Functional impairment in bipolar II disorder: Is it as disabling as bipolar I?

It is well established that patients with bipolar disorder experience functional impairment even in remission. Nevertheless, bipolar II disorder remains understudied because most investigations to date include only bipolar I patients or just a small sample of bipolar II patients, without explicitly comparing both subtypes of disorder. The main objective of the current report is to evaluate overall and multiple domains of functioning, specifically in bipolar II disorder compared to patients with bipolar I disorder and healthy subjects.233 subjects from 3 groups were compared: bipolar I patients (n=106), bipolar II patients (n=66) and healthy controls (n=61). Bipolar patients meeting criteria…

Sensitivity and specificity of the mood disorder questionnaire and the bipolar spectrum diagnostic scale in Argentinean patients with mood disorders

Abstract Objective To assess the sensitivity and specificity of two self-report instruments for detection of bipolarity in a sample of Argentinean patients. Method Spanish versions of the MDQ and the BSDS were administered over four months at 11 sites in Argentina. Diagnoses were made using DSM-IV criteria and the MINI. The study sample consisted of patients diagnosed with Bipolar Disorder (BD) Types I, II, or NOS. BDNOS diagnoses were made using extended guidelines for bipolar spectrum symptoms. Unipolar patients were used as a control group. Of 493 patients screened, 354 completed evaluation by MDQ and MINI, and 363 by BSDS and MINI. Results Specificity of MDQ was 0.97 and BSDS was 0.81. …

Affective temperaments in general population: A review and combined analysis from national studies

Abstract Background The aim of this study was to investigate the characteristics of affective temperaments in general non-clinical population in different countries Method We performed a detailed search of published studies (one unpublished) investigating affective temperaments in non-clinical populations by administering the Temperament Evaluation of Memphis, Paris and San Diego Auto-questionnaire (TEMPS-A) in its 110-items version. We have included a total of six studies published from different countries (Argentina, Germany, Hungary, Korea, Lebanon, and Portugal) and one unpublished with preliminary data from Spain. We analyzed the combined data from the collected studies. Results We fou…

Validation of the TEMPS-A Buenos Aires: Spanish psychometric validation of affective temperaments in a population study of Argentina.

Abstract Background The TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris and San Diego) is a 110-item questionnaire in five scales which has been translated into over 25 language versions: American, Italian (only for Interview version or TEMPS-I), French, Lebanese, Hungarian, Japanese and Turkish versions have already been validated. There are two Spanish versions, one from Barcelona, and the present one from Buenos Aires. This study represents the first attempt at validating the TEMPS-A in Spanish. Methods 932 clinically well subjects were studied, of both sexes (62% female) with mean ± SD age of 35.4 ± 18.1. Standard psychometric tests of reliability and validation were performed. …

Depression: Point-prevalence and sociodemographic correlates in a Buenos Aires community sample

Abstract Background Since the current epidemiology of depression is not well documented in Latin America, we conducted a community-based survey study in Argentina. Methods The Beck Depression Inventory (BDI) and a general health questionnaire were completed by 1335 adult participants, representing most of the neighborhoods of Buenos Aires. Results Prevalence of high total BDI scores (≥ 13) indicating probable current clinically significant depression was 20.0% (women: 20.6%; men: 19.6%). Probable depression was associated with being unmarried and older, less educated, reporting recent stressors and significant medical illness. Limitations Sampling was cross-sectional and by convenience; pro…

Clinical risk factors for bipolar disorders: A systematic review of prospective studies

Background: Early phases and suspected precursor states of bipolar disorder are not well characterized. We evaluate the prevalence, duration, clinical features and predictive value of non-affective psychopathology as clinical risk factors for bipolar disorder in prospective studies. Methods: We screened PubMed, CINAHL, PsycINFO, Embase, SCOPUS, and ISI-Web of Science databases from inception up to January 31, 2014, following PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and searched: bipolar disorder AND [antecedentn OR predictn OR prodromn OR prospectn OR riskn] AND [diagnosis OR development]. We included only English language reports on prospective…

