Major depression is associated with high risk of suicide. But it remains controversial whether the risk is higher in bipolar depression or unipolar one. Objectives: 1. To identify social, clinical and temperamental factors associated with high suicide risk among patients with unipolar or bipolar depression. 2. To compare suicide risk in the two groups. Methods: This cross-sectional study, in progress, is conducted on psychiatric outpatients in the University Hospital, in Sfax (Tunisia). We include subjects with major depressive episode in the context of bipolar disorder or major depressive disorder. We use the Arabic version of the full-scale TEMPS-A auto-questionnaire and the suicidal risk assessment scale (RSD). Preliminary Results: A total of 28 depressive patients were included. Compared to unipolar patients (20), bipolar patients (8) had more frequent previous suicide attempts (25% vs 10%) and had a higher suicide risk (50% vs 25%). Among high-risk suicidal patients (16/28), 62.5% were males. The main stressful life events were: school failure (66.7%), early grief (55.6%) and family violence (44.4%). Psychotic and atypical features were found in 33.3% and 55.6%, respectively. Comorbidity with personality disorder was noted in 44.4% and with anxiety disorders in 22.2%. Cyclothymic (44.4%) and irritable (33.3%) temperaments were the most common. Conclusion: Our results meet those of the literature. Suicide risk is associated with male gender and traumatic events in childhood. Bipolar depression, psychotic features, affective temperaments, as well as personality disorders, and anxiety increase this risk. Attention should be paid to all these factors in depressed patients.
IntroductionBipolar and unipolar disorders share a common depressive clinical manifestation, but have not the same treatment. An early recognition of bipolar depression has an important impact on the prognosis of bipolar disorder.ObjectivesOur study aims at evaluating the prevalence of hypomania among patients with major depression and revealing the factors that distinguish between unipolar and bipolar depression.MethodsOur cross-sectional study, in progress, includes outpatients with major depressive disorder, from the University Hospital in Sfax (Tunisia).We use the Angst’s Hypomania Checklist (HCL-20) to detect episodes of hypomania misdiagnosed by the present psychiatrist.Preliminary ResultsTwenty patients were included. The average age of onset of disease was 31 years. More than half of patients were females (55%). Tobacco dependence was found in 35% of patients, alcohol dependence in 20% of them. Patients had a family history of bipolar disorder in 25% of cases. They attempted suicide in 15% of cases.Hypomania prevalence was 45%. Hypomanic episode was more frequent in early-onset disease, when there is a history of attempted suicide, and in case of atypical or psychotic features. Addiction to tobacco or alcohol, presence of somatic comorbidity and mixed features were also more frequent in patients with past hypomania.ConclusionOur results show that bipolar disorder is underdiagnosed in depressive patients. Systematic search for hypomania, based on a clinical interview or a screening tool, is necessary to avoid misdiagnosis of bipolar disorder and therefore inappropriate treatment.
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