This article reviews theory and research regarding the physiology, situational and dispositional antecedents, behavioral concomitants, and interpersonal consequences of social blushing and offers a new theoretical account of blushing. This model posits that people blush when they experience undesired social attention. Puzzling questions involving blushing in solitude, the phenomenology of blushing, types of blushing, and blushing in dark-skinned people are discussed.
Sir: Koh et al. 1 reported that anger was more likely in depressive disorders than in anxiety and somatoform disorders, that anger was found in 30% to 40% of depressive disorders, and that comparative data were scarce among other mental disorders. My comment is that anger is even more likely in bipolar depression than in major depressive disorder (MDD). 2,3 Finding a higher frequency of anger in bipolar depression has an important impact on the treatment of depression, because misdiagnosis of bipolar depression as MDD is high (at least 40%), 4 and treatment of bipolar depression with antidepressants without concurrent mood stabilizers (and even with mood stabilizers) can induce mania/hypomania, mixed states, and rapid cycling. 5 The importance for clinical practice of this finding is supported by the high frequency of bipolar II disorder in major depressive episode (MDE) outpatients (up to 60%) and in the community (11%, vs. 11% of MDD), found by improving the probing for past hypomania. [3][4][5][6][7][8][9][10][11][12][13][14] Assessing hypomanic symptoms during MDE led to the finding of a high frequency (more than 50%) of bipolar II depressive mixed state (defined as an MDE plus some concurrent hypomanic symptoms not meeting full criteria for hypomania), in which anger was very common. 2,3 Depressive mixed state in MDD was not uncommon (more than 20%), and these patients had a family history of bipolar disorders similar to that found in bipolar II disorder patients. 3 These data suggest that assessment of past hypomania and of hypomanic symptoms during MDE should be done systematically.My last updated sample of consecutive outpatients presenting for MDE treatment in a nontertiary care psychiatric setting (private practice) was assessed with the SCID-CV 15 when patients were still psychoactive drug-free (bipolar II disorder patients: N = 281, mean ± SD age = 41.7 ± 13.9 years, female = 66.9%, and mean ± SD Global Assessment of Functioning scale [GAF] score = 50.4 ± 9.2; MDD patients: N = 202, mean ± SD age = 47.3 ± 15.3 years, female = 59.9%, and mean ± SD GAF score = 51.1 ± 9.2). Concurrent hypomanic symptoms were assessed. Frequency of anger (as defined in the SCID-CV question for irritability in bipolar disorders) was much higher in bipolar II MDE versus in MDD (61.2% vs. 35.6%; χ 2 = 31.8, df = 1, p = .000) (study method details are reported elsewhere 2,3,6,9,10 ). These results are in line with the preliminary report by Perlis et al. 16 showing that 62% of 29 bipolar disorder patients and 26% of 50 MDD patients had anger during MDE. These findings of the possible negative effects of antidepressant treatment on anger in bipolar depression 5,11,17,18 suggest the need for improved diagnostic skills in distinguishing bipolar and depressive disorders.Recognizing anger in MDE could also be a cross-sectional clinical marker of bipolar II depression (leading clinicians to better assessment of past hypomania). In the present sample, logistic regression of bipolar II disorder (dependent variable) versus anger ...
In this small group of patients with schizophrenia, no deterioration in clinical status in several domains was noted after changing from branded to generic clozapine. This finding is consistent with pharmacologic data suggesting bioequivalence of the 2 products. Results, however, must be interpreted cautiously due to the lack of optimal study controls and small sample size.
Although a common and occasionally troubling reaction, social blushing has received little systematic attention from either medical or behavioral researchers. This article reviews what is known of the physiological and psychological processes that mediate social blushing, and speculates regarding the role of central mechanisms in the phenomenon. Blushing is characterized by the unusual combination of cutaneous vasodilatation of the face, neck, and ears, accompanied by activation of the sympathetic nervous system. Psychologically, blushing appears to occur when people receive undesired social attention from others and may be analogous to the appeasement displays observed in non-human primates. Although poorly understood, the central mechanisms that mediate blushing obviously involve both involuntary autonomic effector systems and higher areas that involve self-reflective thought. Questions for future research are suggested.
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