Evening chronotype as a bipolar feature among patients with major depressive disorder: the results of a pilot factor analysis

Objectives: The bipolar spectrum concept has resulted in a paradigm shift that has affected both the diagnosis and therapy of mood disorders, with bipolarity becoming an indicator of treatment resistance in depression. Evening circadian preference has also been linked to affective disorders. The aim of our study was to confirm the relationship between the severity of depressive symptoms, bipolar features, chronotype, and sleep quality among patients with major depressive disorder. Methods: A group of 55 individuals who were recruited from a mental health outpatient clinic completed the following psychometric tools: a Chronotype Questionnaire comprising morningness-eveningness (ME) and subjective amplitude of the rhythm (AM) scales, the Hypomania Checklist 32 (HCL-32), the Beck Depression Inventory (BDI) and the Pittsburgh Sleep Quality Index (PSQI). Results: Factor analysis identified two latent components, accounting cumulatively for 58% of variables: depressive symptoms (BDI and PSQI) and bipolarity (ME, AM, and HCL-32). After rotation, ME loading in the first factor increased the result to a significant level. The correlation between the two components was very low. Conclusions: Evening chronotype appears to be a bipolarity-related marker, with this relationship being independent of its link to depressive symptoms and sleep quality. Eveningness and high circadian rhythm amplitude may offer promise as diagnostic, prognostic, and therapeutic predictors.

Psicopatologia e soluções identitárias: efeito das reconfigurações do imaginário na contemporaneidade / Psychopathologie et solutions identitaires: effet des reconfigurations de l'imaginaire à l'époque contemporaine / Psychopathology and identity solutions: effect of reconfigurations of the imaginary in contemporary times

O presente trabalho discute as repercussões no âmbito da psicopatologia das reconfigurações do imaginário na contemporanei dade, especificamente no que tange às soluções identitárias. Apontamos os marcadores históricos na psicopatologia que contribuíram para a emergência essa nova modalidade de laço social, exemplificando a temática, a partir dos exemplos do autismo e da bipol aridade

Cet article discute des répercussions dans le cadre de la psychopathologie des reconfigurations de l'imaginaire à l'époque contemporaine, en particulier en ce qui concerne les solutions identitaires. Nous rappelons les marqueurs historiques de la psychopathologie qui ont cont ribué à l'émergence de cette nouvelle modalité de lien social, exemplifiant la thématique, à partir des exemples de l'autisme et de la bipolarité.

The present work discusses the repercussions within the psychopathology scope of the reconfigurations of the imaginary in contemporaneity, specifically regarding identity solutions. We point out the historical markers in psychopathology that contributed to the emergence of this new form of socia l link, exemplifying the theme from the examples of autism and bipolarity

Postpartum depression: bipolar or unipolar? Analysis of 434 Polish postpartum women

Objective: To assess the prevalence of soft bipolar features in a sample of women with postpartum depressive symptoms, as well as to compare the sociodemographic and obstetric characteristics of subjects with bipolar or unipolar postpartum depressive symptomatology. Methods: Four hundred and thirty-four participants were enrolled in this cross-sectional study. Postpartum depression (PPD) symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS), while the Mood Disorder Questionnaire (MDQ) was used to screen for bipolarity features. Results: Of the 434 participants, 66 (15.2%) scored ≥ 13 points on the EPDS, thus fulfilling the screening criteria, and 103 scored ≥ 7 points on the MDQ. In comparison with non-depressed subjects, the women who scored positively on the EPDS were significantly more likely to exhibit symptoms of bipolar spectrum disorders (38 vs. 21%; chi-square test, p = 0.015). Women with bipolar PPD symptomatology were significantly younger than those exhibiting unipolar PPD symptoms (31.0±4.8 years vs. 28.5±4.1 years; t-test, p = 0.03). The groups did not differ in terms of obstetric characteristics. Conclusion: Our findings suggest that patients with PPD symptomatology may be more likely to exhibit soft bipolarity features as compared with non-depressed women.

