Beware of the "high functioning trap" - excessive status expectations in patients with bipolar depression / 四川精神卫生

Maintaining long-term stability of patient's condition is crucial in the treatment for bipolar disorder， while accurately assessing the patient's disease status is important and challenging in maintaining treatment. Excessive status expectation is common in patients with bipolar depression， which would warp the patient's perception of his or her own disease status and， thus， ultimately interfere with clinical decisions. Heightened vigilance should be given to such phenomenon. This paper explores the phenomenon and potential mechanisms of excessive status expectation in patients with bipolar disorder， providing ideas for related diagnosis， treatment and research. ［Funded by Jiangsu Provincial Science and Technology PProject （number， BE2015609）］

A Comparative study of insight in patients of depressive spectrum disorders attending outpatient department of tertiary care centre.

Introduction: Poor insight is a common feature of bipolar depression and unipolar depression with and without psychotic symptoms (PS) which may lead to poor clinical outcome. Studies on insight in these populations are relatively limited and the majority of studies were published over the previous decade. Methods: This was a cross-sectional, observation study conducted in Psychiatry O.P.D. of tertiary care hospital. The sample consisted cohort of 20 outpatients each with unipolar depression, unipolar depression with psychotic symptoms and bipolar disorder current episode depression with psychotic symptoms. The depression was assessed by HAM-D and insight by Item G12 of the General Psychopathology section of PANSS. Results: Significant difference in insight is seen in all three groups. Bipolar patients with PS had the poorest insight, patients with unipolar depression had best. Statistically significant correlation is present with older age and lack of insight among patients of unipolar depression with PS (rho =.599, P =.005) and bipolar depression with PS (rho =.686 P=.001). Conclusion: Insight in depressive illness is affected by multiple factors; this study shows that age, bipolarity and presence of psychotic symptoms are associated with poor insight. Management of the patients of depressive spectrum should incorporate strategies to improve insight

The impact of cognitive emotion regulation strategies on adolescents with unipolar depression and bipolar depression / 中华行为医学与脑科学杂志

Objective:To explore the impact of different dimensions of cognitive emotion regulation strategies on adolescents with unipolar depression and bipolar depression.Methods:From June 2019 to July 2021, a total of 216 adolescents with depressive disorder were selected, including 134 patients in unipolar depression group, 82 patients in bipolar depression group, and 111 normal controls were selected at the same time.Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA) and cognitive emotion regulation questionnaire (CERQ) were used to evaluate the emotional symptoms and cognitive emotion regulation strategies of all enrolled subjects. SPSS 23.0 was used for statistical analysis of the data. Kruskal-Wallis rank sum test and multiple Logistic regression analysis were used for statistical analysis.Results:There were significant differences in the dimensions of cognitive emotion regulation strategies and emotional symptoms among the three groups (all P<0.01). The scores of self-blame (14.00(12.00, 17.00), 13.50(12.00, 16.00), 12.00(11.00, 12.00)), rumination (15.00(12.00, 19.00), 14.00(12.00, 17.00), 12.00(10.00, 13.00)) and catastrophizing (13.00(11.00, 17.00), 12.00(9.00, 16.00), 8.00(6.00, 12.00)) in bipolar depression group and unipolar depression group were significantly higher than those in normal control group (all P<0.01). The score of blaming others (11.00(8.75, 13.25), 9.00(8.00, 12.00)) in bipolar depression group was significantly higher than that in normal control group ( P<0.01). The score of positive reappraisal (12.00(12.00, 15.00), 11.00(8.75, 13.00)) in normal control group was significantly higher than that in unipolar depression group ( P<0.01). The putting into perspective score(10.00(8.00, 12.00), 12.00(10.00, 13.25), 12.00(10.00, 13.00)) of normal control group was significantly lower than those of unipolar depression and bipolar depression group (both P<0.01). The scores of HAMD (25.00(22.00, 26.25), 23.00(18.00, 28.00), 3.00(0, 6.00)) and HAMA (17.00(14.00, 21.00), 20.00(16.00, 27.00), 1.00(0, 3.00)) both in unipolar depression group and bipolar depression group were significantly higher than that in normal control group (both P<0.01). Multivariate Logistic regression analysis showed that self-blame, rumination, and catastrophizing were risk factors for unipolar depression ( OR=1.19, 95% CI=1.05-1.35; OR=1.17, 95% CI= 1.06-1.30; OR=1.14, 95% CI=1.02-1.27) and bipolar depression( OR=1.30, 95% CI=1.14-1.50; OR=1.21, 95% CI=1.07-1.36; OR=1.13, 95% CI=1.01-1.28) compared to normal controls, while positive reappraisal were protective factors for unipolar depression ( OR=0.83, 95% CI=0.73-0.95) and bipolar depression ( OR=0.84, 95% CI=0.73-0.98). However, after controlling for HAMD, HAMA and gender, the effects of each dimension of cognitive emotion regulation strategies on unipolar depression and bipolar depression were no longer significant(both P>0.05). Conclusion:The negative cognitive emotion regulation strategies are correlated with the risk of disease in adolescents with unipolar and bipolar depression, and this effect is affected by the patients' own depression, anxiety and other factors.

