mixed features
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2021 ◽  
Vol 17 (1) ◽  
pp. 331-341
Author(s):  
Ludovico Mineo ◽  
Alessandro Rodolico ◽  
Carmen Concerto ◽  
Antimo Natale ◽  
Manuela Pennisi ◽  
...  

Background: The Diagnostic and Statistical Manual for Mental Disorders (5th edition) introduced the specifier “with Mixed Features” to the diagnosis of Major Depressive Episode to designate the presence of (hypo) manic symptoms as part of the clinical presentation. This change has led to renewed attention on the operational definition, diagnosis, and treatment of Mixed Depression. Objective: To investigate the diagnostic and therapeutic approaches towards Mixed Depression among a representative sample of Italian psychiatrists. Methods: Between March and April 2021, 342 psychiatrists working in Italian adult mental health services were invited to participate in an anonymous online survey comprising 32 questions designed to investigate clinical and psychopathological approaches regarding the management of mixed depression in daily psychiatric practice. Results: 83.74% of participants reported having performed a diagnosis of mixed depression in the last five years, with the majority of respondents affirming that they had not used any diagnostic tool. Only 7,5% of the surveyed psychiatrists considered the DSM-5 criteria to be fully adequate in the description of this clinical entity. The most used pharmacological approach was combined therapy, in particular antipsychotics plus mood stabilizers. For monotherapy, the preferred drugs were Valproate and Quetiapine. Regarding the conceptualization of mood disorders, 199 of the participants chose the Kraepelinian unitary spectrum view; meanwhile, 101 expressed their preference for the binary model. Conclusion: Our results suggest a prominent position of mixed depression in the context of mood disorders. Univocal operational criteria and additional research on pharmacological treatment are also needed to ensure the correct recognition and management of mixed depression.


Psychiatry ◽  
2021 ◽  
Vol 19 (4) ◽  
pp. 61-75
Author(s):  
I. A. Lapin ◽  
T. A. Rogacheva ◽  
A. A. Mitrofanov ◽  
S. N. Mosolov

Background: The neuronal correlates of depression with mixed traits (according to DSM-5) at rest have not been studied. Objective: to determine the indicators of imaginary coherence of EEG-rest, which distinguish patients with depression with mixed features (according to DSM-5) from patients with depression without mixed features and healthy subjects, and also to trace the dependence of the identified neurophysiological characteristics on the diagnostic belonging of the symptom complex to bipolar II type or recurrent depressive disorder. Patients and methods: on a background free from drug therapy, 80 patients with depression with mixed features (XD; n = 40 — with bipolar II disorder (XB) and n = 40 — with recurrent depressive disorder (XR)), 80 patients with depression without mixed traits (TD; n = 40 — for bipolar II type (TB) and n = 40 — for recurrent depressive disorder (TR), as well as 80 healthy subjects (N). The study groups were matched by sex and age. The study used clinical-psychopathological, psychometric, neurophysiological and statistical research methods. According to the Kruskal–Wallis criterion for independent samples the parameters of imaginary coherence (modulo) of standard frequency ranges (delta (δ) — 0.5–4 Hz, theta (θ) — 4–8 Hz, alpha (α) — 8–13 Hz, beta-1 (β1) — 13–20 Hz, beta-2 (β2) — 20–30 Hz, gamma (γ) — 30–45 Hz) between pairs of 14 cutaneous standard EEG derivations (according to the “10–20” system) in three (XD, TD and N), and then in five (XB, XR, TB, TR and N) comparison groups. Post-hoc analysis was performed using the U-test. The significance level was adjusted according to the Bonferroni correction. Results: three indicators were identified: α-ICoh(C3–P4), β1-ICoh(C3–P3) and β2-ICoh(F3–C4). For all three parameters, the H-test values for the “Group” factor (n = 3 and n = 5) were highly significant. In this case, α-ICoh(C3– P4) — XD = TD, XD < N, TD < N; β1-ICoh(C3–P3) — XD < TD, XD < N; TD < N; β2-ICoh(F3–C4) — XD > TD; XD > N, TD > N. The groups of patients with XD within the framework of recurrent depressive and bipolar II disorders significantly differed in terms of β1- ICoh(C3–P3) — XR > XB. At the level of statistical trends, in type II bipolar disorder — XB > TB according to α-ICoh(C3–P4), and in recurrent depressive disorder — XR > TR according to β2-ICoh(F3–C4). Conclusion. Thus, depression with mixed features can be considered in terms of dysfunctional interactions of the left frontal, bilateral central and parietal cortical zones, depending on the diagnostic affiliation of the depressive symptom complex and reflecting violations of automatic and voluntary regulation of affect, cognitive and behavioral changes.