Perfiles Fenomenológicos de Evocación Autobiográfi ca en Individuos con Depresión

The potential use of biomarkers as an adjunctive tool for staging bipolar disorder

Recent data show that biomarkers differ in early and late-stage bipolar disorder (BD). Here we propose a model of staging for bipolar disorder that emphasizes the potential use of biomarkers for differentiating early and late-stage BD patients in the inter-episodic period. The proposed model includes a Latent phase: patients at "ultra-high-risk" for developing BD, characterized by a family history of BD, temperament traits, mood, and anxiety symptoms as well as genetic vulnerability for developing the disorder; Stage I: patients who return to their baseline level of functioning when mood episodes resolve; Stage II: biomarkers and functioning impairment are related to comorbidities or rapid-…

Screening for bipolar disorders in Spanish-speaking populations: sensitivity and specificity of the Bipolar Spectrum Diagnostic Scale-Spanish Version.

Background: Bipolar disorder is commonly misdiagnosed, perhaps more so in Latin American and Spanish-speaking populations than in the United States. The Bipolar Spectrum Diagnostic Scale (BSDS) is a 19-item screening instrument designed to assist in screening for all types of bipolar disorder. Methods: The authors investigated the sensitivity of a Spanish-language version of the BSDS in a cohort of 65 outpatients with a diagnosis of bipolar disorder, based on a semi-structured interview and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria. To determine specificity, we assessed a control group of 36 outpatients with diagnosis of unipolar major dep…

Precursors of bipolar disorders: A systematic literature review of prospective studies

Objective To evaluate the presence of affective signs and symptoms as precursors of bipolar disorder in prospective studies, including assessment of their prevalence, duration, and predictive value. Data sources We followed PRISMA guidelines to search PubMed, CINAHL, PsycINFO, EMBASE, SCOPUS, and ISI Web of Science databases to May 31, 2013, using the terms bipolar disorder AND (antecedent* OR predict* OR prodrom* OR prospect*) AND (diagnosis OR development). Hand searching of identified reports led to additional relevant references. Study selection We included only English-language articles containing (1) prospective, longitudinal studies with at least 2 structured clinical assessments (in…

ISAD Regional Meeting 2005. The bipolar spectrum: How far are we going?

Antidepressant-associated mood-switching and transition from unipolar major depression to bipolar disorder: A review

Compare reported rates of mood-shifts from major depression to mania/hypomania/mixed-states during antidepressant (AD)-treatment and rates of diagnostic change from major depressive disorder (MDD) to bipolar disorder (BPD).Searching computerized literature databases, followed by summary analyses.In 51 reports of patients diagnosed with MDD and treated with an AD, the overall risk of mood-switching was 8.18% (7837/95,786) within 2.39 ± 2.99 years of treatment, or 3.42 (95% CI: 3.34-3.50) %/year. Risk was 2.6 (CI: 2.5-2.8) times greater with/without AD-treatment by meta-analysis of 10 controlled trials. Risk increased with time up to 24 months of treatment, with no secular change (1968-2012).…

Characterization of patients with mood disorders for their prevalent temperament and level of hopelessness.

Abstract Background Mood disorders (MD) are disabling conditions throughout the world associated with significant psychosocial impairment. Affective temperaments, as well as hopelessness, may play a significant role in the pathophysiology of MD. The present study was designed to characterize patients with MD for their prevalent affective temperament and level of hopelessness. Methods Five hundred fifty-nine (253 men and 306 women) consecutive adult inpatients were assessed using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire version (TEMPS-A), the Gotland Scale for Male Depression (GSMD), the Beck Hopelessness Scale (BHS) and the Mini International Neurop…

Antecedents of manic versus other first psychotic episodes in 263 bipolar I disorder patients.

