Incidence and Significance of Mixed Affective States in a Bipolar Population

Himmelhoch, Jonathan M.

doi:10.1001/archpsyc.1976.01770090052004

Cited by 227 publications

(95 citation statements)

References 28 publications

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“…co-occurring depression and noneuphoric manic/hypomanic symptoms) is understudied and was reviewed. Sporadic reports on mixed depression (depressive mixed states) before the year 2000 went almost unnoticed [28,29,30,31,32,33,34,35]. The year 2000 saw a rebirth of studies on mixed depression, kindled by a paper by Benazzi [36].…”

Section: Resultsmentioning

confidence: 99%

Is There a Continuity between Bipolar and Depressive Disorders?

Benazzi¹

2007

Psychother Psychosom

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Background: Recent studies questioned the current categorical split of mood disorders into bipolar disorders (BP) and depressive disorders (MDD). Methods: Medline database search of papers from the last 10 years on the categorical-dimensional classification of mood disorders. Various combinations of the following key words were used: mood disorders, bipolar, unipolar, major depressive disorder, spectrum, category/categorical, classification, continuity. Only English language clinical papers were included, review papers were excluded, similar papers selected by quality. The number of papers found was 1,141. The number of papers selected was 109. Results: The continuity/spectrum between BP (mainly BP-II) and MDD was supported by the following findings:(1) high frequency of mixed states (mixed mania, mixed hypomania, mixed depression, i.e. co-occurring depression and noneuphoric manic/hypomanic symptoms) because opposite polarity symptoms in the same episode do not support a hypomania/mania-depression splitting; (2) MDD was the most common mood disorder in BP probands’ relatives; (3) no bimodal distribution of distinguishing symptoms between BP and MDD; (4) bipolar signs not uncommon in MDD; (5) many MDD shifting to BP; (6) many lifetime manic/hypomanic symptoms in MDD; (7) correlation between lifetime manic/hypomanic symptoms and MDD symptoms; (8) hypomania factors in MDD; (9) MDD often recurrent; (10) similar cognitive style.The categorical distinction between BP (mainly BP-I) and MDD was supported by the following findings: (1) BP more common in BP probands’ relatives; (2) lower age at BP onset; (3) females as common as males in BP-I, more common than males in MDD; (4) BP-I depression more atypical and retarded, MDD depression more sleepless and agitated; (5) BP more recurrent. Conclusions: Focusing on mood spectrum’s extremes (BP-I vs. MDD), a categorical distinction seems supported. Focusing on midway disorders (BP-II and MDD plus bipolar signs), a continuity/spectrum seems supported. Results seem to support both a categorical and a dimensional view of mood disorders.

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Section: Resultsmentioning

confidence: 99%

Is There a Continuity between Bipolar and Depressive Disorders?

Benazzi¹

2007

Psychother Psychosom

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Section: Clinical Trials Of Lithium Bipolar Maniamentioning

confidence: 99%

“…In typical "pure" manic states, lithium is usually very effective, with response rates varying from 60 to 90% (Himmelhoch et al 1976;Secunda et al 1985;Swann et al 1986;Prien et al 1988a;Dilsaver et al 1993). However, about 40% of manic patients present with a mixed picture, with a combination of manic and depressive symptoms (Himmelhoch et al 1976;McElroy et al 1992a). These patients tend to have poorer response rates to lithium, varying from 29 to 42% (Himmelhoch et al 1976;Secunda et al 1985;Swann et al 1986;Prien et al 1988a;Dilsaver et al 1993).…”

Section: Clinical Trials Of Lithium Bipolar Maniamentioning

confidence: 99%

“…However, about 40% of manic patients present with a mixed picture, with a combination of manic and depressive symptoms (Himmelhoch et al 1976;McElroy et al 1992a). These patients tend to have poorer response rates to lithium, varying from 29 to 42% (Himmelhoch et al 1976;Secunda et al 1985;Swann et al 1986;Prien et al 1988a;Dilsaver et al 1993). Mania secondary to known medical conditions is also associated with poor response (Krauthammer and Klerman 1978).…”

Section: Clinical Trials Of Lithium Bipolar Maniamentioning

confidence: 99%

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The Lithium Ion: A Foundation for Psychopharmacological Specificity

