scholarly journals Comorbid Premenstrual Dysphoric Disorder and Bipolar Disorder: A Review

2021 ◽  
Vol 12 ◽  
Author(s):  
Anastasiya Slyepchenko ◽  
Luciano Minuzzi ◽  
Benicio N. Frey

Bipolar disorder (BD) differs in its clinical presentation in females compared to males. A number of clinical characteristics have been associated with BD in females: more rapid cycling and mixed features; higher number of depressive episodes; and a higher prevalence of BD type II. There is a strong link between BD and risk for postpartum mood episodes, and a substantial percentage of females with BD experience premenstrual mood worsening of varying degrees of severity. Females with premenstrual dysphoric disorder (PMDD)—the most severe form of premenstrual disturbances—comorbid with BD appear to have a more complex course of illness, including increased psychiatric comorbidities, earlier onset of BD, and greater number of mood episodes. Importantly, there may be a link between puberty and the onset of BD in females with comorbid PMDD and BD, marked by a shortened gap between the onset of BD and menarche. In terms of neurobiology, comorbid BD and PMDD may have unique structural and functional neural correlates. Treatment of BD comorbid with PMDD poses challenges, as the first line treatment of PMDD in the general population is selective serotonin reuptake inhibitors, which produce risk of treatment-emergent manic symptoms. Here, we review current literature concerning the clinical presentation, illness burden, and unique neurobiology of BD comorbid with PMDD. We additionally discuss obstacles faced in symptom tracking, and management of these comorbid disorders.

CNS Spectrums ◽  
2016 ◽  
Vol 22 (2) ◽  
pp. 141-146 ◽  
Author(s):  
Joshua D. Rosenblat ◽  
Roger S. McIntyre

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.


Author(s):  
Licínia Ganança ◽  
David A. Kahn ◽  
Maria A. Oquendo

This chapter discusses the mood disorders. Major depressive disorder is characterized by neurovegetative changes, anhedonia, and suicidal ideation. Persistent depressive disorder is a milder form of depression, lasting for at least 2 years, with little or no remission during that time... Psychotic features can occur in both depressive and manic episodes. Premenstrual dysphoric disorder is diagnosed through use of a prospective daily symptom ratings log showing a cyclical pattern over at least 2 consecutive months. Patients with mood episodes with mixed features have a high risk of suicide. Some patients with bipolar disorder and major depressive disorder may develop catatonic features characterized by marked psychomotor disturbance. Selective serotonin reuptake inhibitors (SSRIs) are the usual first-line medication treatment for patients with major depressive disorder. For patients with bipolar disorder the mainstays of somatic therapy are lithium and the anticonvulsants valproate and carbamazepine.


CNS Spectrums ◽  
2016 ◽  
Vol 22 (2) ◽  
pp. 134-140 ◽  
Author(s):  
Eva Solé ◽  
Marina Garriga ◽  
Marc Valentí ◽  
Eduard Vieta

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.


2010 ◽  
Vol 22 (2) ◽  
pp. 81-86 ◽  
Author(s):  
Cilly Klüger Issler ◽  
Emel Serap Monkul ◽  
José Antonio de Mello Siqueira Amaral ◽  
Renata Sayuri Tamada ◽  
Roseli Gedanke Shavitt ◽  
...  

Issler CK, Monkul ES, Amaral JAMS, Tamada RS, Shavitt RG, Miguel EC, Lafer B. Bipolar disorder and comorbid obsessive-compulsive disorder is associated with higher rates of anxiety and impulse control disorders.Objective:Although bipolar disorder (BD) with comorbid obsessive-compulsive disorder (OCD) is highly prevalent, few controlled studies have assessed this comorbidity. The objective of this study was to investigate the clinical characteristics and expression of comorbid disorders in female BD patients with OCD.Method:We assessed clinically stable female outpatients with BD: 15 with comorbid OCD (BD+OCD group) and 15 without (BD/no-OCD group). All were submitted to the Structured Clinical Interview for DSM-IV, with additional modules for the diagnosis of kleptomania, trichotillomania, pathological gambling, onychophagia and skin picking.Results:The BD+OCD patients presented more chronic episodes, residual symptoms and previous depressive episodes than the BD/no-OCD patients. Of the BD+OCD patients, 86% had a history of treatment-emergent mania, compared with only 40% of the BD/no-OCD patients. The following were more prevalent in the BD+OCD patients than the BD/no-OCD patients: any anxiety disorder other than OCD; impulse control disorders; eating disorders; and tic disorders.Conclusion:Female BD patients with OCD may represent a more severe form of disorder than those without OCD, having more depressive episodes and residual symptoms, and being at a higher risk for treatment-emergent mania, as well as presenting a greater anxiety and impulse control disorder burden.


