Depressive Mixed States: Symptomatology, Prevalence and Principles of Treatment

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
W. Drozdz ◽  
A. Borkowska
Keyword(s):  
Affective Disorders ◽  
Rating Scale ◽  
Depressive Symptomatology ◽  
Depression Scale ◽  
Assessment Tools ◽  
The Other ◽  
Mood Stabilizers ◽  
Hamilton Depression Scale ◽  
Principles Of Treatment ◽  
Bipolar Patients

Current diagnostic systems (DSM-IV-TR and ICD-10) do not include depressive mixed state (DMS) as a separate category. However, both historical descriptions and data from recent research clearly indicate that cooccurrence of (hypo)maniacal and depressive symptoms is standard in clinical picture of affective disorders. Most frequently employed criterion for DMS is the presence of at least three symptoms of (hypo)mania for 7 days during a major depressive episode. Not only formal diagnostic criteria for DMS are lacking but also psychometric assessment tools (for example the Hamilton Depression Scale or the MADRS) were designed around the features of “classical” depression. The other obstacles to recognize DMS could be lack of insight into the (hypo)maniacal symptoms in patients and cognitive dysfunctions present during an episode. On the other hand, newly created instrument, the Bipolar Depression Rating Scale, may assist clinical evaluation of DMS. Despite predominating depressive symptomatology, the principles of treatment of DMS suggest avoidance of antidepressant monotherapy in favor of mood stabilizers' administration. Actually DMS may emerge as a complication of antidepressant monotherapy in some bipolar patients or may be induced with interferon-alpha treatment in some chronic hepatitis C patients. Important consequences of both spontaneous and drug-induced DMS could be the roughening of affective symptomatology, resistance to antidepressants and the increase of suicidality. Thorough appraisal of symptoms seen in patients with affective disorders for indicators of DMS could have critical consequences for functional outcomes.

Responsiveness of observer rating scales by analysis of number of days until improvement in patients with major depression

1998 ◽  
Vol 13 (3) ◽  
pp. 143-145 ◽  
Author(s):  
N Lauge ◽  
K Behnke ◽  
J Søgaard ◽  
B Bahr ◽  
P Bech
Keyword(s):  
Major Depression ◽  
Rating Scales ◽  
Rating Scale ◽  
Depressive Symptomatology ◽  
Depression Scale ◽  
Response To Treatment ◽  
Hamilton Depression Scale ◽  
Scale Scores ◽  
Pre Treatment ◽  
Treatment Onset

SummarySeveral well-known observer scales, including the Hamilton Depression Scale (HAM-D), Montgomery-Åsberg Scale (MADRS), Major Depression Rating Scale (MDS), Melancholia Scale (MES), and Inventory for Depressive Symptomatology (IDS) used for measuring severity of depressive states have been compared by their responsiveness in an open trial including patients treated with a combination of citalopram and mianserin. The patients fulfilled the Diagnostic and Statistical Manual (DSM)-IV criteria for major depressive episode, and all scored 18 or more on the HAM-D before treatment. Onset of antidepressant action was defined as an improvement of rating scale scores of 25% or more of pre-treatment scores. A response to treatment was defined as a reduction of 50% or more on the pre-treatment scores. The results showed that the number of treatment days until improvement was 11 to 13 with no difference between the scales. The days until response were between 18 and 21 with no difference between the scales. In conclusion, the depression scales were found to be equal in their ability to detect changes in depressive symptoms during treatment. The mean of days to response was 19 for the combination of citalopram and mianserin. This is similar to the response for the combination of fluoxetine and pinolol.

Obesity and quality of life in bipolar disorder

2017 ◽  
Vol 41 (S1) ◽  
pp. S423-S424
Author(s):  
R. Jouini ◽  
H. Ben Ammar ◽  
G. Hamdi ◽  
N. Smari ◽  
A. Aissa ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Bipolar Disorder ◽  
Scale Score ◽  
Rating Scale ◽  
Short Form ◽  
Depression Scale ◽  
Overweight And Obesity ◽  
Hamilton Depression Scale ◽  
Bipolar Patients