Objective As initial episode type can predict later morbidity in bipolar disorder, we tested the hypothesis that clinical antecedents might predict initial episode types. Method We studied 263 first-episode, adult, DSM-IV-TR type I bipolar disorder (BD-I) subjects within the McLean-Harvard-International First-Episode Project. Based on blinded assessments of antecedents from SCID examinations and clinical records, we compared first lifetime manic vs. other (mixed, depressive, or non-affective) major psychotic episodes. Results We identified 32 antecedents arising at early, intermediate or later times, starting 12.3 ± 10.7 years prior to first lifetime major psychotic episodes. Based on multi…

International Society for Affective Disorders

Predominant polarity and temperament in bipolar and unipolar affective disorders.

Abstract Introduction Recently, the concept of predominant polarity (two-thirds of episodes belonging to a single pole of the illness) has been introduced to further characterise subtypes of bipolar disorders. This concept has been proven to have diagnostic and therapeutic implications, but little is known on the underlying psychopathology and temperaments. With this study, we aimed to further validate the concept and explore its relationships with temperament. Methods This study enrolled 143 patients with bipolar or unipolar disorder. We analysed predominant polarity in the sample of bipolar I patients (N = 124), focussing on those who showed a clear predominance for one or the other polar…

Teoría de la mente y funcionalidad en pacientes bipolares en remisión sintomática

Resumen Introduccion Los deficits en la funcionalidad son comunes durante la remision en el trastorno bipolar (TB). Adicionalmente, existe evidencia de alteraciones en la cognicion social en remision clinica. Estos deficits podrian contribuir a la disfuncion observada en estos pacientes. Material y metodos Doce pacientes bipolares en remision sintomatica (7 bipolares tipo i y 5 de tipo ii ) y 12 individuos controles sin patologia psiquiatrica completaron el Test de las Miradas y el Test de Faux Pas para evaluar teoria de la mente (ToM), y el Test Breve para la Evaluacion de la Funcionalidad (FAST). Resultados El desempeno de los pacientes bipolares en el aspecto cognitivo de la ToM se ubico…

Perfi les Fenomenológicos de Evocación Autobiográfica en Individuos con Depresión

Autobiographical memories are deeply linked with emotional regulation processes and self-concept. Conversely, in case of affective disorders, the access to specific phenomenological components would be impaired. Intentional non-probabilistic sampling was carried out, involving 94 individuals with major depression and 188 healthy individuals in the city of Buenos Aires, Argentina. The phenomenological components of significant autobiographical recollections were contrasted, considering their quantity and intensity. In addition, the depressive individuals' performances were compared according to the presence or absence of previous depressive episodes, psychopharmacological treatment and sever…

Pharmacotherapy in bipolar disorders during hospitalization and at discharge predicts clinical and psychosocial functioning at follow-up

Objective Individuals with bipolar disorder (BD) usually report significant disability and psychosocial impairment. Both the nature and causes associated with this impairment are poorly understood. In particular, research examining the impact of pharmacotherapy on the different aspects of psychosocial functioning in bipolar patients is currently lacking. The aim of this study was to assess to what extent the psychotropic medications used during psychiatric hospitalization and at discharge can predict clinical psychosocial functioning and the severity of the illness at follow-up in inpatients with bipolar disorder (BD). Methods Patients were 71 adult BD patients contacted on average 31 month…

The impact of psychopharmacology on contemporary clinical psychiatry.

