Determining the cut-off for recurrent depressive episode to predict diagnostic conversion from unipolar depression to bipolar disorder: 5-year retrospective study in one university hospital

IntroductionTo date, the proposition of recurrence as a subclinical bipolar disorder feature has not received adequate testing.Objectives/AimsWe used the Italian version of the bipolar spectrum diagnostic scale (BSDS), a self-rated questionnaire of bipolar risk, in a sample of patients with mood disorders to test its specificity and sensitivity in identifying cases and discriminating between high risk for bipolar disorder major depressive patients (HRU) and low risk (LRU) adopting as a high recurrence cut-off five or more lifetime major depressive episodes.MethodsWe included 115 patients with DSM-5 bipolar disorder (69 type I, 41 type II, and 5 NOS) and 58 with major depressive disorder (29 HRU and 29 LRU, based on the recurrence criterion). Patients filled-out the Italian version of the BSDS, which is currently undergoing a validation process.ResultsThe BSDS, adopting a threshold of 14, had 84% sensitivity and 76% specificity. HRU, as predicted, scored on the BSDS intermediate between LRU and bipolar disorder. Clinical characteristics of HRU were more similar to bipolar disorder than to LRU; HRU, like bipolar disorder patients, had more lifetime hospitalizations, higher suicidal ideation and attempt numbers, and higher rates of family history of suicide.ConclusionsThe BSDS showed satisfactory sensitivity and sensitivity. Splitting the unipolar sample into HRU and LRU, on the basis of the at least 5 lifetime major depressive episodes criterion, yielded distinct unipolar subpopulations that differ on outcome measures and BSDS scores.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Treatment of Bipolar Disorder During the Postpartum Period

CNS Spectrums ◽

10.1017/s1092852900025724 ◽

2006 ◽

Vol 11 (S5) ◽

pp. 13-14

Author(s):

Adele C. Viguera

Keyword(s):

Bipolar Disorder ◽

Postpartum Period ◽

Clinical Information ◽

Mood Stabilizer ◽

Mood Stabilizers ◽

Antipsychotic Treatment ◽

Close Monitoring ◽

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.

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Effects of In Utero Exposure to AEDs on Morphology and Neurodevelopment

CNS Spectrums ◽

10.1017/s1092852900025700 ◽

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.

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TMS in bipolar disorder

10.1093/oxfordhb/9780198568926.013.0041 ◽

2012 ◽

Author(s):

Nimrod Grisaru ◽

Bella Chudakov ◽

Alex Kaptsan ◽

Alona Shaldubina ◽

Julia Applebaum ◽

...

Keyword(s):

Bipolar Disorder ◽

Magnetic Stimulation ◽

Bipolar Depression ◽

Unipolar Depression ◽

Future Directions ◽

Induced Mood ◽

Mood Effects ◽

Clinical Potential ◽

Depressive Episodes ◽

Lateral Specificity

This article reviews the existing animal and human literature on the clinical potential of transcranial magnetic stimulation (TMS) in mania and bipolar depression, and discusses potential future directions for this work. Studies of TMS in depression and normal volunteers suggested lateral specificity of TMS-induced mood effects. Clinical trials to compare left versus right prefrontal TMS in mania have been developed. Studies to understand the effect of TMS in bipolar depression have been undertaken. The results show efficacy similar to that for unipolar depression. But this does not provide support for the concept of TMS as an anti-bipolar, or mood-stabilizing, treatment. The utility of TMS as prophylaxis for subsequent manic or depressive episodes has not been reported in bipolar disorder. More work is needed to clarify the risk of mood switch, and the potential of TMS as prophylaxis against future manic or depressive episodes.

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Clinical status after two-weeks of antidepressant treatment: A prognostic factor in unipolar major depression?

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1478 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S409-S409

Author(s):

I. Domínguez ◽

L. Nuño ◽

G. Oriolo ◽

R. Quintero ◽

V. Navarro ◽

...

Keyword(s):

Major Depression ◽

Pharmacological Treatment ◽

Depressive Episode ◽

Antidepressant Treatment ◽

Clinical Status ◽

Treatment Protocol ◽

Unipolar Depression ◽

Therapeutic Decisions ◽

Competing Interest ◽

Unipolar Major Depression

Although most unipolar depression clinical guidelines advise against evaluating the efficacy of antidepressant pharmacological treatment until it has been administered in therapeutic doses for a minimum of 4–6 weeks, there is an increasing tendency to make therapeutic decisions after only 2 weeks of treatment. We present a study which aim is to determine whether the clinical course, following 2 weeks of antidepressant treatment, allows therapeutic decisions to be made for patients affected by a moderate/severe depressive episode. The study has an 8-week, prospective, observational design in which all consecutive in- and outpatients with moderate/severe unipolar major depression aged over 17 years received antidepressant treatment based on a standardized treatment protocol. Clinical status was assessed at baseline and at 2-, 4-, and 8-weeks. The final sample consisted of a total of 114 subjects. In our sample, the rate of remitters versus non-remitters was similar between the 2-week improvers and the 2-week non-improvers. It should also be emphasized that it was not possible to explain, based on the epidemiological and clinical characteristics assessed, which 2-week non-improvers would tend towards remission and which would show a partial or full response. Based on these results, for patients affected by a moderate/severe unipolar depressive episode, it would not be appropriate to make new therapeutic decisions following 2 weeks of anti-depressive pharmacological treatment depending on whether the patient has shown clinical improvement or not.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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The Late-onset Bipolar Disorder: A Comparative Study

