability), psychomotor agitation, and racing/crowded thoughts. The validity of mixed depression was investigated by documenting its association with BP-II disorder and with external variables distinguishing it from unipolar MDD (i.e., younger age at onset, greater recurrence, and family history of bipolar disorders). We analyzed the data with multivariate regression (STATA 7).ResultsMDE plus psychic tension (irritability) and agitation accounted for 15.4%, and MDE plus agitation and crowded thoughts for 15.1%. The highest rate of mixed depression (38.6%) was achieved with a definition combining MDE with psychic tension (irritability) and crowded thoughts: 23.0% of these belonged to MDD and 76.9% to BP-II. Moreover, any of these permutations of signs and symptoms defining mixed depression was significantly and strongly associated with external validators for bipolarity. The mixed irritable-agitated syndrome depression with racing-crowded thoughts was further characterized by distractibility (74–82%) and increased talkativeness (25–42%); of expansive behaviors from the criteria B list for hypomania, only risk taking occurred with some frequency (15–17%).ConclusionsThese findings support the inclusion of outpatient-agitated depressions within the bipolar spectrum. Agitated depression is validated herein as a dysphorically excited form of melancholia, which should tip clinicians to think of such a patient belonging to or arising from a bipolar substrate. Our data support the Kraepelinian position on this matter, but regrettably this is contrary to current ICD-10 and DSM-IV conventions. Cross-sectional symptomatologic hints to bipolarity in this mixed/agitated depressive syndrome are virtually absent in that such patients do not appear to display the typical euphoric/expansive characteristics of hypomania—even though history of such behavior may be elicited by skillful interviewing for BP-II. We submit that the application of this diagnostic entity in outpatient practice would be of considerable clinical value, given the frequency with which these patients are encountered in such practice and the extent to which their misdiagnosis as unipolar MDD could lead to antidepressant monotherapy, thereby aggravating it in the absence of more appropriate treatment with mood stabilizers and/or atypical antipsychotics.

scholarly journals Association between food insecurity and major depressive episodes amid Covid-19 pandemic: results of four consecutive epidemiological surveys from southern Brazil

2021 ◽  
pp. 1-25
Author(s):  
Leonardo Pozza Santos ◽  
Antônio Augusto Schäfer ◽  
Fernanda Oliveira Meller ◽  
Inacio Crochemore-Silva ◽  
Bruno Pereira Nunes ◽  
...  
Keyword(s):  
Food Insecurity ◽  
Short Form ◽  
Population Based ◽  
Cross Sectional Study ◽  
Major Depressive ◽  
Cross Sectional ◽  
Epidemiological Surveys ◽  
Dsm Iv ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Abstract Objective: To assess the association between household food insecurity (FI) and major depressive episodes (MDE) amid Covid-19 pandemic in Brazil. Design: Cross-sectional study carried out with data from four consecutive population-based studies. Setting: The study was conducted between May and June 2020, in Bagé, a Brazilian southern city. Household FI was measured using the short-form version of the Brazilian Food Insecurity Scale. Utilizing the Patient Health Questionnaire-9, we used two different approaches to define MDE: the cut-off point of ≥9 and the diagnostic criteria proposed by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-R). Association between FI and MDE was analysed using crude and adjusted Poisson regression models. Participants: 1550 adults (≥20 years old). Results: The prevalence of household FI was 29.4% (95%C.I 25.0; 34.4). MDE prevalence varied from 4.4% (95%C.I. 3.1 to 6.0), when we used the DSM-IV-R criteria to define this condition, to 9.6% (95%C.I 7.3; 12.5) of the sample, when we used the cut-off point of ≥9 as definition. Prevalence of MDE was more than two times higher in those individuals living with FI, independent of the criteria adopted to define the outcome. Adjustment for potential confounders did not change the association’s magnitude. Conclusion: Household FI has been positively associated with MDE amid Covid-19 pandemic, independent of sociodemographic characteristics of participants. Actions are needed to warrant basic living conditions to avoid food insecurity and hunger and its consequences for the Brazilian population, especially those consequences linked to mental health disorders.

scholarly journals Loneliness and depression among rural empty-nest elderly adults in Liuyang, China: a cross-sectional study

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e016091 ◽  
Author(s):  
Guojun Wang ◽  
Mi Hu ◽  
Shui-yuan Xiao ◽  
Liang Zhou
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Rural Elderly ◽  
Elderly Adults ◽  
Empty Nest ◽  
Major Depressive ◽  
Cross Sectional ◽  
Cohen’S D ◽  
Major Depressive Episodes ◽  
Depressive Episodes

