Screening for bipolar disorder among patients undergoing a major depressive episode: Report from the BRIDGE study in Egypt

2013 ◽  
Vol 147 (1-3) ◽  
pp. 217-224 ◽  
Author(s):  
Tarek Okasha ◽  
Mohamed Fikry ◽  
Aref Kowailed ◽  
Tamer El-Guwiely ◽  
Hisham Sadek
2014 ◽  
Vol 205 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Zezhi Li ◽  
Chen Zhang ◽  
Jinbo Fan ◽  
Chengmei Yuan ◽  
Jia Huang ◽  
...  

BackgroundEarly identification of patients with bipolar disorder during their first depressive episode is beneficial to the outcome of the disorder and treatment, but traditionally this has been a great challenge to clinicians. Recently, brain-derived neurotrophic factor (BDNF) has been suggested to be involved in the pathophysiology of bipolar disorder and major depressive disorder (MDD), but it is not clear whether BDNF levels can be used to predict bipolar disorder among patients in their first major depressive episode.AimsTo explore whether BDNF levels can differentiate between MDD and bipolar disorder in the first depressive episode.MethodA total of 203 patients with a first major depressive episode as well as 167 healthy controls were recruited. After 3 years of bi-annual follow-up, 164 patients with a major depressive episode completed the study, and of these, 21 were identified as having bipolar disorder and 143 patients were diagnosed as having MDD. BDNF gene expression and plasma levels at baseline were compared among the bipolar disorder, MDD and healthy control groups. Logistic regression and decision tree methods were applied to determine the best model for predicting bipolar disorder at the first depressive episode.ResultsAt baseline, patients in the bipolar disorder and MDD groups showed lower BDNF mRNA levels (P<0.001 and P = 0.02 respectively) and plasma levels (P = 0.002 and P = 0.01 respectively) compared with healthy controls. Similarly, BDNF levels in the bipolar disorder group were lower than those in the MDD group. These results showed that the best model for predicting bipolar disorder during a first depressive episode was a combination of BDNF mRNA levels with plasma BDNF levels (receiver operating characteristics (ROC) = 0.80, logistic regression; ROC = 0.84, decision tree).ConclusionsOur findings suggest that BDNF levels may serve as a potential differential diagnostic biomarker for bipolar disorder in a patient's first depressive episode.


2015 ◽  
Vol 21 (2) ◽  
pp. 4 ◽  
Author(s):  
Robyn Anne Van Schoor ◽  
Pierre M Joubert

<p><strong>Background.</strong> Adverse life events (ALEs) as precipitants of a major depressive episode (MDE) have been the subject of many studies. These studies indicate an increase in ALEs in the 6 months preceding an MDE.</p><p><strong>Objectives. </strong>The study examined what participants, suffering from major depressive disorder (MDD) or bipolar disorder (BD), perceived as the precipitating ALE of a current MDE. The severity and categories of ALEs were compared between these two patient groups.</p><p><span><strong>Methods. </strong>Consenting, adult inpatients were sourced from Weskoppies Hospital, Steve Biko Academic Hospital, Tshwane District Hospital, Denmar Psychiatric Hospital and Vista Clinic in the Pretoria area. A semi-structured questionnaire was used to obtain demographic data and the diagnosis. Information regarding the course of the disorder, including the number of previous MDEs and the age at which the first MDE occurred, was also obtained. The perceived precipitating ALE was detailed for each participant. A severity value referred to as a Life Change Unit Score (LCU score), based on the Recent Life Changes Questionnaire (RLCQ) by Miller and Rahe, was then assigned to each participant’s perceived precipitant.</span></p><p><span><strong>Results.</strong> Of the 64 participants, 12.7 % were experiencing a first MDE. In those participants who had experienced prior episodes the average number (standard deviation (SD)) of previous episodes was 3.86 (2.46). The mean approximate age (SD) at first onset of an MDE was 24.81 (10.9) years. The BD group had significantly more previous MDEs than the MDD group. Although the average LCU scores were higher in the BD group than the MDD group this did not reach statistical significance. Therefore, this study could not find a difference in the severity of the perceived precipitants between the BD group and MDD group. However, when the LCU scores were analysed within subcategories of the RLCQ, it was found that participants with BD perceived significantly more problems associated with the workplace as precipitants of a current MDE than individuals with MDD.</span></p><p><strong>Conclusion.</strong> Most participants could link an ALE to the onset of a current MDE. The study did not find a differential response to ALEs between patients with BD and MDD. The severity of the social precipitants did not differ significantly between the two groups. The notion of a ‘kindling effect’ could not be supported by the outcome of this study. Because some study participants experienced ALEs not accounted for by the RLCQ, a more comprehensive assessment instrument may be more appropriate for similar studies.</p>


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