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1893 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S113-S114

Author(s):

C. Derbel ◽

R. Feki ◽

S. Ben Nasr ◽

S. Bouhlel ◽

B. Ben Hadj Ali

Keyword(s):

Comparative Study ◽

Late Onset ◽

Demographic Data ◽

Bipolar Disorders ◽

The Elderly ◽

University Hospital ◽

Professional Activity ◽

Competing Interest ◽

Secondary Mania ◽

Depressive Episodes

IntroductionBipolar disorders (BP) with late onset are underestimated by their frequency, their misleading presentations and therapeutic difficulties due to the high prevalence of somatic comorbidities.AimTo identify sociodemographic, clinical and therapeutic characteristics in subjects with a late-onset BP.Patients and methodsRetrospective and comparative study of 101 patients followed for a BP (12 patients with BP started after 50 years and 89 patients with BP started earlier) from 2009 to 2015, in the department of psychiatry of the University Hospital Farhat Hached, Sousse, Tunisia.ResultsThe mean age of subjects with late-onset TBP was 46.11 ± 12.85 years. Women were in the majority (65.3%). Ten patients had a novo mania, four patients had a late-onset mania and one patient had a secondary mania. Regarding the socio-demographic data, only the regular professional activity was more reported in the elderly (P = 0.017). Regarding clinical data, BP type 1 and secondary mania were more reported in elderly with (P = 0.050 and P = 0.000 respectively). Elderly had significantly fewer depressive episodes (P = 0.026), fewer hypomanic episodes (P = 0.000). The durations of the latest episodes and the last intervals were shorter in elderly (P = 0.045 and P = 0.000). Concerning therapeutic data, elderly had fewer hospitalizations (P = 0.045), required lower mean doses of lithium (P = 0.04) and greater mean doses of tricyclic antidepressants (P = 0.047).ConclusionIt is always necessary to look for an organic cause in manic syndrome in late-onset BP. Doses of lithium should be lower. However, doses of TAD should be higher.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Quality of life of patients with unipolar depression

Medicinski pregled ◽

10.2298/mpns1002113z ◽

2010 ◽

Vol 63 (1-2) ◽

pp. 113-116 ◽

Cited By ~ 1

Author(s):

Olivera Zikic ◽

Suzana Tosic-Golubovic ◽

Violeta Slavkovic

Keyword(s):

Quality Of Life ◽

Depressive Episode ◽

Unipolar Depression ◽

Negative Influence ◽

World Health ◽

Healthy Controls ◽

World Health Organization Quality ◽

Depressive Episodes ◽

The Impact

Introduction. Quality of life has gained increasing attention as an important component of functional outcome in mood disorders. The aim of our study was to investigate the relationship between unipolar depression and quality of life. Material and methods. The group consisted of 84 patients with unipolar depression (depressive episode or recurrent depression, without psychotic presentation) and 30 healthy controls. We applied socio demographic questionnaire, World Health Organization Quality of Life-Brief and The Patient Health Questionnaire - 9. Results. The impact of unipolar depression on quality of life was significant. The patients had significantly lower scores in all 4 domains of quality of life (Physical health, Psychological health, Social relations, Environment) compared with healthy controls. The biggest influence was on physical (43.71 vs. 76.67) and psychological (36.01 vs. 65.83) domains. The quality of life decreased with the increase of severity of depressive episode and duration of current episode, as well as with incidence of depressive episodes. The absence of emotional relationship had also a very negative influence. There were no differences in quality of life between male and female depressive patients. The level of education had an impact on physical and psychological domain. Discussion. Generally, the quality of life in unipolar depression is very modest. One of the reasons for such influence could be the main pathological factor in depression - negative view of self world and future. Beside that, the reason could be significant psychological suffering and decreased function in depression. Conclusion. Unipolar depression has negative influence on quality of life.

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Radiomics Nomogram Analyses for Differentiating Pneumonia and Acute Paraquat Lung Injury

Scientific Reports ◽

10.1038/s41598-019-50886-7 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 6

Author(s):

Wang Yanling ◽

Gao Duo ◽

Geng Zuojun ◽

Shi Zhongqiang ◽

Wu Yankai ◽

...

