The relationship between depression with anxious distress DSM-5 specifier and mixed depression: a network analysis

CNS Spectrums ◽  
2020 ◽  
pp. 1-7
Author(s):  
Antonio Tundo ◽  
Laura Musetti ◽  
Claudia Del Grande ◽  
Rocco de Filippis ◽  
Luca Proietti ◽  
...  
Keyword(s):  
Major Depression ◽  
Network Analysis ◽  
Central Position ◽  
Response Characteristics ◽  
Dsm 5 ◽  
Mixed Features ◽  
Depressive Episodes ◽  
The Relationship ◽  
Symptom Criteria ◽  
Inner Tension

Abstract Introduction. Epidemiological, clinical, and treatment response characteristics of major depression with anxious distress (ADS) are quite similar to those of mixed depression, but no study investigated the symptom interplay of these conditions. Objective. To analyze the correlations among symptom criteria for major depression with ADS and for mixed depression using a network analysis. Methods. Two hundred and forty-one outpatients with major depression were consecutively recruited. DSM-5 criteria for major depression with ADS or with mixed features (MF) and Koukopoulos’ criteria for mixed depression (MXD) were assessed using a structured clinical interview. Results. A total of 58.9% of patients met DSM-5 criteria for major depression with ADS, 48.5% for MXD, and 2.5% for major depression with MF, so that the symptoms of this specifier were excluded from the network analysis. The most frequent symptoms were difficulty concentrating due to worries (57.7%), feeling keyed up or on edge (51%) (major depression with ADS), and psychic agitation or inner tension (51%) (MXD). Psychic agitation or inner tension had a central position in the network and bridged MXD to major depression with ADS through feeling keyed up or on edge. Conclusions. Criteria for major depression with ADS and for MXD are partially overlapping, with psychic agitation or inner tension and feeling keyed up or on edge that feature in both conditions and are difficult to distinguish in clinical practice. The clarification of the relationship between these two psychopathological conditions could bring important implications for diagnosis, prognosis, and treatment of depressive episodes.

Treatment of mixed features in bipolar disorder

CNS Spectrums ◽  
2016 ◽  
Vol 22 (2) ◽  
pp. 141-146 ◽  
Author(s):  
Joshua D. Rosenblat ◽  
Roger S. McIntyre
Keyword(s):  
Bipolar Disorder ◽  
Bipolar Depression ◽  
Treatment Resistance ◽  
Course Of Illness ◽  
Stabilizing Agents ◽  
Dsm 5 ◽  
Mixed Features ◽  
Post Hoc ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Mood episodes with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)–defined mixed features are highly prevalent in bipolar disorder (BD), affecting ~40% of patients during the course of illness. Mixed states are associated with poorer clinical outcomes, greater treatment resistance, higher rates of comorbidity, more frequent mood episodes, and increased rates of suicide. The objectives of the current review are to identify, summarize, and synthesize studies assessing the efficacy of treatments specifically for BD I and II mood episodes (ie, including manic, hypomanic, and major depressive episodes) with DSM-5–defined mixed features. Two randomized controlled trials (RCTs) and 6 post-hoc analyses were identified, all of which assessed the efficacy of second-generation antipsychotics (SGAs) for the acute treatment of BD mood episodes with mixed features. Results from these studies provide preliminary support for SGAs as efficacious treatments for both mania with mixed features and bipolar depression with mixed features. However, there are inadequate data to definitively support or refute the clinical use of specific agents. Conventional mood stabilizing agents (eg, lithium and divalproex) have yet to have been adequately studied in DSM-5–defined mixed features. Further study is required to assess the efficacy, safety, and tolerability of treatments specifically for BD mood episodes with mixed features.