IntroductionOverweight and obesity, despite their comorbidities and mortality, could deteriorate the quality of life of people with bipolar disorder.ObjectivesThe objective of this study is to evaluate the quality of life among patients with bipolar disorder and investigate a possible interaction between obesity and deterioration of the quality of life.AimsThis study aims to highlight the importance of preventing overweight and obesity in people with bipolar disorder to obtain an adequate quality of life subsequently an acceptable control of the illness.MethodsFifty euthymic bipolar patients (Hamilton Depression Scale score ≤ 8, and Young Mania Rating Scale score ≤ 6) received the Medical Outcomes Study 36-Item Short-Form Health Survey in Arabic validated version in order to investigate the quality of life.ResultsWe examined 50 euthymic bipolar patients (60% men, 40% women). The average age was 46, 5 years (23–70). Most patients (69%) were over weighted (BMI ≥ 25.0 kg/m2) (body mass index), of whom 40% were obese (BMI ≥ 30.0 kg/m2). Seventy-two percent of the investigated patients had an affected quality of life (score < 66.7). The mental items were deteriorated in 80% of the cases. An affected quality of life was correlated with obesity. The BMI was significantly and negatively correlated with the scores of dimensions D4 (mental health) and D8 (perceived health) (P < 0.01).ConclusionThe investigation of quality of life in people with mental disorder enables to reveal the social handicap caused by these illnesses consequently emphasizes health care in mental affections.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Insight in bipolar disorder: a comparison between mania, depression and euthymia using the Insight Scale for Affective Disorders

2015 ◽  
Vol 37 (3) ◽  
pp. 152-156 ◽  
Author(s):  
Rafael de Assis da Silva ◽  
Daniel C. Mograbi ◽  
Evelyn V. M. Camelo ◽  
Jaqueline Bifano ◽  
Mayra Wainstok ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Clinical Management ◽  
Affective Disorders ◽  
Rating Scale ◽  
Mood State ◽  
Depression Scale ◽  
Treatment Compliance ◽  
Hamilton Depression Scale ◽  
Young Mania ◽  
Insight Into

Objective: To evaluate whether having general insight into bipolar disorder and its symptoms is affected by the mood state of the patient, using the Insight Scale for Affective Disorders, a hetero-application scale for people with mood disorders.Methods: Ninety-five patients with bipolar disorder were evaluated and divided into different groups according to the mood state presented during assessment (i.e., euthymia, mania and depression). Sociodemographic and clinical data (Hamilton Depression Scale, Young Mania Rating Scale, and Clinical Global Impressions Scale) were recorded. Insight was evaluated using the Insight Scale for Affective Disorders.Results: Patients with bipolar disorder in mania show less insight about their condition than patients in depression or euthymia, and less insight about their symptoms than patients with depression, with the exception of awareness of weight change.Conclusions: Loss of insight during mania may have important implications for treatment compliance and adherence and needs to be taken into account in the clinical management of people with bipolar disorder.

Cognitive Function in Older Euthymic Bipolar Patients

2017 ◽  
Vol 41 (S1) ◽  
pp. S116-S117
Author(s):  
K. Hajbi ◽  
I. Baati ◽  
S. Ellouze ◽  
S. Mkaouar ◽  
I. Abida ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Cognitive Dysfunction ◽  
Low Income ◽  
Cognitive Rehabilitation ◽  
Depression Scale ◽  
Cognitive Disorders ◽  
Hamilton Depression Scale ◽  
Affective Symptoms ◽  
Bipolar Patients ◽  
Psychotic Features