ObjectiveTo compare loneliness, depressive symptoms and major depressive episodes between empty-nest and not-empty-nest older adults in rural areas of Liuyang city, Hunan, China.MethodsA cross-sectional multi-stage random cluster survey was conducted from November 2011 to April 2012 in Liuyang, China. A total of 839 rural older residents aged 60 or above completed the survey (response rate 97.6%). In line with the definition of empty nest, 25 participants who had no children were excluded from the study, while the remaining 814 elderly adults with at least one child were included for analysis. Loneliness and depressive symptoms in rural elderly parents were assessed using the short-form UCLA Loneliness Scale (ULS-6) and the Geriatric Depression Scale (GDS). Major depressive episodes were diagnosed using the Structured Clinical Interview for DSM-IV (SCID-I).ResultsSignificant differences were found between empty-nest and not-empty-nest older adults regarding loneliness (16.19±3.90 vs. 12.87±3.02, Cohen’s d=0.97), depressive symptoms (8.50±6.26 vs. 6.92±5.19, Cohen’s d=0.28) and the prevalence of major depressive episodes (10.1% vs. 4.6%) (all p<0.05). After controlling for demographic characteristics and physical disease, the differences in loneliness, depressive symptoms and major depressive episodes remained significant. Path analysis showed that loneliness mediated the relationship between empty-nest syndrome and depressive symptoms and major depressive episodes.ConclusionLoneliness and depression are more severe among empty-nest than not-empty-nest rural elderly adults. Loneliness was a mediating variable between empty-nest syndrome and depression.

Effects of In Utero Exposure to AEDs on Morphology and Neurodevelopment

CNS Spectrums ◽  
2006 ◽  
Vol 11 (S5) ◽  
pp. 9-10
Author(s):  
Martha J. Morrell
Keyword(s):  
Bipolar Disorder ◽  
Clinical Information ◽  
Mood Stabilizer ◽  
Mood Stabilizers ◽  
Antipsychotic Treatment ◽  
Close Monitoring ◽  
History Of ◽  
Major Congenital Malformations ◽  
Major Depressive Episodes ◽  
Depressive Episodes

AbstractThe presentations and clinical courses of patients with bipolar disorder differ greatly by gender. In addition, medical therapy must be tailored differently for men and women because of emerging safety concerns unique to the female reproductive system. In November 2005, these topics were explored by a panel of experts in psychiatry, neurology, and reproductive health at a closed roundtable meeting in Dallas, Texas. This clinical information monograph summarizes the highlights of that meeting.Compared to men with bipolar disorder, women have more pervasive depressive symptoms and experience more major depressive episodes. They are also at higher risk for obesity and certain other medical and psychiatric comorbidities. Mood changes across the menstrual cycle are common, although the severity, timing, and type of changes are variable. Bipolar disorder is frequently associated with menstrual abnormalities and ovarian dysfunction, including polycystic ovarian syndrome. Although some cases of menstrual disturbance precede the treatment of bipolar disorder, it is possible that valproate and/or antipsychotic treatment may play a contributory role in young women.Pregnancy does not protect against mood episodes in untreated women. Maintenance of euthymia during pregnancy is critical because relapse during this period strongly predicts a difficult postpartum course. Suspending therapy in the first months of pregnancy may be an option for some women with mild-to-moderate illness, or those with a long history of euthymia during pre-pregnancy treatment. However, a mood stabilizer should be reintroduced either in the later stages of pregnancy or in the immediate postpartum period. Preliminary data suggest that fetal exposure to some mood stabilizers may raise the risk of major congenital malformations and neurodevelopmental delays. For women planning to become pregnant, clinicians may consider switching to other drugs before conception. The value and drawbacks of breastfeeding during treatment must be considered in partnership with the patient, with close monitoring of nursing infants thereafter. The risks and benefits of medical treatment for women with bipolar disorder should be carefully reconsidered at each stage of their reproductive lives, with a flexible approach that is responsive to the changing needs of patients and their families.