Grief

2017 ◽  
pp. 43-54
Author(s):  
Myrna M. Weissman ◽  
John C. Markowitz ◽  
Gerald L. Klerman
Keyword(s):  
Major Depression ◽  
Complicated Grief ◽  
Problem Area ◽  
Emotional Life ◽  
Case Examples ◽  
Adaptive Process ◽  
Dsm 5 ◽  
Grief Reaction ◽  
Complicated Bereavement ◽  
The Relationship

The symptoms of a normal grief reaction typically resolve over the course of a few months as the person processes the loss, thinking through remembered experiences with the deceased. This period of grief or mourning is a normal, useful, adaptive process. In contrast, in complicated grief, the person tries to contain her emotions, distancing herself from emotional life. This postponing and avoidance of grief is characteristic of complicated bereavement, a long-recognized form of major depression. This chapter discusses both normal and complicated grief and how grief is defined by the DSM-5 and how it presents as a problem area in IPT. The two goals of the therapist are to facilitate mourning (catharsis) and to reestablish interests and relationships that can to some degree substitute for the person and the relationship that have been lost. Case examples are included.

Mixed features in major depressive disorder: diagnoses and treatments

CNS Spectrums ◽  
2017 ◽  
Vol 22 (2) ◽  
pp. 155-160 ◽  
Author(s):  
Trisha Suppes ◽  
Michael Ostacher
Keyword(s):  
Major Depression ◽  
Mood Disorders ◽  
Diagnostic System ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Mixed Features ◽  
Depression Disorders ◽  
First Time ◽  
Linear Manner

For the first time in 20 years, the American Psychiatric Association (APA) updated the psychiatric diagnostic system for mood disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Perhaps one of the most notable changes in the DSM-5 was the recognition of the possibility of mixed symptoms in major depression and related disorders (MDD). While MDD and bipolar and related disorders are now represented by 2 distinct chapters, the addition of a mixed features specifier to MDD represents a structural bridge between bipolar and major depression disorders, and formally recognizes the possibility of a mix of hypomania and depressive symptoms in someone who has never experienced discrete episodes of hypomania or mania. This article reviews historical perspectives on “mixed states” and the recent literature, which proposes a range of approaches to understanding “mixity.” We discuss which symptoms were considered for inclusion in the mixed features specifier and which symptoms were excluded. The assumption that mixed symptoms in MDD necessarily predict a future bipolar course in patients with MDD is reviewed. Treatment for patients in a MDD episode with mixed features is critically considered, as are suggestions for future study. Finally, the premise that mood disorders are necessarily a spectrum or a gradient of severity progressing in a linear manner is argued.

scholarly journals Treatment response in major depression: effects of personality dysfunction and prior depression

2010 ◽  
Vol 196 (2) ◽  
pp. 139-142 ◽  
Author(s):  
P. Gorwood ◽  
F. Rouillon ◽  
C. Even ◽  
B. Falissard ◽  
E. Corruble ◽  
...  
Keyword(s):  
Major Depression ◽  
Treatment Response ◽  
Structural Equation ◽  
Antidepressant Treatment ◽  
Poor Response ◽  
Response To Treatment ◽  
Personality Dysfunction ◽  
Depressive Episodes ◽  
The Impact ◽  
The Relationship

BackgroundThe impact of personality dysfunction on the outcome of treatment for depression remains debated.AimsTo examine the relationship between the number of prior depressive episodes, personality dysfunction and treatment response for depression.MethodIn a large sample (n = 8229) of adult out-patients with a major depressive episode (DSM–IV), personality dysfunction was assessed using the Standardised Assessment of Personality – Abbreviated Scale (SAPAS). Potential predictors of treatment response at 6 weeks were examined via structural equation modelling.ResultsThe amount of personality dysfunction and number of prior episodes of depression were both associated with poor response to treatment. Once personality dysfunction was controlled for, the number of prior episodes of depression was not associated with treatment response.ConclusionsPersonality dysfunction is associated with impaired short-term response to antidepressant treatment in major depression. The apparent detrimental effect of prior depression on treatment response may be accounted for by pre-existing personality dysfunction.