Comparison of Metacognitive Beliefs Between Patients with Unipolar Depression and Bipolar Depression

ABSTRACT Objective: The aim of this article is to compare differences in metacognitive beliefs between bipolar disorder type I depressed (BPD1) patients with Unipolar Depression (UPD) patients, and a control group; and to discuss the relationship between metacognitive beliefs and depression parameters. Methods: Sixty six consecutive outpatients with a diagnosis of depressed BPD1, 70 patients with UPD and 70 healthy controls were enrolled in the study. Following assessment with the Sociodemographic Data Form, Structured Clinical Interview for DSM-IV (SCID-I), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scales (HAM-A), Young Mania Evaluation Scale, and the Metacognition Questionnaire-30 (MCQ-30). Results: UPD and BPD1 patients included in the study had higher scores in metacognitive beliefs other than positive beliefs compared with healthy controls (p<0.05), but no significant difference was found between the BPD1 and UPD groups (p>0.05). A statistically significant positive correlation was observed between the HAM-A, HAM-D scores and MCQ-30 scores in UPD group (p<0.05) but not in BPD1 group (p>0.05). Discussion: The metacogitive structures of UPD and BPD1, may be helpful in identifying and choosing the right treatment modality. We think that our results may have implications for the metacognitive approaches in the treatment of BPD1.

A comparative study of clinical features of major depressive episode in major depressive disorder and bipolar disorder at tertiary care centre of Saurashtra region

Background: Robust clinical research data are available distinguishing clinical features of the major depressive episode between bipolar depression and major depressive disorder (MDD). Depression is having a highly heterogeneous clinical presentation. MDD and bipolar depression show a significant difference in terms of epidemiology, natural course, genetics, outcome, treatment, and disability thus becoming the major areas of rising concern which need to be addressed. Objectives: The aim was to study and compare clinical features of the major depressive episode in MDD and bipolar disorder. Materials and Methods: We compared 40 patients with bipolar depression (all 40 patients had bipolar I disorder) and 40 patients with MDD using semi-structured pro forma, DSM-5 criteria for diagnosis, Hamilton rating scale for depression (HRSD-17), Montgomery-Asberg depression rating scale (MADRS), and mood disorder questionnaire. Results: Patients with bipolar depression had early age of onset of illness, positive family history of bipolar disorders in family members, longer illness duration, greater rates of any lifetime suicide attempt, higher percentage of hypersomnia, psychomotor retardation, delusions, social withdrawal, and leaden paralysis and scored higher on individual depressive symptoms of the MADRS items in apparent sadness, reported sadness, concentration difficulties, lassitude, inability to feel and of the HRSD in work and interest, and retardation compared to the patients with MDD. Conclusions: Subtle differences in phenomenological presentation of unipolar and bipolar depression indicate requirement of a large multicentre, long term prospective and comparative study.

