Exploration of mood spectrum symptoms during a major depressive episode: The impact of contrapolarity—Results from a transdiagnostic cluster analysis on an Italian sample of unipolar and bipolar patients

Abstract

Background Subthreshold hypomania during a major depressive episode challenges the bipolar-unipolar dichotomy. In our study we employed a cross-diagnostic cluster analysis - to identify distinct subgroups within a cohort of depressed patients. Methods A k-means cluster analysis— based on the domain scores of the Mood Spectrum Self-Report (MOODS-SR) questionnaire—was performed on a data set of 300 adults with either bipolar or unipolar depression. After identifying groups, between-clusters comparisons were conducted on MOODS-SR domains and factors and on a set of sociodemographic, clinical and psychometric variables. Results Three clusters were identified: one with intermediate depressive and poor manic symptomatology (Mild), one with severe depressive and poor manic symptomatology (Moderate), and a third one with severe depressive and intermediate manic symptomatology (Mixed). Across the clusters, bipolar patients were significantly less represented in the Mild one, while the DSM-5 “Mixed features” specifier did not differentiate the groups. When compared to the other patients, those of Mixed cluster exhibited a stronger association with most of the illness-severity, quality of life, and outcomes measures considered. After performing pairwise comparisons significant differences between “Mixed” and “Moderate” clusters were restricted to: current and disease-onset age, psychotic ideation, suicidal attempts, hospitalization numbers, impulsivity levels and comorbidity for Cluster B personality disorder. Conclusions In the present study, a clustering approach based on a spectrum exploration of mood symptomatology led to the identification of three transdiagnostic groups of patients. Consistent with our hypothesis, the magnitude of subthreshold (hypo)manic symptoms was related to a greater clinical severity, regardless of the main categorical diagnosis.

Patterns of Neural Network Functional Connectivity Associated With Mania/Hypomania and Depression Risk in 3 Independent Young Adult Samples

“…The Mood Spectrum Self-Report (MOODS-SR) measures lifetime vulnerability to mania/hypomania and depression, detecting subthreshold-level and threshold-level manifestations, with manic and depressive mood domain scales assessing the subtle behaviors over an individual’s lifetime that are associated with mania/hypomania and/or depression risk. By contrast, standard clinical rating scales assess current mania/hypomania or depression severity . The manic mood domain in particular discriminates between individuals with BD vs unipolar depression, highlighting the potential of this scale to screen for mania/hypomania and thus BD-specific risk in young adults on the BD spectrum, some of whom might already be diagnosed with unipolar depression …”

“…By contrast, standard clinical rating scales assess current mania/hypomania or depression severity. 11 , 12 , 13 The manic mood domain in particular discriminates between individuals with BD vs unipolar depression, 11 , 13 , 14 highlighting the potential of this scale to screen for mania/hypomania and thus BD-specific risk in young adults on the BD spectrum, some of whom might already be diagnosed with unipolar depression. 15 , 16 …”

Editorial: New trends in the treatment of mood disorders

“…Mood disorders, such as major depressive disorder (MDD) and bipolar disorder (BD), are psychiatric conditions influenced by a combination of psychosocial, genetic, and epigenetic factors (Mineo et al, 2022 ). Despite notable advancements, a significant number of patients do not achieve complete responsiveness to conventional therapeutic strategies and may experience a chronic course.…”