Keyword(s):

Lung Injury ◽

Predictive Value ◽

Clinical Symptoms ◽

Demographic Data ◽

Characteristic Curve ◽

Public Health Problem ◽

Clinical Information ◽

Therapy Decision ◽

Paraquat Poisoning ◽

Radiomics Signature

Abstract Paraquat poisoning has become a serious public health problem in some Asian countries because of misuse or suicide. We sought to develop and validate a radiomics nomogram incorporating radiomics signature and laboratory bio-markers, for differentiating bacterial pneumonia and acute paraquat lung injury. 180 patients with pneumonia and acute paraquat who underwent CT examinations between December 2014 and October 2017 were retrospectively evaluated for testing and validation. Clinical information including demographic data, clinical symptoms and laboratory test were also recorded. A prediction model was built by using backward logistic regression and presented on a nomogram. The radiomics-based features yielded areas under the receiver operating characteristic curve of 0.870 (95% CI 0.757–0.894), sensitivity of 0.857, specificity of 0.804, positive predictive value of 83.3%, negative predictive value of 0.818 in the primary cohort, while in the validation cohort the model showed similar results (0.865 (95% CI 0.686–0.907), 0.833, 0.792, 81.5%, respectively). The individualized nomogram included radiomics signature, body temperature, nausea and vomiting, and aspartate transaminase. We have developed a radiomics nomogram that combination of the radiomics features and clinical risk factors to differentiate paraquat lung injury and pneumonia for patients with an unclear medical history of exposure to paraquat poisoning, providing appropriate therapy decision support.

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Ratio of height to thyromental distance: a comparison with Mallampati and Upper lip Bite test for predicting difficult intubation in Pakistani population

Journal of the Pakistan Medical Association ◽

10.47391/jpma.1215 ◽

2021 ◽

pp. 1-15

Author(s):

Saman Tauheed Ali ◽

Khalid Samad ◽

Syed Amir Raza ◽

Muhammad Qamarul Hoda

Keyword(s):

Predictive Value ◽

Characteristic Curve ◽

Cross Sectional Study ◽

Difficult Laryngoscopy ◽

University Hospital ◽

Upper Lip ◽

Cross Sectional ◽

Elective Surgical Procedures ◽

Lehane Grade ◽

Sensitivity Specificity

Objectives: We conducted this study to compare the accuracy of three diagnostic tests; ratio of height to thyromental distance (RHTMD), Modified Mallampati Test (MMT) and Upper Lip Bite Test (ULBT) in predicting difficult laryngoscopy using Cormack and Lehane grade as gold standard.Methods: This study was conducted in Aga Khan University Hospital, Karachi. Based on calculated sample size, 383 patients who required endotracheal intubation for elective surgical procedures were enrolled with consecutive sampling techniques during August 2014 to August 2015 for this cross-sectional study. Primary investigator used RHTMD, ULBT, and MMT for assessing the airway and correlated with laryngoscopic view.Results: A total of 383 patients were incorporated in this research, out of which 59(15.4%) classified as difficult laryngoscopy based on Cormack and Lehane (CL) grading. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of RHTMD (84.7%, 90.1%, 60.9%, 97%, 89.3%) and ULBT (83.1%, 89.2%, 58.3%, 96.7%, 88.3%) values were highest as compared to MMT (30.5%, 84.3%, 26.1%, 86.9%, 79.9%). The area under a receiver-operating characteristic curve (AUC of ROC curve) for ULBT and RHTMD was significantly more than for MMT (P<0.01). RHTMD and ULBT both are acceptable alternatives for prediction of difficult laryngoscopy as a simple, single bed-side test. Continuous...

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The importance of establishing a good differential diagnosis in bipolar disorder

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1182 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S338-S338

Author(s):

I. Peñuelas Calvo ◽

J. Sevilla Llewellyn-Jones ◽

C. Cervesi ◽

A. Sareen ◽

A. González Moreno

Keyword(s):

Mental Health ◽

Bipolar Disorder ◽

Personality Disorder ◽

Correct Diagnosis ◽

Unipolar Depression ◽

Health Condition ◽

Diagnostic Process ◽

Negative Consequences ◽

Competing Interest ◽

Disorder Type

Diagnosis plays a key role in identification of a disease, learn about its course, management and predicting prognosis. In mental health, diseases are often complex and coalesce of different symptoms. Diagnosing a mental health condition requires careful evaluation of the symptoms and excluding other differential disorders that may share common symptoms. Diagnose hastily can lead to misdiagnosis. A premature diagnosis or misdiagnosis has clear negative consequences. This is one of the problems related to mental health and one needs to optimize the diagnostic process to achieve a balance between sensitivity and specificity. Currently, the diagnosis of bipolar disorder (BD) is one of the major mental health conditions that is often misdiagnosed.To differentiate BD from unipolar depression with recurrent episodes or with personality disorder (PD), especially type Cluster B – with features shared with mania/hypomania like mental instability or impulsivity, it is important to differentiate between a diagnosis and its comorbidity. BD is often misdiagnosed as personality disorder and vice versa specially when both are coexisting (almost 20% of patients with bipolar disorder type II are misdiagnosed as personality disorders). This is common especially with borderline PD, although in some cases the histrionic PD may also be misdiagnosed as mania.Due to the inconsistency in patient care involving different psychiatrists combined with difficulty in obtaining a precise patient history and family history leads to loss of key information which in turn leads to misdiagnosis of the condition. The time delay in making the correct diagnosis cause by such inconsistencies may worsen the prognosis of the disease in the patient.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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