Detection and clinical study of serum thyroid hormone levels in patients with depression / 国际检验医学杂志

Objective To investigate the changes and clinical significance of thyroid function in patients with depression by detecting serum thyroid hormone levels.Methods Totally 127cases of depression in the Department of Psychiatric of our hospital from January 2016to January 2018were collected as research objects.According to the characteristics of depression, patients with unipolar depression were selected as unipolar group (n=45), while patients with bipolar depression were selected as bipolar group (n=82).Meanwhile, 53cases of healthy volunteers underwent physical examination in the same period in our hospital were collected as control group.The serum samples of three groups were collected and the serum levels of thyroid hormones (T3, T4, FT3, FT4, TSH) were detected by chemiluminescence immunoassay.The changes of thyroid function between the three groups were compared and analyzed.Results The proportion of patients with T3and T4decreased in unipolar group were significantly higher than those in bipolar group, and the proportion of patients with T3increased in unipolar group was significantly lower than that in bipolar group, and the proportion of patients with FT4decreased in unipolar group was significantly higher than that in bipolar group;and the proportion of patients with TSH increased and TSH decreased in unipolar group were significantly higher than those in bipolar group, the differences were statistically significant (P＜0.05).The level of FT3in unipolar group was significantly lower than that in bipolar group (P＜0.05), while the level of FT4in unipolar group was significantly lower than that in control group and bipolar group, and the differences were statistically significant (P＜0.05).Conclusion The level of thyroid hormone in patients with different types of depression was different, so the treatment should be distinguished.Psychological treatment should be focused on the unipolar depression patients with hypothyroidism, while attention should be paid to drug treatment for bipolar depression patients with high levels of free thyroid hormone.

Comparisons of exploratory eye movement, adrenocorticotropic hormone and cortisol levels in bipolar and unipolar depression aged patients / 中国神经精神疾病杂志

To explore the characteristics of exploratory eye movement (EEM) and hypothalamic-pituitary-adrenal axis (HPA) in elderly patients with acute bipolar and unipolar depression. Methods Thirty-eight elderly patients with bipolar depression (bipolar group) and thirty-nine patients with unipolar depression (unipolar group) were enrolled. The 24-item Hamilton depression rating scale (HAMD-24) was used to evaluate depressive symptoms. The levels of peripheral serum adrenocorticotropic hormone (ACTH) and cortisol (COR) were detected. EEM was recorded to obtain the number of eye fixation (NEF), responsive search score (RSS) and discriminant analysis (D). Results Compared with the unipolar group, the bipolar group had earlier onset, longer duration, and more admissions (P＜0.05). In comparison with the bipolar group, the unipolar group had higher levels of ACTH and COR (P＜0.05), and higher abnormal proportion of COR and ACTH levels. D-values were higher and RSS-values were lower in unipolar group than in bipolar group. There were no significant differences in NEF and HAMD total scores and its subfactors between the two groups (P＞0.05). Correlation analysis showed that the D value of unipolar group was positively correlated with COR level (r=0.482, P=0.002) but not with other indexes (P＞0.05). There were no significant correlations between EEM parameters and serum levels of HPA hormones in bipolar group (P＞0.05). Conclusion There are different clinical features, EEM indicators, the serum levels of ACTH and COR between acute unipolar and bipolar depression, which suggests the heterogeneity between the two diseases.

Combined Measures of Psychomotor and Cognitive Alterations as a Potential Hallmark for Bipolar Depression

OBJECTIVE: The current study aimed to examine whether specific features of psychomotor retardation (PMR) and cognitive functioning established different profiles in unipolar (UD) and bipolar depression (BD).METHODS: Two groups of age-matched patients with UD (n=54) and BD (n=20) completed the Montgomery-Asberg Depression Rating Scale (MADRS/60), the Montreal Cognitive Assessment (MoCA/30), and the Salpêtrière Retardation Rating Scale (SRRS/60). We analyzed the group effect and then performed intra-group analyses.RESULTS: The BD patients have higher SRRS score, and lower MoCA score than UD despite no difference on the level of depression between UD and BD. Our results show that PMR can be predicted by the level of depression in UD and by the cognitive alteration and onset of disease in BD.CONCLUSION: PMR is a relevant marker of depression. Our results highlight the importance of concomitant evaluation of psychomotor and cognitive functions in the distinction of UD and BD symptoms.