2021 ◽  
Vol 53 ◽  
pp. S305
Author(s):  
R. McIntyre ◽  
S. Durgam ◽  
J. Huo ◽  
S. Mates ◽  
S. Stahl

2021 ◽  
Author(s):  
Ludovico Mineo ◽  
Alessandro Rodolico ◽  
Giorgio Alfredo Spedicato ◽  
Andrea Aguglia ◽  
Simone Bolognesi ◽  
...  
Keyword(s):  
Dsm 5 ◽  

2021 ◽  
Vol 12 ◽  
Author(s):  
Borjanka Batinic ◽  
Ivan Ristic ◽  
Milica Zugic ◽  
David S. Baldwin

Cariprazine is currently approved for the treatment of patients with schizophrenia (USA and EU), and for manic, depressive, and episodes with mixed features in bipolar I disorder (USA): several randomized controlled studies have also explored its efficacy in patients with major depressive disorder. This review summarizes its current therapeutic uses and potential advantages for treating the main symptoms of schizophrenia, bipolar I and major depressive disorder, considering its pharmacodynamic properties, efficacy, and tolerability. Its predominantly D3 receptor preferring affinity, with functional selectivity according to the prevailing neuronal environment, contributes to its efficacy across a wide array of psychopathological symptoms (including reality distortion, disorganized thought, negative symptoms, mood disturbance, anhedonia, and cognitive impairment), and to a favorable side effect profile. Cariprazine may be a “drug of choice” in patients with predominant negative and cognitive symptoms of schizophrenia, as well as those with metabolic syndrome. Further investigation of its relative efficacy when compared to aripiprazole or other active comparators is warranted. Its effectiveness in the treatment of bipolar mania, bipolar I depression and bipolar I episodes with mixed features, with minimal accompanying metabolic changes is well-established. The longer half-life and delayed time to relapse in patients diagnosed with schizophrenia when compared to other second-generation antipsychotics represent other advantages, given the high rates of non-adherence and frequent relapses seen in clinical practice. Its efficacy in overlapping symptom domains in other major psychiatric disorders appears promising.


2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Christoph Born ◽  
Heinz Grunze ◽  
Robert M. Post ◽  
Lori L. Altshuler ◽  
Ralph Kupka ◽  
...  

Abstract Background Depending on the classification system used, 5–40% of manic subjects present with concomitant depressive symptoms. This post-hoc analysis evaluates the hypothesis that (hypo)manic subjects have a higher burden of depression than non-(hypo)manic subjects. Methods Data from 806 Bipolar I or II participants of the Stanley Foundation Bipolar Network (SFBN) were analyzed, comprising 17,937 visits. A split data approach was used to separate evaluation and verification in independent samples. For verification of our hypotheses, we compared mean IDS-C scores ratings of non-manic, hypomanic and manic patients. Data were stored on an SQL-server and extracted using standard SQL functions. Linear correlation coefficients and pivotal tables were used to characterize patient groups. Results Mean age of participants was 40 ± 12 years (range 18–81). 460 patients (57.1%) were female and 624 were diagnosed as having bipolar I disorder (77.4%) and 182 with bipolar II (22.6%). Data of 17,937 visits were available for analyses, split into odd and even patient numbers and stratified into three groups by YMRS-scores: not manic < 12, hypomanic < 21, manic < 30. Average IDS-C sum scores in manic or hypomanic states were significantly higher (p < .001) than for non-manic states. (Hypo)manic female patients were likely to show more depressive symptoms than males (p < .001). Similar results were obtained when only the core items of the YMRS or only the number of depressive symptoms were considered. Analyzing the frequency of (hypo)manic mixed states applying a proxy of the DSM-5 mixed features specifier extracted from the IDS-C, we found that almost 50% of the (hypo)manic group visits fulfilled DSM-5 mixed features specifier criteria. Conclusion Subjects with a higher manic symptom load are also significantly more likely to experience a higher number of depressive symptoms. Mania and depression are not opposing poles of bipolarity but complement each other.


Author(s):  
Adithya Chandregowda ◽  
Heather M. Clark

Purpose The purpose of this clinical focus article is to illustrate how speech-language pathologist (SLP) characterization of anarthria can contribute to neurological diagnosis and to highlight the challenges associated with such an endeavor. Method Used in this study are a retrospective chart review and clinicians' experience-based reflections. Results A 65-year-old man, who, in the context of a neurodegenerative disease, presented with near-complete-loss of speech, was referred by neurologists to SLPs for further characterization of his speech difficulty. Assessment of his limited speech output revealed anarthria with mixed features (spastic and hypokinetic) with superimposed apraxia of speech. Conclusions SLP characterization of anarthria to facilitate neurological diagnosis is challenging but possible. Clinical lessons learned from this unusual scenario are discussed.


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.


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