Clinical psychiatric evaluations of patients have changed dramatically in recent decades. Both initial assessments and follow-up visits have become brief and superficial, focused on searching for categorical diagnostic criteria from checklists, with limited inquiry into patient-reported symptomatic status and tolerability of treatments. The virtually exclusive therapeutic task has become selecting a plausible psychotropic, usually based on expert consensus guidelines. These guidelines and practice patterns rest mainly on published monotherapy trials that may or may not be applicable to particular patients but are having a profound impact, not only on modern psychiatric practice but also on…

Staging systems in bipolar disorder: an International Society for Bipolar Disorders Task Force Report

Objective: We discuss the rationale behind staging systems described specifically for bipolar disorders. Current applications, future directions and research gaps in clinical staging models for bipolar disorders are outlined. Method: We reviewed the literature pertaining to bipolar disorders, focusing on the first episode onwards. We systematically searched data on staging models for bipolar disorders and allied studies that could inform the concept of staging. Results: We report on several dimensions that are relevant to staging concepts in bipolar disorder. We consider whether staging offers a refinement to current diagnoses by reviewing clinical studies of treatment and functioning and t…

Recurrence rates in bipolar disorder: Systematic comparison of long-term prospective, naturalistic studies versus randomized controlled trials

Bipolar disorder (BD) is a recurrent, lifelong illness with high risks of disability and excess mortality. Despite many treatment options with demonstrated short-term efficacy, evidence concerning long-term treatment effectiveness in BD remains limited and the relative value of naturalistic studies versus randomized, controlled trials (RCTs) in its assessment, uncertain. Systematic computer-searching yielded 10 naturalistic studies and 15 RCTs suitable for analysis of recurrence rates and their association with treatments and selected clinical factors. In naturalistic studies (3904 BD subjects, 53.3% women, 85.8% BD-I, mean onset age 29.1, followed up to 2.1 years), the pooled recurrence ra…

Affective temperaments in tango dancers.

Background: Links between affective temperaments and folk culture have been infrequently explored systematically. Creativity and personality and temperament studies, conversely, have reported several associations. Tango is one of the most typical Argentinean folk dance-musical repertoires. The main purpose of this study is to compare affective temperaments between Argentinean professional tango dancers and the general population. Methods: TEMPS-A was administered to a sample of 63 professional tango dancers and 63 comparison subjects from the general population who did not practice tango. Subscale median scores and total median scores with non-parametric statistics were analyzed. Results: M…

Mania associated with antidepressant treatment: comprehensive meta-analytic review

Tondo L, Vazquez G, Baldessarini RJ. Mania associated with antidepressant treatment: comprehensive meta-analytic review. Objective:  To review available data pertaining to risk of mania–hypomania among bipolar (BPD) and major depressive disorder (MDD) patients with vs. without exposure to antidepressant drugs (ADs) and consider effects of mood stabilizers. Method:  Computerized searching yielded 73 reports (109 trials, 114 521 adult patients); 35 were suitable for random effects meta-analysis, and multivariate-regression modeling included all available trials to test for effects of trial design, AD type, and mood-stabilizer use. Results:  The overall risk of mania with/without ADs averaged …

Hyperthymic temperament may protect against suicidal ideation.

Abstract Background The aim of this study was to investigate the role of hyperthymic temperament in suicidal ideation between a sample of patients with affective disorders (unipolar and bipolar). Method We investigated affective disorders outpatients (unipolar, bipolar I, II and NOS) treated in eleven participating centres during at least a six-month period. DSM-IV diagnosis was made by psychiatrists experienced in mood disorders, using the corresponding modules of the Mini International Neuropsychiatric Interview (MINI). In addition, bipolar NOS diagnoses were extended by guidelines for bipolar spectrum symptoms as proposed by Akiskal and Pinto in 1999. Thereby we also identified NOS III (…

Teoría de la mente y funcionalidad en pacientes bipolares en remisión sintomática

Introducción: Los déficits en la funcionalidad son comunes durante la remisión en el trastorno bipolar (TB). Adicionalmente, existe evidencia de alteraciones en la cognición social en remisión clínica. Estos déficits podrían contribuir a la disfunción observada en estos pacientes. Material y métodos: Doce pacientes bipolares en remisión sintomática (7 bipolares tipo i y 5 de tipo ii) y 12 individuos controles sin patología psiquiátrica completaron el Test de las Miradas y el Test de Faux Pas para evaluar teoría de la mente (ToM), y el Test Breve para la Evaluación de la Funcionalidad (FAST). Resultados: El desempeño de los pacientes bipolares en el aspecto cognitivo de la ToM se ubicó por d…