Relationship between Childhood Maltreatment, Suicidality, and Bipolarity: A Retrospective Study

OBJECTIVE: The aims of current study were to determine whether childhood maltreatment contributes to the occurrence of major depressive disorder (MDD) with bipolarity or suicidality. METHODS: In total, 132 outpatients diagnosed with MDD between 2014 and 2015 on the medical records were included. The subjects were divided into two groups according to the presence of childhood maltreatment (CM group) and no childhood maltreatment (NCM group). Depression severity and bipolarity were identified using Beck Depression Inventory (BDI) and the Korean version of Mood Disorder Questionnaire (K-MDQ) respectively on the medical records. In addition, the baseline loud dependence of auditory evoked potentials of 36 patients on medical records were analyzed. RESULTS: The mean total BDI, BDI item 9 (suicide ideation), and total K-MDQ score were significantly higher in the CM group than the NCM group. The number of subjects with bipolarity was significantly higher in the CM than in the NCM group. Furthermore two thirds subjects experienced the significant maltreatment during childhood. The central serotonergic activity of the CM group was also lower than that of the NCM group. CONCLUSION: The findings of this study support that there is a relationship between childhood maltreatment and bipolarity or suicidality in patients with MDD.

How Childhood Maltreatment Is Related to Suicidality, Bipolarity and Central Serotonergic Activity in Patients with Major Depressive Disorder: A Cross-Sectional Pilot Study

OBJECTIVE: The aims of this study were to determine whether childhood maltreatment contributes to the occurrence of major depressive disorder (MDD) with bipolarity, and whether there is a relationship between central serotonergic activity, as assessed using loudness dependence of auditory evoked potentials (LDAEP), and childhood maltreatment. METHODS: Thirty-five MDD patients were stratified according to the presence or absence of childhood trauma into two subgroups, childhood trauma (CT) and no childhood trauma (NCT), using the Korean version of the Childhood Trauma Questionnaire (K-CTQ). The CT group was subjected to further analysis. Several psychometric ratings were also applied. In addition, auditory processing for the loudness dependence of auditory evoked potentials (LDAEP), which was used as a marker of serotonergic activity, was measured before beginning medication. RESULTS: There was a significant difference in total Korean Bipolar Spectrum Disorder Scale score between the CT and NCT groups (t=-2.14, p=0.04). The total K-CTQ score was positively correlated with the total Beck Scale for Suicidal Ideation (BSS) score (r=0.36, p=0.036). In particular, emotional abuse was positively correlated with the total Barratt Impulsiveness Scale (r=0.38, p=0.026), BSS (r=0.38, p=0.025), and Hamilton Depression Rating Scale (HAMD) (r=0.36, p=0.035) scores. There was also a positive correlation between LDAEP and total Hypomania Personality Scale (r=0.49, p=0.02) and HAMD (r=0.58, p=0.004) scores within CT group. CONCLUSION: The findings of this study support that there is a relationship between childhood maltreatment and bipolarity in patients with MDD.

Life Satisfaction and Bipolarity according to Circadian Typology

OBJECTIVES: The purpose of this study was to investigate the relationships among circadian typology, bipolarity and life satisfaction of university students. METHODS: A total 1232 participants completed questionnaires, which included Composite Scale of Morningness (CSM), Satisfaction with Life Scale (SWLS), and Mood Disorder Questionnaire (MDQ). Statistical analyses were done using correlation analysis, and analysis of covariance. RESULTS: The CSM score was positively associated with SWLS score (r = 0.232 ; p < 0.001). The morningness group has higher life satisfaction than the eveningness group (p < 0.001). The eveningness group has higher bipolarity than the morningness group (p < 0.001). The CSM score was negatively associated with MDQ score (r = -0.128 ; p < 0.001). CONCLUSIONS: Bipolarity and life satisfaction were associated with circadian typology. Morningness was the important determinant of life satisfaction and bipolarity.