2009 ◽  
Vol 40 (2) ◽  
pp. 289-299 ◽  
Author(s):  
M. J. A. Tijssen ◽  
J. van Os ◽  
H.-U. Wittchen ◽  
R. Lieb ◽  
K. Beesdo ◽  
...  

BackgroundReported rates of bipolar syndromes are highly variable between studies because of age differences, differences in diagnostic criteria, or restriction of sampling to clinical contacts.MethodIn 1395 adolescents aged 14–17 years, DSM-IV (hypo)manic episodes (manic and hypomanic episodes combined), use of mental health care, and five ordinal subcategories representing the underlying continuous score of (hypo)manic symptoms (‘mania symptom scale’) were measured at baseline and approximately 1.5, 4 and 10 years later using the Munich-Composite International Diagnostic Interview (DIA-X/M-CIDI).ResultsIncidence rates (IRs) of both (hypo)manic episodes and (hypo)manic symptoms (at least one DSM-IV core symptom) were far higher (714/105 person-years and 1720/105 person-years respectively) than traditional estimates. In addition, the risk of developing (hypo)manic episodes was very low after the age of 21 years [hazard ratio (HR) 0.031, 95% confidence interval (CI) 0.0050–0.19], independent of childhood disorders such as attention deficit hyperactivity disorder (ADHD). Most individuals with hypomanic and manic episodes were never in care (87% and 62% respectively) and not presenting co-morbid depressive episodes (69% and 60% respectively). The probability of mental health care increased linearly with the number of symptoms on the mania symptom scale. The incidence of the bipolar categories, in particular at the level of clinical morbidity, was strongly associated with previous childhood disorders and male sex.ConclusionsThis study showed, for the first time, that experiencing (hypo)manic symptoms is a common adolescent phenomenon that infrequently predicts mental health care use. The findings suggest that the onset of bipolar disorder can be elucidated by studying the pathway from non-pathological behavioural expression to dysfunction and need for care.


2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
E. Oral ◽  
E. Ozan ◽  
E. Deveci ◽  
N. Aydın ◽  
I. Kirpinar

Previous studies have suggested that OCD has comorbidity with bipolar disorder (BD) (1,2). We evaluated the three bipolar OCD cases.C1: Because of the OCD symptoms Chlomipramine was started. Her OCD symptoms improved in several days but manic symptoms was apeeared, switched to Lithium Carbonate. In her out patient exams, manic and obsessive compulsive symptoms were almost never observed simultaneously at the course.C2: In 2003, her complaints started as combined OCD and Manic symptoms, Risperidon and Lithium carbonate were started, manic and OCD symptoms improved. In 2005, OCD and Depressive symptoms appeared together. She got improved with Lithium Carbonate and Chlomipramine. She had one episode with obsessive and manic symptoms or obsessive and depressive symptoms every year till now. Her uncle had Depression and her aunt had Bipolar disorder.C3: Because of his OCD symptoms we prescribed SSRI and lower dose antipsychotic. At that time he hospitalized for his manic symptoms, his OCD was partially remitted. His manic symptoms improved with Lithium carbonate1200p/d. He had resistant obsessive compulsive symptoms and episodic manic symptoms. His father had M. Depressive episodes.Conclusion:Our cases suggest that bipolar OCD has episodic course, treatment resistant symtomatology, high family loading and high frequency of recurrence.