Comparison of Psychological Characteristics of Lesch Types 2 (Anxiety Model) and 3 (Depressive Model) Alcoholism / 우울ㆍ조울병

BACKGROUND: Lesch types 2 (L2, anxiety model) and 3 (L3, depressive model) of alcoholism exhibit different responses to anti-craving agents, and most treatment guidelines provide differential treatment strategies for bipolar depression (DEP) and unipolar DEP. We compare the psychological characteristics of L2 and L3 alcoholism and between the unipolar and bipolar subgroups.METHODS: We reviewed medical records of patients who were diagnosed with alcohol use disorder using the DSM-5 diagnostic criteria and classified as L2 and L3 using Lesch Alcohol typology software. All patients completed self-report scales (Alcohol Use Disorders Identification Test [AUDIT], Beck Anxiety Inventory [BAI], Beck Depression Inventory-II [BDI-II], and Korean Symptom Checklist-95 [KSCL95]). The data were analyzed using descriptive statistics, the Wilcoxon Rank-Sum test, and ANOVA.RESULTS: Of the 43 patients, 23 were assigned L2, and 20 were assigned L3. The scores for the KSCL95 subscales fell generally in the increasing order of the L2-unipolar (L2U, n=10), L2-bipolar (L2B, n=13), L3-unipolar (L3U, n=11), and L3-bipolar (L3B, n=9) types. The L3B scores were greater than the L3U scores for most KSCL95 subscales, by contrast with the DEP and BAI scores.CONCLUSION: We found psychological differences between L2 and L3 and identified the unique psychological characteristics for each subgroup by polarity. The psychological characteristics of these subgroups of alcohol use disorder may help improve the treatment success rates through individualized treatment strategies.

Pharmacological Treatment Strategies for Acute Bipolar Depression / 신경정신의학

Of the different phases of bipolar disorder, bipolar depression is more prevailing and is more difficult to treat. However, there is a deficit in systemic research on the pharmacological treatment of acute bipolar depression. Therefore, consensuses on the pharmacological treatment strategies of acute bipolar depression has yet to be made. Currently, there are only three drugs approved by the Food and Drug Administration for acute bipolar depression : quetiapine, olanzapine-fluoxetine complex, and lurasidone. In clinical practice, other drugs such as mood stabilizers (lamotrigine, lithium, valproate) and/or the other atypical antipsychotics (aripiprazole, risperidone, ziprasidone) are frequently prescribed. There remains controversy on the use of antidepressants in bipolar depression. Here, we summarized the evidence of current pharmacological treatment options and reviewed treatment guidelines of acute bipolar depression from recently published studies.

Hypomania Induced by Bifrontal Transcranial Direct Current Stimulation in a Patient with Bipolar Depression

Transcranial direct current stimulation (tDCS), a non-invasive neuromodulation technique, has been increasingly used to treat bipolar depression. Researchers recently noticed the risk of tDCS-emergent mania/hypomania in depressed patients and started to evaluate this risk by launching a meta-analysis. Here we present a female with bipolar II depression who rapidly developed hypomanic switching during bifrontal tDCS.