Chronotype in Relation to Bipolarity, Suicidal Ideation, and Auditory Evoked Potentials in Patients with Major Depressive Disorder : Preliminary Study

OBJECTIVES: The current study investigated the putative relationship between chronotype and suicidality or bipolarity in patients with major depressive disorder (MDD). METHOD: Nineteen outpatients who met the criteria for MDD according to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders-text revision were recruited for the current study. The subjects were divided into two subgroups based on their Basic Language Morningness (BALM) scores (dichotomized according to the median BALM score). The Loudness Dependence of Auditory Evoked Potentials (LDAEP) was evaluated by measuring the auditory event-related potentials before beginning medication with serotonergic agents. In addition, K-Mood Disorder Questionaire (K-MDQ), Beck Scale for Suicidal Ideation (BSS), Beck Hopelessness Scale (BHS), Barratt Impulsiveness Scale (BIS) were applied. RESULTS: The K-MDQ, BSS, BHS, BIS score was higher for the eveningness group than for the morningness group. However, the LDAEP, Hamilton Depression Rating Scale, Hamilton Anxiety Scale scores did not differ significantly between them. There were negative correlations between the total BALM score and the total K-MDQ, BSS, and BHS scores (r = -0.64 and p = 0.0033, r = -0.61 and p = 0.0055, and r = -0.72 and p = 0.00056, respectively). CONCLUSIONS: Depressed patients with eveningness are more vulnerable to the suicidality than those with morningness. Eveningness is also associated with bipolarity.

Clinical Usefulness of Loudness Dependence of Auditory Evoked Potentials (LDAEP) in Patients with Bipolar Disorder

While it has been reported previously that the loudness dependence of auditory evoked potentials (LDAEP) is a putative biological marker or a predictor of treatment response, there have been few studies of LDAEP in bipolar disorder. However, a recent study by Park and colleagues raised the possibility that the LDAEP could be useful as a biological marker of bipolar disorder. They found that the LDAEP was significantly higher in normal controls than in patients with either bipolar disorder or schizophrenia. Lee and colleagues also examined the LDAEP in bipolar disorder and normal controls, and found that it differed according to the bipolar phase, being significantly higher in cases of euthymic bipolar disorder, bipolar depression, and bipolar mania. With regard to treatment response, early clinical findings were that a higher LDAEP and a stronger intensity dependence of visual evoked potentials were related to a favorable response to lithium treatment. Juckel and colleagues recently demonstrated that the pretreatment LDAEP could be a predictor of successful prophylactic lithium treatment. The present article reviews the literature in order to determine whether the LDAEP can be used as a biological marker or a predictor of treatment response in patients with bipolar disorder and of manic switch or treatment resistance in patients with major depressive episode(s).

Can the Loudness Dependence of Auditory Evoked Potentials and Suicidality Be Used to Differentiate between Depressive Patients with and without Bipolarity

OBJECTIVE: This study aimed to test the hypothesis that the loudness dependence of auditory evoked potentials (LDAEP) can be used to predict the presence of bipolarity in patients with major depressive episodes. METHODS: A cohort of 61 patients who met the criteria for major depressive disorder (MDD) following diagnosis using Axis I of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders-text revision, and who had no history of hypomanic or manic episodes was included in this study. The patients were stratified into two subgroups based on whether or not they achieved a positive score for the Korean versions of the Mood Disorder Questionnaire (K-MDQ). The LDAEP was evaluated by measuring the auditory event-related potentials before beginning medication with serotonergic agents. RESULTS: The Barratt Impulsiveness Scale (BIS) score was also higher for the positive screening group (81.24+/-11.87) than for the negative screening group (73.30+/-14.92; p=0.039, independent t-test). However, the LDAEP, Beck Depression Inventory, Hamilton Depression Rating Scale, Beck Hopelessness Scale (BHS), and Hamilton Anxiety Scale scores did not differ significantly between them. When binary logistic regression analysis was carried, the relationship between the positive or negative subgroups for K-MDQ and BIS or Beck Scale for Suicidal Ideation (BSS) score was also significant (respectively, p=0.017, p=0.038). CONCLUSION: We found that LDAEP was not significantly different between depressive patients with and without bipolarity. However, our study has revealed the difference between two subgroups based on whether or not they achieved a positive score for the K-MDQ in BIS or BSS score.