From putative genes to temperament and culture: Cultural characteristics of the distribution of dominant affective temperaments in national studies

Abstract Background Affective temperaments may carry distinct evolutionary advantages both on the individual or a group level, so we can expect that in different cultural and national samples the frequency of dominant affective temperaments will show characteristic differences. The aim of the present study was to investigate the characteristics of distribution of dominant affective temperaments in different national studies of general non-clinical population. Method In our study we included six studies published in different countries around the world (Argentina, Germany, Hungary, Korea, Portugal, and Lebanon) which investigated a large sample of non-clinical population using TEMPS-A, and r…

Assessment and management of agitation in psychiatry: Expert consensus

International audience; BACKGROUND:Psychomotor agitation is associated with different psychiatric conditions and represents an important issue in psychiatry. Current recommendations on agitation in psychiatry are not univocal. Actually, an improper assessment and management may result in unnecessary coercive or sedative treatments. A thorough and balanced review plus an expert consensus can guide assessment and treatment decisions.METHODS:An expert task force iteratively developed consensus using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new, re-worded or re-rated items.RESULTS:Out of 2175 papers assessing psychomo…

¿La esquizofrenia empieza en la adolescencia?

La esquizofrenia es una grave enfermedad mental que se encuentra asociada a una importante morbilidad, a diferencia de otras enfermedades, los síntomas esquizofrénicos en general no se presentan por décadas. En la mayoría de los pacientes, el inicio manifiesto de la enfermedad está precedido por los síntomas prodrómicos, que incluyen síntomas positivos, negativos, afectivos y aislamiento social. Existen diversas teorías sobre la etiopatogenia de la esquizofrenia, algunas de ellas basadas en factores genéticos, ambientales (por ejemplo, stress), disfunciones moleculares y alteraciones en el desarrollo y en la migración neuronal. Una interesante hipótesis sostiene la influencia de…

International Consensus Group on Depression Prevention in Bipolar Disorder

The conference was chaired by Mark A. Frye, MD, Department of Psychiatry, The Mayo Clinic, Rochester, Minnesota, United States. The faculty were Kyooseob Ha, MD, PhD, Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, and the Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Republic of Korea; Shigenobu Kanba, MD, PhD, Department of Neuropsychiatry, University of Kyushu, Fukuoka-shi, Fukuoka, Japan; Tadafumi Kato, MD, PhD, Laboratory for Molecular Dynamics of Mental Disorders, RIKEN Brain Science Institute, Hirosawa, Wako, Saitama, Japan; Susan L. McElroy, MD, Department of Psychiatry and Behavioral Sciences, …

Affective Temperaments and Mood Disorders: A Review of Current Knowledge

Bipolar disorders and affective temperaments: a national family study testing the "endophenotype" and "subaffective" theses using the TEMPS-A Buenos Aires.

The purpose of this study is to examine the prevalence of affective temperaments between clinically unaffected relatives of bipolar patients and secondarily to investigate the impact of these "subaffective" forms on their quality of life (QoL).The study was performed in seven sites across Argentina. We administered the scales TEMPS-A and Quality of Life Index to a sample of 114 non-ill first degree relatives of bipolar disorder patients ("cases") and 115 comparison subjects without family history of affective illness ("controls"). We used The Mood Disorder Questionnaire to rule out clinical bipolarity.Mean scores on all TEMPS-A subscales were significantly higher in cases, except for hypert…

Association between affective temperaments and season of birth in a general student population.