Bright Light Therapy in the Morning or at Mid-Day in the Treatment of Non-Seasonal Bipolar Depressive Episodes (LuBi): Study Protocol for a Dose Research Phase I / II Trial

OBJECTIVE: This study protocol aims to determine, using a rigorous approach in patients with bipolar disorder (BD) and non-seasonal major depressive episode (MDE), the characteristics of bright light therapy (BLT) administration (duration, escalation, morning and mid-day exposures) depending on the tolerance (hypomanic symptoms). METHODS: Patients with BD I or II and treated by a mood stabilizer are eligible. After 1 week of placebo, patients are randomized between either morning or mid-day exposure for 10 weeks of active BLT with glasses using a dose escalation at 7.5, 10, 15, 30 and 45 minutes/day. A further follow-up visit is planned 6 months after inclusion. Patients will be included by cohorts of 3, with at least 3 days of delay between them, and 1 week between cohorts. If none meet a dose limiting toxicity (DLT; i.e hypomanic symptoms), the initiation dose of the next cohort will be increased. If one patient meet a DLT, an additionnal cohort will start at the same dose. If 2 or 3 patients meet a DLT, from the same cohort or from two cohorts at the same dose initiation, the maximum tolerated dose is defined. This dose escalation will also take into account DLTs observed during the intra-subject escalation on previous cohorts, with a “Target Ceiling Dose” defined if 2 DLTs occured at a dose. DISCUSSION: Using an innovative and more ergonomic device in the form of glasses, this study aims to better codify the use of BLT in BD to ensure a good initiation and tolerance. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03396744.

Dissociative Experience in Unipolar and Bipolar Depression: Exploring the Great Divide

OBJECTIVE: Unipolar and bipolar depression (UD and BD) differ strikingly in respect to neurobiology, course and management, but their apparent clinical similarity often leads to misdiagnosis resulting in chronicity of course and treatment failure. In this study we have tried to assess whether UD and BD can be differentiated on the basis of their dissociative symptoms. METHODS: Thrty-six UD patients and 35 BD patients in active episodes, without any psychiatric comorbidity were selected from outpatient department and compared for depressive and dissociative symptoms using Hamilton Depression Rating Scale and Dissociative Experience Scale-II (DES-II). RESULTS: We found that thought the two groups didn’t differ in terms of the socio-demographic or clinical variables, BD group had significantly higher dissociative experience (U=343, p=0.001) than UD and the difference remained significant even after adjusting for the confounding factors. CONCLUSION: Our study shows that dissociative symptoms are significantly more prevalent in the depressive episodes of bipolar affective disorder as compared to the UD and can be an important tool in differentiating between the two disorders with very similar clinical profile. The difference can be measured using a simple self-report questionnaire like DES-II.

Clinical correlates of loss of insight in bipolar depression / Correlatos clínicos da perda de insight no transtorno bipolar

Abstract Introduction Affective state may influence insight, especially regarding mania. Nevertheless, studies have so far suggested that depression seems not to significantly impair insight. To the best of our knowledge, this study pioneers the evaluation of how insight variations in bipolar depression correlate with clinical variables. Method A group of 165 bipolar patients, 52 of whom had depressive episodes according to DSM-5 criteria, were followed during a year. All patients underwent clinical assessment, and insight was evaluated through the Insight Scale for Affective Disorders (ISAD). Repeated-measures ANOVA was calculated comparing scores on the four ISAD factors (insight into symptoms, the condition itself, self-esteem and social relationships) in order to investigate differences in insight according to different objects. Correlational analysis explored which clinical symptoms were linked to reduced insight. Results Worse total insight correlated with suicide attempt/ideation and fewer subsyndromal manic symptoms such as mood elevation, increased energy and sexual interest. Worse self-esteem insight was associated with not only suicide ideation/attempt but also with activity reduction and psychomotor retardation. Worse symptom insight also correlated with psychomotor retardation. Better insight into having an affective disorder was associated with more intense hypochondria symptoms. Finally, worse insight into having an illness was associated with psychotic episodes. Conclusion Our study found that symptoms other than psychosis - suicide ideation, psychomotor retardation and reduction of activity and work - correlate with insight impairment in bipolar depression.

