Clinical features and diagnosis

Author(s):  
Raymond W. Lam

• Depression is associated with a number of physical, emotional, and cognitive symptoms.• Sub-typing of major depressive disorder has implications for treatment choice and selection.• The differential diagnosis of depression includes bereavement, bipolar disorder, and other medical or substance-induced conditions.Depression is associated with many different types of symptoms which can result to a variable presentation in any given person. The features of depression can be physical (sleep, energy, appetite, libido), emotional (low mood, anxiety, crying) or cognitive (guilt, pessimism, suicidal thoughts). ...

2011 ◽  
Vol 199 (4) ◽  
pp. 303-309 ◽  
Author(s):  
Philip B. Mitchell ◽  
Andrew Frankland ◽  
Dusan Hadzi-Pavlovic ◽  
Gloria Roberts ◽  
Justine Corry ◽  
...  

BackgroundAlthough genetic epidemiological studies have confirmed increased rates of major depressive disorder among the relatives of people with bipolar affective disorder, no report has compared the clinical characteristics of depression between these two groups.AimsTo compare clinical features of depressive episodes across participants with major depressive disorder and bipolar disorder from within bipolar disorder pedigrees, and assess the utility of a recently proposed probabilistic approach to distinguishing bipolar from unipolar depression. A secondary aim was to identify subgroups within the relatives with major depression potentially indicative of ‘genetic’ and ‘sporadic’ subgroups.MethodPatients with bipolar disorder types 1 and 2 (n = 246) and patients with major depressive disorder from bipolar pedigrees (n = 120) were assessed using the Diagnostic Interview for Genetic Studies. Logistic regression was used to identify distinguishing clinical features and assess the utility of the probabilistic approach. Hierarchical cluster analysis was used to identify subgroups within the major depressive disorder sample.ResultsBipolar depression was characterised by significantly higher rates of psychomotor retardation, difficulty thinking, early morning awakening, morning worsening and psychotic features. Depending on the threshold employed, the probabilistic approach yielded a positive predictive value ranging from 74% to 82%. Two clusters within the major depressive disorder sample were found, one of which demonstrated features characteristic of bipolar depression, suggesting a possible ‘genetic’ subgroup.ConclusionsA number of previously identified clinical differences between unipolar and bipolar depression were confirmed among participants from within bipolar disorder pedigrees. Preliminary validation of the probabilistic approach in differentiating between unipolar and bipolar depression is consistent with dimensional distinctions between the two disorders and offers clinical utility in identifying patients who may warrant further assessment for bipolarity. The major depressive disorder clusters potentially reflect genetic and sporadic subgroups which, if replicated independently, might enable an improved phenotypic definition of underlying bipolarity in genetic analyses.


2021 ◽  
Author(s):  
Hong Wang ◽  
Yan-Xia Xiao ◽  
Jing-Ge Du ◽  
Xia Du ◽  
Lin Chen

Abstract Background: To investigate the clinical phenomenology and clinical features of the new concept of major depressive disorder and bipolar disorder depressive episodes with mixed features.Methods: A total of 357 patients with major depressive disorder or bipolar disorder depressive episodes were assessed, we compared the differences of clinical features with or without mixed features.Results: According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria, the overall prevalence of mixed features was 9.52% (34/357) in major depressive disorder and bipolar disorder depressive episodes; specifically, the prevalence was 6.0% in major depressive disorder and 23.3% in bipolar disorder depressive episodes. Compared with the non-mixed features group, the mixed features group had more single individuals (P=0.002), earlier onset age (P=0.003), more patients with an onset age <25 years (P=0.001), and more previous incidences and prior hospitalizations (P<0.001, P=0.004, respectively), and fewer melancholic features (P=0.013).Logistic regression analysis showed that marital status (OR=0.237) and previous incidence (OR=1.478) was associated with mixed features.Conclusion: It indicates that previous incidence may be a risk factor of in patients with major depressive disorder and bipolar disorder depressive episodes with mixed features, and marital status may be a protective factor.


2013 ◽  
Vol 15 (2) ◽  
pp. 199-205 ◽  
Author(s):  
Yu-Tao Xiang ◽  
Ling Zhang ◽  
Gang Wang ◽  
Chen Hu ◽  
Gabor S Ungvari ◽  
...  

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