Who Becomes a Depressive Ruminator? Developmental Antecedents of Ruminative Response Style

2002 ◽  
Vol 16 (4) ◽  
pp. 405-419 ◽  
Author(s):  
Jelena Spasojević ◽  
Lauren B. Alloy
Keyword(s):  
College Freshmen ◽  
Response Style ◽  
Major Depressive ◽  
History Of Childhood ◽  
Developmental Factors ◽  
History Of ◽  
Developmental Antecedents ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Developmental antecedents of ruminative response style were examined in 137 college freshmen, who were followed prospectively for 2.5 years. Reports of mothers’ and fathers’ psychologically overcontrolling parenting as well as a history of childhood sexual (for women only) and emotional maltreatment were all related to ruminative response style. In addition, ruminative response style mediated the relationships between these developmental factors and the number of major depressive episodes experienced by participants during the follow-up period. Potential explanations and important implications of these findings are discussed.

Core Beliefs and History of Major Depressive Episodes in Currently Non-depressed University Students

2008 ◽  
Vol 33 (1) ◽  
pp. 50-58 ◽  
Author(s):  
John R. Z. Abela ◽  
Randy P. Auerbach ◽  
Sabina Sarin ◽  
Zia Lakdawalla
Keyword(s):  
University Students ◽  
Core Beliefs ◽  
Major Depressive ◽  
History Of ◽  
Major Depressive Episodes ◽  
Depressive Episodes

scholarly journals The Prevalence of Major Depressive Episodes Is Higher in Urban Regions of Canada

2016 ◽  
Vol 62 (1) ◽  
pp. 57-61 ◽  
Author(s):  
Kathryn Wiens ◽  
Jeanne V. A. Williams ◽  
Dina H. Lavorato ◽  
Andrew G. M. Bulloch ◽  
Scott B. Patten
Keyword(s):  
Rural Areas ◽  
Odds Ratio ◽  
Service Needs ◽  
Rural Regions ◽  
Major Depressive ◽  
Cross Sectional ◽  
Urban Regions ◽  
The Difference ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Objective: Major depressive disorder is an important contributor to disease burden. Anticipation of service needs is important, yet basic information is lacking. For example, there is no consensus as to whether major depressive episodes (MDE) are more or less prevalent in urban or rural areas. The objective of this study was to determine whether a difference exists in Canada. Method: A series of 11 Canadian national cross-sectional studies were examined from 2000 to 2014, providing much greater precision than prior analyses. Survey-specific MDE prevalence estimates were synthesized into a pooled odds ratio comparing urban to rural areas using meta-analytic methods. Results: Differences in the survey-specific estimates were not in excess of what would be expected due to sampling variability. This suggests that inconsistency in the prior literature is due to inadequate power and precision, an issue addressed by the meta-analytic pooling. The pooled odds ratio for Canada is 1.18 (95% confidence interval, 1.12 to 1.25), indicating that urban regions have higher MDE prevalence than rural regions. However, the difference is very small and of uncertain significance for policy and planning. Conclusions: Prevalence of MDE is approximately 18% higher in urban compared to rural regions of Canada. The difference is insufficient to impute differing need for services, but the result resolves an inconsistency in the existing literature and may play a role in future needs assessment.

Treatment of Bipolar Disorder During Pregnancy

CNS Spectrums ◽  
2006 ◽  
Vol 11 (S5) ◽  
pp. 11-12
Author(s):  
Lee S. Cohen
Keyword(s):  
Bipolar Disorder ◽  
Clinical Information ◽  
Mood Stabilizer ◽  
Mood Stabilizers ◽  
Antipsychotic Treatment ◽  
Close Monitoring ◽  
History Of ◽  
Major Congenital Malformations ◽  
Major Depressive Episodes ◽  
Depressive Episodes

AbstractThe presentations and clinical courses of patients with bipolar disorder differ greatly by gender. In addition, medical therapy must be tailored differently for men and women because of emerging safety concerns unique to the female reproductive system. In November 2005, these topics were explored by a panel of experts in psychiatry, neurology, and reproductive health at a closed roundtable meeting in Dallas, Texas. This clinical information monograph summarizes the highlights of that meeting.Compared to men with bipolar disorder, women have more pervasive depressive symptoms and experience more major depressive episodes. They are also at higher risk for obesity and certain other medical and psychiatric comorbidities. Mood changes across the menstrual cycle are common, although the severity, timing, and type of changes are variable. Bipolar disorder is frequently associated with menstrual abnormalities and ovarian dysfunction, including polycystic ovarian syndrome. Although some cases of menstrual disturbance precede the treatment of bipolar disorder, it is possible that valproate and/or antipsychotic treatment may play a contributory role in young women.Pregnancy does not protect against mood episodes in untreated women. Maintenance of euthymia during pregnancy is critical because relapse during this period strongly predicts a difficult postpartum course. Suspending therapy in the first months of pregnancy may be an option for some women with mild-to-moderate illness, or those with a long history of euthymia during pre-pregnancy treatment. However, a mood stabilizer should be reintroduced either in the later stages of pregnancy or in the immediate postpartum period. Preliminary data suggest that fetal exposure to some mood stabilizers may raise the risk of major congenital malformations and neurodevelopmental delays. For women planning to become pregnant, clinicians may consider switching to other drugs before conception. The value and drawbacks of breastfeeding during treatment must be considered in partnership with the patient, with close monitoring of nursing infants thereafter. The risks and benefits of medical treatment for women with bipolar disorder should be carefully reconsidered at each stage of their reproductive lives, with a flexible approach that is responsive to the changing needs of patients and their families.