Bipolaridad en atención primaria: una revisión general y apoyo diagnóstico para el clínico / Bipolarity in primare care: a review and a diagnostic guidance for the clinician

Nuestro país ha avanzado con la incorporación del tratamiento de la depresión unipolar a todo paciente, con acceso universal y garantías de tratamiento con oportunidad y calidad. Como resultado de esto el manejo de la depresión en la atención primaria ha mejorado en la última década. Diversos estudios han mostrado que alrededor de un 25 por ciento de los pacientes correspondería a las depresiones en trastornos en el espectro bipolar, cifra que aumenta al 40 por ciento en depresión recurrente. Se hace necesario diseñar un enfrentamiento clínico rápido para el reconocimiento de características indicadoras de un trastorno afectivo bipolar (TAB), considerando que estos pacientes no responden bien al tratamiento con antidepresivos, se deterioran más, o son más refractarios a tratamiento, con mayor riesgo de suicidio, incluso con el riesgo de gatillar episodios maniacos o hipomaniacos. El estudio presenta una breve revisión sobre bipolaridad y desarrolla un método clínico, basado en un cuestionario breve diseñado a partir de pruebas de tamizaje estándares, para poder reconocer con mayor facilidad a pacientes que estén con mayor riesgo de presentar un trastorno afectivo bipolar.

In the last decade, Chile has improved its primary care service by providing timely and good quality assistence to all patients treated with mayor depression. Different studies show that 25 percent of patients treated with depression are within the spectrum of bipolar affective disorders (TAB), figure that rises up to 40 percent in recurrent depression. These patients did not respond to the treatment with antidepressant, or more refractory to treatment, and have a higuer rate of suicide, even with the risk of triggering manic or hypomanic episodes. Therefore, it is necessary to design fast clinical clues to recognize features that may be indicative of TAB. Based on a standard screening tests, this study presents a brief review about bipolarity disorders and develops a clinical method to suspect patients that are at risk of presenting TAB in an easier way.

Mejoramiento de la pesquisa de enfermedades afectivas en atención terciaria de salud / Improvement in detection of affective disorders in general hospital

Unipolar and bipolar disorders are pathologies highly prevalent in our population. They have been studied in the last decades due to their impact on public health and because of the need for a prompt diagnosis and treatment. Objective: The study’s aim was: to show the utility of mood disorders self administered screening tools in several clinical services of two general hospitals. Method We applied the screening tools to a total of 100 patients. For depression (PHQ-9) and bipolarity (MDQ) s.The results were analysed through the statistical package SPSS 15.0 program. Results: 19 percent presented a positive screening with PHQ-9 and 8 percent was positive to the MDQ. It was found that a 75 percent of patients with MDQ (+) were treated in the surgery service. In our sample appear a relationship between PHQ-9 (+) and a depressive episodes historys. Conclusions: The frequency of mood disorders is higher in specialty services consultant medical population than in the general population. The consultants to surgery services got positive categorical MDQ in greater proportion than other evaluated disciplines. A positive PHQ-9 is related to the existence of a history of psychiatric pathology.

