Journal Mobile Options
Table of Contents
Vol. 41, No. 1, 2008
Issue release date: November 2007
Psychopathology 2008;41:39–42
(DOI:10.1159/000109954)

Continuous Distribution of Atypical Depressive Symptoms between Major Depressive and Bipolar II Disorders: Dose-Response Relationship with Bipolar Family History

Akiskal H.S. · Benazzi F.
aInternational Mood Center, University of California at San Diego, San Diego, USA; bHecker Psychiatry Research Center at Forli, and cDepartment of Psychiatry, National Health Service, Forli, Italy; dDepartment of Psychiatry, University of Szeged, Szeged, Hungary

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Background: Despite the categorical position of formal diagnostic approaches (i.e. ICD-10 and DSM-IV) to mood disorders, atypical depression (AD) occupies an ambiguous position between major depressive (MDD) and bipolar II (BP-II) disorders. Methods: Three hundred and eighty-nine and 261 consecutive BP-II and MDD patients, respectively, presenting for treatment of depression in an Italian private practice, were interviewed by a mood specialist psychiatrist using the Structured Clinical Interview for DSM-IV Axis I Disorders – Clinician Version as modified by the authors to improve the probing for hypomania. Familial bipolarity was measured by the Family History Screen. AD was defined, according to DSM-IV, as a major depressive episode with the ‘atypical features’ specifier. Results: BP-II, versus MDD, had the usual distinguishing features (i.e. earlier age at onset, higher rate of depressive recurrences, AD symptoms, and bipolar family history). Such categorical distinction notwithstanding, the distribution of the number of AD symptoms between BP-II and MDD depressions, studied by Kernel estimate, was continuous, showing no bimodality. Furthermore, there was a dose-response relationship between such symptoms and bipolar family history. Conclusions: The continuous distribution of a distinct clinical feature (i.e. atypical symptoms) between BP-II and MDD supports a dimensional view of depressive disorders. Our data could also be interpreted as providing further support for the subclassification of AD within the bipolar spectrum.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4, text revision (DSM-IV-TR). Washington, American Psychiatric Association, 2000.
  2. World Health Organization: The ICD-10 Classification of Mental and Behavioural Disorders. Geneva, World Health Organization, 1992.
  3. Akiskal HS, Djenderedjian AM, Rosenthal RH, Khani MK: Cyclothymic disorder: validating criteria for inclusion in the bipolar affective group. Am J Psychiatry 1977;134:1227–1233.
  4. Akiskal HS: The prevalent clinical spectrum of bipolar disorders: beyond DSM-IV. J Clin Psychopharmacol 1996;16(suppl 1):4s–14s.

    External Resources

  5. Judd LL, Akiskal HS: Delineating the longitudinal structure of depressive illness: beyond clinical subtypes and duration thresholds. Pharmacopsychiatry 2000;33:3–7.
  6. Ghaemi SN, Ko JY, Goodwin FK: ‘Cade’s disease’ and beyond: misdiagnosis, antidepressant use, and a proposed definition for bipolar spectrum disorder. Can J Psychiatry 2002;47:125–134.
  7. Akiskal HS: Validating ‘hard’ and ‘soft’ phenotypes within the bipolar spectrum: continuity or discontinuity? J Affect Disord 2003;73:1–5.
  8. Angst J, Gamma A, Benazzi F, Ajdacic V, Eich D, Rossler W: Toward a re-definition of subthreshold bipolarity: epidemiology and proposed criteria for bipolar-II, minor bipolar disorders and hypomania. J Affect Disord 2003;73:133–146.
  9. Cassano GB, Rucci P, Frank E, Fagiolini A, Dell’Osso L, Shear MK, Kupfer DJ: The mood spectrum in unipolar and bipolar disorder: arguments for a unitary approach. Am J Psychiatry 2004;161:1264–1269.
  10. Smith DJ, Harrison N, Muir W, Blackwood DHR: The high prevalence of bipolar spectrum disorders in young adults with recurrent depression: toward an innovative diagnostic framework. J Affect Disord 2005;84:167–178.
  11. Rybakowski JK, Suwalska A, Lojko D, Rymaszewska J, Kiejna A: Bipolar mood disorders among Polish psychiatric outpatients treated for major depression. J Affect Disord 2005;84:141–147.
  12. Benazzi F: Family history validation of a definition of mixed depression. Compr Psychiatry 2005;46:159–166.
  13. Akiskal HS, Benazzi F: The DSM-IV and ICD-10 categories of recurrent (major) depressive and bipolar II disorders: evidence that they lie on a dimensional spectrum. J Affect Disord 2006;92:45:54.
  14. Kendell R, Jablensky A: Distinguishing between the validity and utility of psychiatric diagnoses. Am J Psychiatry 2003;160:4–12.
  15. Akiskal HS, Benazzi F: Atypical depression: a variant of bipolar II or a bridge between unipolar and bipolar II? J Affect Disord 2005;84:209–217.
  16. First MB, Spitzer RL, Gibbon M, Williams JBW: Structured Clinical Interview for DSM-IV Axis I Disorders – Clinician Version (SCID-CV). Washington, American Psychiatric Press, 1997.
  17. Akiskal HS, Benazzi F: Optimizing the detection of bipolar II disorder in outpatient private practice: toward a systematization of clinical diagnostic wisdom. J Clin Psychiatry 2005;66:914–921.
  18. Weissman MM, Wickramaratne P, Adams P, Wolk S, Verdeli H, Olfson M: Brief screening for family psychiatric history. The family history screen. Arch Gen Psychiatry 2000;57:675–682.
  19. Benazzi F: Bipolar II disorder and major depressive disorder: continuity or discontinuity? World J Biol Psychiatry 2003;4:166–171.
  20. Salgado-Ugarte IH, Shimizu M, Taniuchi T: Exploring the shape of univariate data using Kernel density estimators. STATA Tech Bull 1994;16:8–19.
  21. Benazzi F: Does age at onset support a dimensional relationship between bipolar II disorder and major depressive disorder? World J Biol Psychiatry, in press.
  22. Benazzi F: Mood patterns and classification in bipolar disorder. Curr Opin Psychiatry 2006;19:1–8.
  23. Benazzi F: Is there a continuity between bipolar and depressive disorders? Psychother Psychosom, in press.
  24. Gershon ES, Hamovit J, Guroff JJ, Dibble E, Leckman JF, Sceery W, Targum SD, Nurnberger JI Jr, Goldin LR, Bunney WE Jr: A family study of schizoaffective, bipolar I, bipolar II, unipolar, and normal control probands. Arch Gen Psychiatry 1982;39:1157–67.
  25. Craddock N, Forty L: Genetics of affective (mood) disorders. Eur J Hum Genet 2006;14:660–668.
  26. Benazzi F, Akiskal HS: Delineating bipolar II mixed states in the Ravenna-San Diego collaborative study: the relative prevalence and diagnostic significance of hypomanic features during major depressive episodes. J Affect Disord 2001;67:115–122.


Pay-per-View Options
Direct payment This item at the regular price: USD 33.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 23.00