2013 ◽  
Vol 43 (12) ◽  
pp. 2583-2592 ◽  
Author(s):  
A. Gershon ◽  
S. L. Johnson ◽  
I. Miller

BackgroundExposure to life stress is known to adversely impact the course of bipolar disorder. Few studies have disentangled the effects of multiple types of stressors on the longitudinal course of bipolar I disorder. This study examines whether severity of chronic stressors and exposure to trauma are prospectively associated with course of illness among bipolar patients.MethodOne hundred and thirty-one participants diagnosed with bipolar I disorder were recruited through treatment centers, support groups and community advertisements. Severity of chronic stressors and exposure to trauma were assessed at study entry with in-person interviews using the Bedford College Life Event and Difficulty Schedule (LEDS). Course of illness was assessed by monthly interviews conducted over the course of 24 months (over 3000 assessments).ResultsTrauma exposure was related to more severe interpersonal chronic stressors. Multiple regression models provided evidence that severity of overall chronic stressors predicted depressive but not manic symptoms, accounting for 7.5% of explained variance.ConclusionsOverall chronic stressors seem to be an important determinant of depressive symptoms within bipolar disorder, highlighting the importance of studying multiple forms of life stress.


2010 ◽  
Vol 41 (8) ◽  
pp. 1593-1604 ◽  
Author(s):  
J. H. Barnett ◽  
J. Huang ◽  
R. H. Perlis ◽  
M. M. Young ◽  
J. F. Rosenbaum ◽  
...  

BackgroundSome personality characteristics have previously been associated with an increased risk for psychiatric disorder. Longitudinal studies are required in order to tease apart temporary (state) and enduring (trait) differences in personality among individuals with bipolar disorder (BD). This study aimed to determine whether there is a characteristic personality profile in BD, and whether associations between BD and personality are best explained by state or trait effects.MethodA total of 2247 participants in the Systematic Treatment Enhancement Program for Bipolar Disorder study completed the NEO Five-Factor Inventory administered at study entry, and at 1 and 2 years.ResultsPersonality in BD was characterized by high neuroticism (N) and openness (O), and low agreeableness (A), conscientiousness (C) and extraversion (E). This profile was replicated in two independent samples, and openness was found to distinguish BD from major depressive disorder. Latent growth modeling demonstrated that manic symptoms were associated with increased E and decreased A, and depressed symptoms with higher N and lower E, A, C and O. During euthymic phases, high N and low E scores predicted a future depression-prone course.ConclusionsWhile there are clear state effects of mood on self-reported personality, personality variables during euthymia predict future course of illness. Personality disturbances in extraversion, neuroticism and openness may be enduring characteristics of patients with BD.


2016 ◽  
Vol 33 (S1) ◽  
pp. S338-S338 ◽  
Author(s):  
B. Dunjic-Kostic ◽  
M. Pantovic Stefanovic ◽  
M. Lackovic ◽  
A. Damjanovic ◽  
A. Jovanovic ◽  
...  

IntroductionOestrogen fluctuations may be an important factor in the etiology of bipolar disorder and age at menarche is associated with the clinical course of BD. Moreover, it is associated with traits related to mood.AimsThe aim of our study was to explore the differences in age at menarche between euthymic BD patients and healthy controls, as well as to explore the relationship between age at menarche and lifetime psychopathology within BD.MethodsThe study group consisted of 83 patients diagnosed with BD, compared to the healthy control group (n = 73) and matched according to age, gender, and body mass index (BMI). Lifetime psychopathology has been assessed according to predominant polarity as well as previous history of suicide attempts and psychotic episodes.ResultsAge at menarche in BD patients was similar to that in controls. After covarying for confounders, we observed that age at menarche is negatively related to number of previous depressive episodes in euthymic BD patients, but not other indicators of lifetime psychopathology.ConclusionsBD patients with earlier age at menarche are more likely to present with more depressive episodes in the course of illness. Systemic, longitudinal monitoring of the course of illness, and potential hormonal fluctuations within particular groups of patients are warranted.Disclosure of interestThe authors have not supplied their declaration of competing interest.


2009 ◽  
Vol 166 (2) ◽  
pp. 173-181 ◽  
Author(s):  
Joseph F. Goldberg ◽  
Roy H. Perlis ◽  
Charles L. Bowden ◽  
Michael E. Thase ◽  
David J. Miklowitz ◽  
...  

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