Resumo Introdução O estado afetivo pode influenciar o insight , especialmente a mania. No entanto, até o momento os estudos mostram que a depressão parece não prejudicar significativamente o insight . De acordo com o conhecimento dos autores, este estudo é pioneiro em avaliar como as alterações de insight na depressão bipolar se correlacionam com variáveis clínicas. Método Um grupo de 165 pacientes bipolares, com 52 pacientes apresentando episódios depressivos de acordo com os critérios do DSM-5, foi acompanhado por um ano. Os pacientes foram submetidos a avaliação clínica, e o insight foi avaliado utilizandose a Insight Scale for Affective Disorders (ISAD). Diferenças no insight de acordo com o objeto foram investigadas utilizandose ANOVA de medidas repetidas, comparando os escores dos quatro fatores da ISAD ( insight sobre sintomas, sobre sua condição, autoestima e relações sociais). Análises de correlação exploraram quais sintomas clínicos estiveram associados a redução de insight . Resultados Pior insight total correlacionou-se com ideação/tentativa de suicídio e com sintomas subsindrômicos de mania (elevação do humor, energia aumentada e interesse sexual). Pior insight sobre autoestima associou-se não somente a ideação/tentativa de suicídio, mas também a redução de atividade e alentecimento psicomotor. Pior insight sobre sintomas também mostrou correlação com alentecimento psicomotor. Melhor insight sobre ter uma doença afetiva associou-se a sintomas hipocondríacos mais intensos. Finalmente, pior insight sobre a condição esteve associado a sintomas psicóticos. Conclusão O estudo mostrou que, além da psicose, outros sintomas parecem se correlacionar com prejuízo de insight na depressão bipolar, como ideação suicida, redução de atividade e alentecimento psicomotor.

More Resilience in Males with Probable Bipolar Depression than Probable Unipolar Depression among Korean Conscripts

OBJECTIVE: This study investigated whether the resilience of males with probable bipolar depression (PBD) can be strengthened and compared it to that of males with probable unipolar depression (PUD). METHODS: Prospective data for 198 participants (PBD: 66, PUD: 66, normal control: 66) were analyzed. The participants' resilience, bipolarity and severity of depressive symptoms were evaluated at baseline and after 5 weeks. Analysis of variance (ANOVA) and repeated measure ANOVA was performed for comparing resilience between three groups through a basic military training. RESULTS: The PBD group demonstrated more resilience than the PUD group at baseline. Participants with PBD became significantly more resilient than participants with PUD after 5 weeks (p<0.01, F=6.967, η²(p)=0.052). CONCLUSION: The study indicates that interventions that strengthen resilience need to be developed for males with PBD and that such interventions are more effective for males with PBD than PUD.

Observation of efficacy of quetiapine combined with paroxetine in the treatment of bipolar depression / 中国基层医药

Objective To explore the curative effect of quetiapine combined with paroxetine in the treatment of bipolar depression,and to provide reference for the choice of clinical treatment.Methods According to the digital table,96 patients with bipolar disorder were randomly divided into observation group and control group,48 cases in each group.The control group was treated with quetiapine orally,the observation group was treated with quetiapine combined with paroxetine.After 6 weeks of treatment,the clinical curative effect,the Montgomery Asberg Depression Rating Scale and the Beck pull fan Sen Mania Rating table score before and after treatment were compared between the two groups.At the same time,the adverse reactions of the two groups were compared.Results After 6 weeks of treatment,the total effective rate of the observation group was 70.83％,which was significantly higher than 50.00％ in the control group,the difference was statistically significant(x2 =4.356,P =0.037).After 6 weeks of treatment,the Montgomery Asberg Depression Rating quantity score in the observation group was (14.01 ± 2.95) points,which was significantly lower than (18.07 ± 3.05)points in the control group,the difference was statistically significant (t =5.527,P =0.036).The Baker-pull fan Sen Mania Rating score before and after treatment between the two groups had no statistically significant differences.There were no serious adverse reactions in the two groups.Conclusion Quetiapine combined with paroxetine can effectively inhibit bipolar depressive episodes,avoid manic episodes,has good clinical efficacy and high safety,it is worthy of popularization and application.