Abstract Background Several studies indicate a significant association between birth season and personality and neuropsychiatric disorders. The aim of our present study was to investigate the association between affective temperaments and season of birth in a nonclinical sample. Methods 366 university students completed the standardized Hungarian version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Auto-questionnaire (TEMPS-A). Ordinary Least Squares regression was applied to explain the relationship between TEMPS-A subscale and birth season of the respondents. Results We found a significant association between temperament scores and birth season in the case of the Hy…

Clinical responses to antidepressants among 1036 acutely depressed patients with bipolar or unipolar major affective disorders.

Whether responses to antidepressants differ in bipolar and unipolar depression remains unresolved.We analyzed patient characteristics and outcomes of antidepressant treatment of 1036 depressed patients with bipolar-I or bipolar-II disorder, or unipolar major depression, using bivariate and multivariate methods and survival analysis, testing the hypothesis that responses would be superior in unipolar depression.Antidepressants were given to 84.8% (878/1036) of depressed patients: 58.9% of 93 bipolar-I, 80.1% of 117 bipolar-II, and 91.3% of 668 unipolar disorder cases. The 158 not given antidepressants had more manias/year, spent more months in mania and depression, and were far more likely t…

Characteristics of bipolar disorder patients given antidepressants

Evidence concerning efficacy of antidepressants in bipolar disorder remains inconsistent and inconclusive. As the appropriate clinical use for such patients remains unclear, we characterized outpatients with bipolar disorders who were or were not treated with antidepressants. Clinical data were collected systematically from consecutive outpatients in 11 participating Argentine mood-disorder clinics in 2007–2008. Diagnoses met DSM-IV criteria, supported by structured interviews based on the MINI-500. Of 338 outpatients diagnosed with bipolar I (45.0%), II (29.3%), or not-otherwise-specified (NOS) (25.7%) disorder, 128 (37.9%) received antidepressants. Subjects given antidepressants or not di…

Predictors of functional outcome after a manic episode.

Abstract Background The identification of functional outcome predictors after acute episodes of bipolar disorders (BD) may allow designing appropriate treatment aiming at restoring psychosocial functioning. Our objective was to identify the best functional outcome predictors at a 6-month follow-up after an index manic episode. Methods We conducted a naturalistic trial (MANACOR) focusing on the global burden of BD, with special emphasis on manic episode-associated costs. We observed patients with BD seen in services of four hospitals in Catalonia (Spain).The total sample included 169 patients with chronic DSM-IV-TR BD I suffering from an acute manic episode who were followed-up for 6 months.…

Temperamentos afectivos y edad de inicio en pacientes bipolares tipo II

Actualmente es imperante contar con indicadores que posibiliten realizar una detección temprana y correcta del trastorno bipolar en general, y del tipo II, en particular. Los temperamentos afectivos constituyen estilos de reactividad emocional temporalmente estables a lo largo del ciclo vital, con una importante base biológica. Dada la escasez de investigaciones al respecto, se exploraron posibles asociaciones entre la edad de inicio de 32 pacientes eutímicos con diagnóstico de trastorno bipolar tipo II y los temperamentos afectivos ciclotímico, depresivo, irritable, ansioso e hipertímico. Los participantes presentaron una edad media de 51,5 años (rango intercuartil 8) y el 65,6% de la mues…

Level of response and safety of pharmacological monotherapy in the treatment of acute bipolar I disorder phases: a systematic review and meta-analysis.

In recent years, combinations of pharmacological treatments have become common for the treatment of bipolar disorder type I (BP I); however, this practice is usually not evidence-based and rarely considers monotherapy drug regimen (MDR) as an option in the treatment of acute phases of BP I. Therefore, we evaluated comparative data of commonly prescribed MDRs for both manic and depressive phases of BP I. Medline, PsycINFO, EMBASE, the Cochrane Library, the ClinicalStudyResults.org and other data sources were searched from 1949 to March 2009 for placebo and active controlled randomized clinical trials (RCTs). Risk ratios (RRs) for response, remission, and discontinuation rates due to adverse …