Mixed features of depression: why DSM-5 is wrong (and so was DSM-IV)

2013 ◽  
Vol 203 (1) ◽  
pp. 3-5 ◽  
Author(s):  
Athanasios Koukopoulos ◽  
Gabriele Sani ◽  
S. Nassir Ghaemi
Keyword(s):  
Diagnostic Criteria ◽  
Central Position ◽  
Mixed States ◽  
Dsm 5 ◽  
Mixed Features ◽  
Dsm Iv

SummaryThe DSM system has never acknowledged a central position for mixed states; thus, mixed depressions have been almost completely neglected for decades. Now, DSM-5 is proposing diagnostic criteria for depression with mixed features that will lead to more misdiagnosis and inadequate treatment of this syndrome. Different criteria, based on empirically stronger evidence than exists for the DSM-5 criteria, should be adopted.

Clinical presentation of postnatal and non-postnatal depressive episodes

2007 ◽  
Vol 37 (9) ◽  
pp. 1273-1280 ◽  
Author(s):  
CARLY COOPER ◽  
LISA JONES ◽  
EMMA DUNN ◽  
LIZ FORTY ◽  
SAYEED HAQUE ◽  
...  
Keyword(s):  
Major Depression ◽  
Clinical Presentation ◽  
Early Morning ◽  
Recurrent Depression ◽  
Icd 10 ◽  
Dsm Iv ◽  
Relationship Of ◽  
Recurrent Major Depressive Disorder ◽  
Depressive Episodes ◽  
The Relationship

ABSTRACTBackgroundThe relationship of postnatal (postpartum) depression (PND) to episodes of depression occurring at other times is not well understood. Despite a number of studies of clinical presentation, there is little consistency in the literature. We have undertaken within- and between-individual comparisons of the clinical presentation of postnatal (PN) and non-postnatal (NPN) depressive episodes in women with recurrent depression.MethodIn a sample of well-characterized, parous women meeting DSM-IV and ICD-10 criteria for recurrent major depressive disorder, the clinical presentation of episodes of major depression with onset within 4 weeks of giving birth (PND group, n=50) were compared with (i) the non-postnatal episodes of women with PND, and (ii) episodes of major depression in parous women who had not experienced episodes of mood disorder in relation to childbirth (NPND group, n=132). In addition, the non-postnatal episodes of the PND group of women were compared with the depressive episodes of the NPND group.ResultsThe small number of differences found between PN and NPN depressive episodes, such as reduced early morning wakening in postnatal episodes, are likely to be explicable by the context of having a new baby rather than by any difference in the nature of the underlying depression.ConclusionsThe results do not point to substantial differences in clinical presentation between episodes of major depression occurring in relation to childbirth and at other times. Other avenues of research are therefore required to demonstrate a specific relationship between childbirth and depression.

Factors related to suicidal behavior in korean patients with bipolar disorder: The effect of mixed features on suicidality

2016 ◽  
Vol 33 (S1) ◽  
pp. s270-s271
Author(s):  
H.J. Seo ◽  
H.R. Wang ◽  
Y.S. Woo ◽  
H.C. Kim ◽  
W.M. Bahk ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bipolar Disorder ◽  
Suicidal Behavior ◽  
Significant Risk ◽  
Suicidal Behaviors ◽  
Korean Patients ◽  
Dsm 5 ◽  
Mixed Features ◽  
Bipolar Patients ◽  
Depressive Episodes