Perfil clínico dos pacientes com transtorno bipolar atendidos em um ambulatório especializado na região sul catarinense / Clinical profile of patients with bipolar disorder treated at a specialized clinic in southern Santa Catarina

Introdução: O transtorno bipolar é uma doença crônica e grave, caracterizada por episódios recorrentes, representando um enorme fardo aos indivíduos acometidos e seus familiares. Objetivos: Conhecer o perfil clínico de pacientes com transtorno bipolar atendidos em um ambulatório especializado do Sul Catarinense. Metodologia: Realizou-se um estudo exploratório, descritivo, transversal, retrospectivo e de abordagem quantitativa, totalizando 50 prontuários de pacientes diagnosticados com Transtorno Bipolar tipo I conforme Entrevista Clínica Estruturada para Transtornos do Eixo I. Resultados: Da amostra, a média de idade foi de 46,6(±11,4), 68% composta por mulheres, com média de 9,1(±5,0) anos de estudos completos, 68,0% se declararam em união estável e apenas 30% exercia trabalho renumerado. A média de idade do início dos sintomas foi de 27,6(±12,2) anos, tendo a depressão como primeiro diagnóstico em 46,0% e após 9,0(±11,4) anos foi confirmado o diagnóstico. Da casuística, 16% tentaram suicídio e 52% referiram ser cicladores rápidos, a média de internações hospitalares foi de 2 internações por paciente. Conclusão: O perfil epidemiológico revelado foi composto em sua maioria por mulheres com idade superior a 40 anos, em união estável, de baixa escolaridade e sem trabalho remunerado. O início dos sintomas ocorreu mais comumente em adultos jovens, sendo a depressão o principal diagnóstico e somente após 9 anos foi que se obteve o diagnóstico correto. Afetando o curso e a gravidade, levando a maiores probabilidades de recorrência dos episódios e resultando em mais cicladores rápidos, tentativas de suicídio e internações hospitalares.

Introduction: The bipolar disorder is a chronic, serious disease characterized by recurrent episodes, representing a huge burden to the affected individuals and their familiars. Objectives: to know the clinical profile of the patients with bipolar disorder attended ina specialized ambulatory from the south of the state. Methodology: It was performed an exploratory, descriptive, cross-sectional, retrospective search of quantitative approach, having a total of 50 records of patients diagnosed with Bipolar Disorder Type I, according to the Structured Clinical Interview for Axis I Disorders. Results: From the sample, the average age was 46, 6(±11,4), 68% composed of women, with an average of 9,1 (+-5,0) years of completed studies, 68,0% of them declared themselves in a stable union and only 30% had a paid job. The average age of the beginning of the symptoms was 27, 6 (+-12, 2) years, having depression as primary diagnosis in 46, 0% of them, with the diagnosis being confirmed only after 9, 0(±11,4) years. Of casuistry, 16% attempted suicide and 52% referred being rapid cyclers, the average number of hospitalizations was 2 hospitalizations per patient. Conclusion: the revealed epidemiological profile was mainly composed by women with age over 40 years old, in a stable union, with low education and without a paid job. The initial symptoms occurred more commonly in young adults, being depression the main diagnosis. The correct diagnosis was obtained only after nine years, affecting the course and severity of the disorder, leading to higher probabilities of recurrence of the episodes and resulting in more fast cyclers, suicide attempts and hospitalizations.