ObjectivesTo assess cognitive function in older euthymic bipolar patients. To investigate the relationship between cognitive disorders and clinical features in this population.MethodsWe conducted a cross-sectional study during the period from August to November 2015. It included 34 stable bipolar outpatients, aged at least 65 years. We used the Montreal Cognitive Assessment (MoCA) to screen for cognitive disorders. Our patients were clinically euthymic, as checked by the Hamilton depression scale and the Young mania scale.ResultsThe sex ratio was 1. The mean age of our patients was 68.2 years. Most of them were married (82.4%), unemployed (55.8%), living in urban area (82.4%), had low educational level (58.8%) and low income (64.7%).The majority was bipolar type 1 (67.6%). The most recent episode was manic in 55.9% of cases, including psychotic features in 50% of cases. Subsyndromal affective symptoms were noted between episodes in 23.5% of them. The average MoCA score was 23.6. Cognitive disorders were found in 61.5% of patients, who showed impairments across all cognitive domains. The most frequent deficits were found in attention (100%) and executive functions (85.3%).Cognitive dysfunction correlated to psychotic features during the last episode (P = 0.005), subsyndromal affective symptoms between episodes (P = 0.13), high number of mood episodes (P = 0.007) and hospitalisations (P = 0.014).ConclusionOur study confirmed that cognitive dysfunction was frequent in older bipolar patients in Tunisia. Preventing mood episodes, screening for addictive and somatic comorbidities, as well as cognitive rehabilitation, are suitable strategies for improving cognitive functioning among these patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Association among Items from the Self-Report Version of the Hamilton Depression Scale (Carroll Rating Scale) and Respondents' Sex

2007 ◽  
Vol 101 (1) ◽  
pp. 291-301 ◽  
Author(s):  
Ana Luiza Camozzato ◽  
Maria Paz Hidalgo ◽  
Sônia Souza ◽  
Márcia L. F. Chaves
Keyword(s):  
Sex Differences ◽  
Regression Analysis ◽  
General Population ◽  
Rating Scale ◽  
Depression Scale ◽  
The Self ◽  
Self Report ◽  
Sex Bias ◽  
Hamilton Depression Scale ◽  
Nonclinical Sample

The association among items of the self-reported version of the Hamilton Depression Scale (Carroll Rating Scale), answered according to a memory of a maximally disturbing event experienced, and respondents' sex was examined in a nonclinical sample of 320 college students, 164 women ( M age = 21.7 yr., SD = 3.6) and 156 men ( M age = 23.5 yr., SD = 5.8). An assessment of sex bias was also evaluated. Multiple regression analysis showed that statements regarding unhappiness, urge to cry, dizziness and faintness, and waking in the middle of the night were significantly associated with women. Removal of these items from the Carroll Rating Scale Total scores eliminated the sex differences in depression rates. Items that displayed significant sex bias were those regarding behavior and emotions commonly attributed to women within the general population.

Manic switch in bipolar patients treated with electroconvulsive therapy for treatment-resistant depression: The experience at the mood disorder unit of Milan (Italy)

2017 ◽  
Vol 41 (S1) ◽  
pp. S768-S768
Author(s):  
D. Delmonte ◽  
S. Brioschi ◽  
B. Barbini ◽  
R. Zanardi ◽  
C. Colombo
Keyword(s):  
Rating Scale ◽  
Remission Rate ◽  
Antidepressant Treatment ◽  
Age At Onset ◽  
Antidepressant Drugs ◽  
Mood Stabilizers ◽  
High Morbidity ◽  
Safe Procedure ◽  
Young Mania ◽  
Bipolar Patients

IntroductionDespite appropriate treatment, 30–40% of depressed patients, both unipolar and bipolar, do not achieve improvement, with high morbidity and mortality. For bipolar patients another risk is the switch into mania due to antidepressant treatment. The concern about the switch, suggests to administer antidepressants at lower doses, in combination with mood stabilizers and second generation anti-psychotics.ObjectivesWe performed an observational study on a sample of 23 bipolar patients treated with ECT for severe TRD in last 3 years, in order to evaluate the risk of switch.MethodsTwenty-three bipolar inpatients, undergoing bitemporal ECT twice/week, with MECTA spectrum device. Main demographic and clinical data collected. Hamilton rating scale for depression (HAM-D). Clinical response defined as 50% reduction of HAM-D score at the endpoint from baseline; remission as HAM-D score at the endpoint < 8. Young Mania rating scale (YMRS) weekly in order to assess switch into mania.ResultsThirteen (56.5%) females, 10 (43.5%) males, mean age 60.1 ± 10.3 years. Mean age at onset 35.5 ± 13.6 years. Mean number of episodes: 7.1 ± 3.6. Mean duration of current episode: 33.4 ± 24.9 weeks. Mean HAM-D basal score: 30.0 ± 5. Each patient underwent a cycle of ECT (mean No. 6.7 ± 3.3). Pharmacological treatment was administered upon clinical need. Response rate 87%, remission rate 43.5%. Three out of 23 (13.04%) patients had transient hypomanic switch, spontaneous recovery within 7 days after the last ECT.ConclusionsOur experience confirms that ECT is a powerful antidepressant, especially in patients with severe long-lasting depression, refractory to treatment. ECT is also a safe procedure: no adverse effects were reported. The manic switch rate is comparable with antidepressant drugs.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Depressed Mood after Stroke: Predictive Factors at Six Months Follow-Up