IntroductionThe aim of the present study was to investigate various risk factors of suicidal behaviors, including the mixed features specifier, in Korean patients with bipolar disorder.MethodsWe retrospectively reviewed medical charts from 2005 to 2014. A total of 334 patients diagnosed with bipolar disorder using the DSM-IV TR were enrolled. Subjects were categorized into two groups according to their history of suicidal behavior and the demographic and clinical characteristics of the groups were compared, including the mixed features specifier. We re-evaluated the index episode using DSM-5 criteria and classified subjects into an index episode with mixed features group and an index episode without mixed features group. Logistic regression was performed to evaluate significant risk factors associated with suicidal behavior.ResultsSuicidal behavior had an independent relationship with mixed features at the index episode using DSM-5 criteria (OR = 3.39; 95% CI: 1.57–7.34) and number of previous depressive episodes (OR = 1.62; 95% CI: 1.34–1.95) in Korean bipolar patients. The mixed feature specifier was the strongest risk factor for suicidal behavior in the present study. Limitations: this was a retrospective study and structured psychiatric interviews were not conducted.ConclusionsThis study may help clinicians understand potential risk factors and manage bipolar disorders with suicidal behaviors. Clinicians should carefully monitor patients with bipolar disorder who exhibit numerous depressive episodes or mixed features for suicidal behavior.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Mixed features in bipolar disorder

CNS Spectrums ◽  
2016 ◽  
Vol 22 (2) ◽  
pp. 134-140 ◽  
Author(s):  
Eva Solé ◽  
Marina Garriga ◽  
Marc Valentí ◽  
Eduard Vieta
Keyword(s):  
Bipolar Disorder ◽  
Diagnostic Category ◽  
Specific Treatment ◽  
Unipolar Depression ◽  
Manic Symptoms ◽  
Dsm 5 ◽  
Increased Risk ◽  
Mixed Features ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Mixed affective states, defined as the coexistence of depressive and manic symptoms, are complex presentations of manic-depressive illness that represent a challenge for clinicians at the levels of diagnosis, classification, and pharmacological treatment. The evidence shows that patients with bipolar disorder who have manic/hypomanic or depressive episodes with mixed features tend to have a more severe form of bipolar disorder along with a worse course of illness and higher rates of comorbid conditions than those with non-mixed presentations. In the updated Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5), the definition of “mixed episode” has been removed, and subthreshold nonoverlapping symptoms of the opposite pole are captured using a “with mixed features” specifier applied to manic, hypomanic, and major depressive episodes. However, the list of symptoms proposed in the DSM–5 specifier has been widely criticized, because it includes typical manic symptoms (such as elevated mood and grandiosity) that are rare among patients with mixed depression, while excluding symptoms (such as irritability, psychomotor agitation, and distractibility) that are frequently reported in these patients. With the new classification, mixed depressive episodes are three times more common in bipolar II compared with unipolar depression, which partly contributes to the increased risk of suicide observed in bipolar depression compared to unipolar depression. Therefore, a specific diagnostic category would imply an increased diagnostic sensitivity, would help to foster early identification of symptoms and ensure specific treatment, as well as play a role in suicide prevention in this population.

The Association between Depression and Gastroesophageal Reflux based on Phylogenetic Analysis of miRNA Biomarkers

2020 ◽  
Vol 27 (38) ◽  
pp. 6536-6547 ◽  
Author(s):  
Yi-Hau Chen ◽  
Hsiuying Wang
Keyword(s):  
Phylogenetic Analysis ◽  
Major Depression ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Research Work ◽  
Epidemiological Evidence ◽  
The Relationship ◽  
Global Population ◽  
Shed Light

A number of clinical studies have revealed that there is an association between major depression (MD) and gastroesophageal reflux disease (GERD). Both the diseases are shown to affect a large proportion of the global population. More advanced studies for understanding the comorbidity mechanism of these two diseases can shed light on developing new therapies of both diseases. To the best of our knowledge, there has not been any research work in the literature investigating the relationship between MD and GERD using their miRNA biomarkers. We adopt a phylogenetic analysis to analyze their miRNA biomarkers. From our analyzed results, the association between these two diseases can be explored through miRNA phylogeny. In addition to evidence from the phylogenetic analysis, we also demonstrate epidemiological evidence for the relationship between MD and GERD based on Taiwan biobank data.

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