Diferencias en la experiencia subjetiva entre depresión unipolar y bipolar / Differences in Subjective Experience Between Unipolar and Bipolar Depression

Introducción: Es importante distinguir la depresión unipolar de la bipolar, pues hay diferencias en el tratamiento y el pronóstico. Dado que el diagnóstico de las dos condiciones es netamente clínico, encontrar diferencias sintomáticas puede ser de gran utilidad. Objetivos: Buscar diferencias en la experiencia subjetiva (de primera persona) entre depresión unipolar y bipolar. Métodos: Estudio exploratorio de tipo cualitativo, de orientación fenomenológica, con 12 pacientes (7 con depresión bipolar y 5 con depresión unipolar; 3 varones y 9 mujeres). Se utilizó una entrevista semiestructurada basada en el Examen de la Experiencia Anómala del Self (EASE). Resultados: Estado de ánimo predominante: en la depresión bipolar es el apagamiento emocional; en la unipolar, la tristeza. Experiencia del cuerpo: en la bipolar, el cuerpo se siente pesado, francamente cansado y como un obstáculo para el movimiento. En la unipolar, la experiencia del cuerpo se parece a la pereza cotidiana. Cognición y flujo de conciencia: en la depresión bipolar, en comparación con la unipolar, el pensamiento se vive lentificado, como si tuviera que vencer obstáculos en su curso; hay mayor dificultad para comprender lo que se escucha o se lee. Perspectiva del futuro: en la depresión bipolar, la desesperanza es más intensa y de mayor alcance que en la unipolar, como si se perdiera la posibilidad misma de la esperanza. Conclusiones: Se encontraron diferencias cualitativas en el estado de ánimo predominante, la experiencia corporal, la cognición y la perspectiva del futuro entre la depresión unipolar y la bipolar.

Introduction: It is important to make distinction between bipolar and unipolar depression because treatment and prognosis are different. Since the diagnosis of the two conditions is purely clinical, find symptomatic differences is useful. Objectives: Find differences in subjective experience (first person) between unipolar and bipolar depression. Methods: Phenomenological-oriented qualitative exploratory study of 12 patients (7 with bipolar depression and 5 with unipolar depression, 3 men and 9 women). We used a semi-structured interview based on Examination of Anomalous Self-Experience (EASE). Results: The predominant mood in bipolar depression is emotional dampening, in unipolar is sadness. The bodily experience in bipolar is of a heavy, tired body; an element that inserts between the desires of acting and performing actions and becomes an obstacle to the movement. In unipolar is of a body that feels more comfortable with the stillness than activity, like laziness of everyday life. Cognition and the stream of consciousness: in bipolar depression, compared with unipolar, thinking is slower, as if to overcome obstacles in their course. There are more difficult to understand what is heard or read. Future perspective: in bipolar depression, hopelessness is stronger and broader than in unipolar, as if the very possibility of hope was lost. Conclusions: Qualitative differences in predominant mood, bodily experience, cognition and future perspective were found between bipolar and unipolar depression.

Pharmacotherapy of Acute Bipolar Depression in Adults: An Evidence Based Approach / 가정의학회지

In the majority of cases of bipolar disorder, manic episodes are usually brief and typically responsive to currently available psychopharmacological agents. In contrast, depressive manifestations are more prevalent and persistent, and can present as major depressive/mixed episodes or residual interepisode symptoms. The depressive phase is often associated with other neuropsychiatric conditions, such as anxiety spectrum disorders, substance use disorders, stressor-related disorders, and eating disorders. It is viewed as a systemic disease with associated ailments such as metabolic syndrome, diabetes mellitus, and cardiovascular disease. There is an increased rate of mortality not only from suicide, but also from concomitant physical illness. This scenario is made worse by the fact that depressive symptoms, which represent the main disease burden, are often refractory to existing psychotropic drugs. As such, there is a pressing need for novel agents that are efficacious in acute depressive exacerbations, and also have applicable value in preventing recurrent episodes. The rationale of the present review is to delineate the pharmacotherapy of the depressive phase of bipolar disorder with medications for which there is evidence in the form of observational, open-label, or double-blind randomized controlled studies. In the treatment of acute bipolar depression in adults, a comprehensive appraisal of the extant literature reveals that among mood stabilizers, the most robust proof of efficacy exists for divalproex sodium; while atypical antipsychotics, which include olanzapine, quetiapine, lurasidone, and cariprazine, are also effective, as demonstrated in controlled trials.