scholarly journals Prospective study of risk factors for attempted suicide among patients with DSM–IV major depressive disorder

2005 ◽  
Vol 186 (4) ◽  
pp. 314-318 ◽  
Author(s):  
T. Petteri Sokero ◽  
Tarja K. Melartin ◽  
Heikki J. Rytsälä ◽  
Ulla S. Leskelä ◽  
Paula S. Lestelä-Mielonen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Structured Interviews ◽  
Major Depressive ◽  
Dsm Iv ◽  
Major Depressive Episodes ◽  
Depressive Episodes

BackgroundThere are few prospective studies on risk factors for attempted suicide among psychiatric out- and in-patients with major depressive disorder.AimsTo investigate risk factors for attempted suicide among psychiatric out- and in-patients with major depressive disorder inthe city of Vantaa, Finland.MethodThe Vantaa Depression Study included 269 patients with DSM–IV major depressive disorder diagnosed using semi-structured interviews and followed up at 6- and 18-month interviews with a life chart.ResultsDuring the 18-month follow-up, 8% of the patients attempted suicide. The relative risk of an attempt was 2.50 during partial remission and 7.54 during a major depressive episode, compared with full remission (P<0.001). Numerous factors were associated with this risk, but lacking a partner, previous suicide attempts and total time spent in major depressive episodes were the most robust predictors.ConclusionsSuicide attempts among patients with major depressive disorder are strongly associated with the presence and severity of depressive symptoms and predicted by lack of partner, previous suicide attempts and time spent in depression. Reducing the time spent depressed is a credible preventive measure.

scholarly journals Associations of current and remitted major depressive disorder with brain atrophy: the AGES–Reykjavik Study

2012 ◽  
Vol 43 (2) ◽  
pp. 317-328 ◽  
Author(s):  
M. I. Geerlings ◽  
S. Sigurdsson ◽  
G. Eiriksdottir ◽  
M. E. Garcia ◽  
T. B. Harris ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
White Matter ◽  
Depressive Disorder ◽  
Brain Atrophy ◽  
Older Persons ◽  
Age At Onset ◽  
Prior History ◽  
Major Depressive ◽  
History Of ◽  
Dsm Iv

BackgroundTo examine whether lifetime DSM-IV diagnosis of major depressive disorder (MDD), including age at onset and number of episodes, is associated with brain atrophy in older persons without dementia.MethodWithin the population-based Age, Gene/Environment Susceptibility (AGES)–Reykjavik Study, 4354 persons (mean age 76 ± 5 years, 58% women) without dementia had a 1.5-T brain magnetic resonance imaging (MRI) scan. Automated brain segmentation total and regional brain volumes were calculated. History of MDD, including age at onset and number of episodes, and MDD in the past 2 weeks was diagnosed according to DSM-IV criteria using the Mini-International Neuropsychiatric Interview (MINI).ResultsOf the total sample, 4.5% reported a lifetime history of MDD; 1.5% had a current diagnosis of MDD (including 75% with a prior history of depression) and 3.0% had a past but no current diagnosis (remission). After adjusting for multiple covariates, compared to participants never depressed, those with current MDD (irrespective of past) had more global brain atrophy [B = –1.25%, 95% confidence interval (CI) −2.05 to −0.44], including more gray- and white-matter atrophy in most lobes, and also more atrophy of the hippocampus and thalamus. Participants with current, first-onset MDD also had more brain atrophy (B = –1.62%, 95% CI −3.30 to 0.05) whereas those remitted did not (B = 0.06%, 95% CI −0.54 to 0.66).ConclusionsIn older persons without dementia, current MDD, irrespective of prior history, but not remitted MDD was associated with widespread gray- and white-matter brain atrophy. Prospective studies should examine whether MDD is a consequence of, or contributes to, brain volume loss and development of dementia.

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