2020 ◽  
Vol 17 (24) ◽  
pp. 9542
Author(s):  
Fidel López-Espuela ◽  
Raúl Roncero-Martín ◽  
Maria de la Luz Canal-Macías ◽  
Jose M. Moran ◽  
Vicente Vera ◽  
...  
Keyword(s):  
Rating Scale ◽  
Depression Scale ◽  
Length Of Hospital Stay ◽  
Hamilton Depression Scale ◽  
Modified Rankin Scale ◽  
Cross Sectional ◽  
Post Stroke ◽  
Depression Assessment ◽  
Degree Of Disability ◽  
Post Stroke Depression

We aimed to know the prevalence of post-stroke depression (PSD) in our context, identify the variables that could predict post-stroke depression, by using the Hamilton Depression Rating Scale, occurring within six months after stroke, and identify patients at high risk for PSD. Methods: descriptive, cross-sectional and observational study. We included 173 patients with stroke (transient ischemic attack (TIA) included) and collected sociodemographic and clinical variables. We used the Hamilton Depression Scale (HDS) for depression assessment and Barthel Index and modified Rankin Scale (mRS) for functional assessment. The neurological severity was evaluated by the National Institutes of Health Stroke Scale (NIHSS). Results: 35.5% were women, aged 71.16 (±12.3). Depression was present in 42.2% patients (n = 73) at six months after stroke. The following variables were significantly associated with PSD: diagnosis of previous depression (p = 0.005), the modified Rankin Scale at discharge (p = 0.032) and length of hospital stay (p = 0.012). Conclusion: PSD is highly prevalent after stroke and is associated with the severity, left location of the stroke, and the degree of disability at discharge. Its impact justifies the evaluation and early treatment that still continues to be a challenge today.

scholarly journals Prevalence of depression in people living with HIV and AIDS at the Kalafong Provincial Tertiary Hospital Antiretroviral Clinic

2019 ◽  
Vol 25 ◽  
Author(s):  
Brett Van Coppenhagen ◽  
Helene S. Duvenage
Keyword(s):  
Rating Scale ◽  
Depressive Symptomatology ◽  
Depression Scale ◽  
Hiv And Aids ◽  
Cd4 Count ◽  
Definitive Treatment ◽  
People Living With Hiv ◽  
Cross Sectional ◽  
Prevalence Of Depression ◽  
Living With Hiv

Background: Compared to the general population, there is an increased prevalence of depression in people living with HIV and AIDS (PLWHA). The combination of these two common illnesses has profound consequences on the patient and on the healthcare system.Objective: This study determined the prevalence of depressive symptomatology in PLWHA attending the Kalafong Hospital ARV Clinic. The study also established if the patients received definitive treatment for unipolar depression.Methods: A cross-sectional, descriptive study was carried out on 622 adult patients, aged 18 years or older. A brief rating scale for depression, the Centre for Epidemiological Study Depression Scale (CES-D) was administered to participants. The CES-D is a 20-item self-rating scale that assesses current levels of depression as per DSM-IV criteria. The traditional score of 16 and above was used to define a case of depression.Results: The prevalence of depression according to CES-D scale was 53.8%. The study found that none of the 622 patients ever received definitive treatment for depression. A lower CD4 count is associated with more depressive symptomatology, most significantly in patients with a CD4 count of 50 or less.Conclusions: Depressive symptomatology was highly prevalent in the study patients. Despite the high prevalence, none of the study sample patients were treated for clinical depression. The findings reflect the importance of evaluating for depression in PLWHA, especially in high-risk groups such as patients presenting for their initiation visit or patients with a CD4 count of 50 or less. Depression remains under-recognised and under-treated in PLWHA.

Sign in / Sign up

Export Citation Format

Share Document