The impact of being newly diagnosed with a bipolar disorder and the short-term outcome of disorder-specific management.

OBJECTIVES: The aim of the study was to determine the impact of a first-time diagnosis of bipolar disorder in patients previously generally managed as having a unipolar disorder, and to quantify the impact of disorder-specific management strategies for such newly diagnosed patients over the following three months. METHODS: A total of 157 patients receiving a diagnosis of bipolar disorder for the first time by a psychiatrist at a specialist depression clinic completed a research interview and questionnaires, with 106 (68%) also completing 12-week quantitative and qualitative evaluations. Assessing psychiatrists undertook baseline and follow-up assessments recording management changes, reactions to the diagnosis and global changes in functioning over time. RESULTS: The majority of patients had a positive response to receiving a diagnosis of bipolar disorder, and most implemented a number of clinician-suggested bipolar management strategies. Patients showed improvement on five of the six self-report measures over the three-month study period. Multivariate analyses quantified lamotrigine as making the most distinctive contribution to 'improver' status, particularly for the bipolar II disorder subset. CONCLUSIONS: Results are encouraging in identifying a generally positive acceptance of a diagnosis of bipolar disorder, improved outcome following the introduction of diagnostic-specific management components, and a distinctive contribution of lamotrigine to improved three-month outcome.

Validation of a new prototypic measure of melancholia.

Multiple approaches have been adopted in an attempt to effectively identify and discriminate melancholic and non-melancholic depressive subtypes. We recently developed the Sydney Melancholia Prototype Index (SMPI) which incorporates antecedent and illness course variables as well as symptoms, with clinician-rated and self-rated SMPI versions, and with the former having been shown to have superior sensitivity and specificity in discriminating melancholic from non-melancholic depression. The aim of this study was to further evaluate the capacity of the SMPI to identify melancholia in comparison to DSM-based and clinician-judged assignments. The sample comprised 214 patients diagnosed with melancholic or non-melancholic depression according to a detailed clinical assessment and by the Mini International Neuropsychiatric Structured Interview (MINI) assessing formal DSM-IV melancholia criteria. DSM-IV assignment to melancholic versus non-melancholic depression was contrasted with clinician-judged allocation, the combination of these two strategies ("concordant diagnoses"), and to the SMPI (CR or clinician-rated and SR or self-report versions), with the likely validity of each approach examined against historical ascriptions for melancholia. DSM-IV criteria assigned the highest percentage of the sample with a melancholic diagnosis (64%), whereas the SMPI-SR assigned the smallest percentage with a melancholic diagnosis (37%). DSM-IV assignment was associated with the fewest number of validating variables, whilst SMPI-CR and independent clinician diagnosis were associated with the greatest number of differentiating variables including negative childhood experiences, past and recent stressors, satisfaction with life and perceived social support. These comparative analyses provide further support for the SMPI-CR in identifying and discriminating melancholic depression from non-melancholic depression. Replication of these findings in other samples with independent raters is recommended.

Identifying antecedent and illness course variables differentiating bipolar I, bipolar II and unipolar disorders.

BACKGROUND: Clinical differentiation of bipolar conditions (and especially bipolar II disorder) from unipolar conditions is not always straightforward. We sought to identify illness antecedents and correlates that may assist their differentiation and complement clinical symptoms. METHODS: We undertook detailed comparative analyses of comprehensive data obtained from patients diagnosed with a bipolar or unipolar mood disorder. RESULTS: The sample comprised 138 bipolar (45 bipolar I and 93 bipolar II) and 214 unipolar participants. Univariate analyses identified numerous differentiating variables, while multivariate analyses generated a refined variable list to determine discriminatory capacity. Controlling for all other factors, those with a bipolar (I or II) condition were more likely than the unipolar sub-set to report a family history of bipolar disorder, experiencing bullying at school, to make a suicide/self-harm attempt, and be less likely to be clinically judged as having 'problematic' personality traits. Factors differentiating bipolar II from unipolar sub-sets included the aforementioned variables, as well as higher rates of lifetime heavy drinking and female gender, and briefer depressive episodes in the bipolar II group. Bipolar I and II sub-sets differentiated solely by higher rates of hospitalization in the former group. LIMITATIONS: Some study variables (e.g., hospitalization) may merely reflect DSM-IV diagnostic criteria or consequences rather than illness antecedents or correlates. Other self-reported variables (e.g., bullying) are subject to memory biases, and may reflect higher-order variables (e.g., early problematic personality traits). CONCLUSIONS: Study findings provide assistance to determining non-symptom features that may improve discrimination of the bipolar disorders from themselves and from unipolar conditions.

A diagnostic profile of those who return a false positive assignment on bipolar screening measures.

OBJECTIVES: Our aim was to identify the diagnostic profile of patients classified as 'false positives' on two bipolar screening measures; the Mood Swings Questionnaire (MSQ) and the Mood Disorders Questionnaire (MDQ). METHODS: A total of 1534 patients attending the Black Dog Institute Depression Clinic completed the MSQ-46, and a smaller subset of 852 completed the MDQ. All patients underwent clinical assessment by one or more Institute psychiatrists. RESULTS: Using clinical assignment (i.e. bipolar vs. unipolar) as the criterion measure for assessing the screening measures, the overall agreement rates were 84% for the MSQ-46 and 74% for the MDQ. Patients identified as 'false positives' were most likely to be clinically diagnosed as having a unipolar non-melancholic depression (37% for MSQ-46; 46% for MDQ), or a primary anxiety condition with secondary non-melancholic depression (19% for MSQ-46; 15% for MDQ). In addition, within the unipolar non-melancholic group, 46% of the MSQ-46 assigned false positives and 63% of the MDQ assigned false positives had co-morbid anxiety conditions. CONCLUSIONS: These findings suggest that patients with anxiety conditions account for a significant proportion of false positive diagnoses on bipolar screening tests - a finding that should be conceded in the development and refinement of such screening measures and in clinical assessment of the possibility of a bipolar disorder.