Introducción: Los trastornos afectivos, uni y bipolares, son patologías altamente prevalentes en nuestra población, siendo objeto de estudio en las últimas décadas, tanto por el impacto que generan en la salud pública, como por la necesidad de realizar un diagnóstico y tratamiento precoz. El diagnóstico tardío o erróneo de esta patología empeora el pronóstico y hace más complejo su manejo para los especialistas. Objetivo: Evaluar la utilidad, a través de la comparación de la tasa de pesquisa del uso de dos cuestionarios autoaplicados validados en Chile de tamizaje de depresión y bipolaridad, en cuatro servicios de especialidades médicas de dos hospitales con nivel de atención terciaria. Método: A un total de 100 pacientes consultantes de los servicios de endocrinología, oftalmología, cirugía y medicina interna se les aplicó dos escalas de autoevaluación de tamizaje de depresión (PHQ-9) y bipolaridad (MDQ) y se analizaron los resultados con el software estadístico para ciencias sociales SPSS 15.0. Resultados: 19 por ciento presentó un tamizaje positivo con el PHQ-9 y 8 por ciento resultó positivo al aplicar el MDQ. Se encontró que un 75 por ciento de los pacientes con MDQ (+) provenían del servicio de cirugía y que existe asociación entre PHQ- 9 (+) y antecedentes de enfermedad psiquiátrica. Conclusiones: La frecuencia de patología afectiva es mayor en la población consultante a servicios de especialidades médicas que en la población general. La población consultante a cirugía obtiene MDQ categorial positivo en mayor proporción que las otras especialidades evaluadas. El PHQ-9 categorial positivo tiene relación con la existencia de antecedentes de patología psiquiátrica.

Quetiapina en bajas dosis, una alternativa para tratar el insomnio relacionado a la depresión en el trastorno afectivo bipolar II / Low doses of quetiapine: one option for bipolar II affective disorder depression insomnia related treatment

Introduction: there in convenient have no addictive, well tolerated and efficient options for the symptomatic treatment of insomnia, at the onset of a stabilizer like lamotrigine treatment of mild major depressive episodes in the bipolar II affective disorder. Method: thirty (30<9 bipolar II patients whit insomnia related to mild mjor depressive episode (DSM-IV) were treated whit quetiapine under 100 mg/day at the first month of lamotrigine treatment. They were evaluated at the onset and at he thirty days whit the Montgomery-Asberg Depression Rating Scale (MADRS) and the Oviedo Sleep Quality Questionnaire (COS). Results: twenty (20) patients finished the studio, eighteen (18) each insomnia relief whit 57.7 mg/day mean doses of quetiapine. Conclusions: low doses quetiapine seems a good option for insomnia treatment of mild major depressive episodes in the bipolar II affective disorder. Although controlled trials are necessary.

Introducción: es conveniente contra con alternativas no adictivas, eficaces y bien toleradas para tratar sintomáticamente el insomnio en el inicio del tratamiento con estabilizadores como lamotrigina, en episodios depresivos moderados del trastorno afectivo bipolar II. Método: 30 pacientes bipolares II con insomnio relacionado a un episodio depresivo mayor moderado según el DSM-IV, fueron tratados con dosis inferiores a los 100 mg/día de quetiapina, durante su primer mes de tratamiento con lamotrigina, fueron evaluados a inicio y a los 30 días de tratamiento con la Escala de Depresión de montgomery-Asberg (Montgomery-Asberg Depression Rating Scale), y el Cuestionario de Oviedo de Calidad del Sueño COS. Resultados: los pacientes que completaron el protocolo fueron veinte (20), de ellos 18 consiguieron mejoría del insomnio con dosis promedio de 57,7 mg/día de quetiapina. Conclusiones: quetiapina en bajas dosis parece ser una buena alternativa para el tratamiento del insomnio en episodios depresivos moderados de trastorno afectivo bipolar II. Sin embargo, se requieren estudios con grupo de control.

Bipolar Diathesis in Patients with Treatment-Resistant Depression / 대한정신약물학회지

Despite the availability of numerous options for the treatment of depression, treatment-resistant depression remains common. Several patient-related and treatment-related risk factors have been identified as increasing the likelihood of nonresponsiveness to antidepressant treatment including psychiatric and physical comorbidity, the chronic subtype of depression, and treatment nonadherence. Evidence linking many cases of treatment-resistant depression with a diathesis to bipolar disorder has also emerged. This article reviews the current literature regarding the relevance of bipolarity to treatment-resistant depression, with particular attention to the prevalence of bipolarity in treatment-resistant depression.