Soares

Gershon

1998

Neuropsychopharmacology

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“…Se ha referido que los pacientes con TB tipo I suelen tener más conductas adictivas (Merikangas et al, 2008) pero otros autores refieren que en los pacientes adictos son más habituales los cuadros hipomanía-cos o mixtos (Do y Mezuk, 2013;Himmelhoch, Mulla, Neil, Detre y Kupfer, 1976;Keller et al, 1986;Mazza et al, 2009). Nosotros no observamos diferencias respecto a la prevalencia de los distintos TUS, aunque la prevalencia de TUS era ligeramente mayor en los TB tipo I. Dado el pequeño número de pacientes bipolares procedentes de la red de salud mental no podemos extraer conclusiones sobre diferencias entre los subtipos de bipolares entre las dos redes asistenciales.…”

Section: Discussionunclassified

Trastorno bipolar y trastorno por uso de sustancias. Estudio Madrid sobre prevalencia de patología dual

Arias¹,

Szerman²,

Vega³

et al. 2016

Adicciones

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adicciones vol. 29, nº 3 · 2017Given its prevalence and impact on public health, the comorbidity of bipolar and substance use disorders is one of the most relevant of dual diagnoses. The objective was to evaluate the characteristics of patients from community mental health and substance abuse centres in Madrid. The sample consisted of 837 outpatients from mental health and substance abuse centres. We used the Mini International Neuropsychiatric Interview (MINI) and Personality Disorder Questionnaire (PDQ4+) to evaluate axis I and II disorders. Of these patients, 174 had a lifetime bipolar disorder, 83 had bipolar disorder type I and 91 had type II. Most patients had dual pathology. Of the 208 participants from the mental health centres, 21 had bipolar disorder and 13 (61.9%) were considered dually-diagnosed patients, while 33.2% of non-bipolar patients had a dual diagnoses (p = 0.03).Of the 629 participants from the substance abuse centres, 153 patients (24.3%) had a bipolar diagnosis. Bipolar dual patients had higher rates of alcohol and cocaine dependence than non-bipolar patients. Moreover, age at onset of alcohol use was earlier in bipolar duallydiagnosed patients than in other alcoholics. Bipolar dually-diagnosed patients had higher personality and anxiety disorder comorbidities and greater suicide risk. Thus, alcohol and cocaine are the drugs most associated with bipolar disorder. Given the nature of the study, the type of relationship between these disorders cannot be determined. La comorbilidad entre trastorno bipolar y trastorno por uso de sustancias (TUS) es de las más relevantes dentro del espectro de la patología dual por su prevalencia y sus repercusiones evolutivas y sociosanitarias. Nuestro objetivo fue estudiar las características de los pacientes con diagnóstico de trastorno bipolar y trastorno por uso de sustancias procedentes del Estudio Madrid sobre prevalencia de patología dual en sujetos en tratamiento en el servicio sanitario público. KeywordsLa muestra procede de pacientes en tratamiento en las redes públicas de salud mental y de tratamiento para las adicciones de la Comunidad de Madrid. Los sujetos fueron evaluados con la entrevista Mini International Neuropsychiatric Interview (MINI) para el diagnóstico de los trastornos mentales y con la escala Personality Disorder Questionnaire (PDQ) para el diagnóstico de los trastornos de personalidad. De los 837 pacientes incluidos, 174 tenían un diagnóstico a lo largo de la vida de trastorno bipolar, 83 con trastorno bipolar tipo I y 91 del tipo II. La mayoría de ellos tenían algún diagnóstico de TUS. En la red de salud mental, de los 208 participantes, 21 tenían un diagnóstico de trastorno bipolar, de estos el 13 (61.9%) tenían un diagnóstico de TUS y se consideraron duales, mientras que en el resto de los pacientes de salud mental el 33.2% tenían un diagnóstico comórbido de TUS (p = 0.03). En los centros de drogas, de los 629 pacientes valorados, un 24.3% (n = 153) tenían un diagnóstico de trastorno bipolar. El subgrupo de pacientes con trastorn...

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Incidence and Significance of Mixed Affective States in a Bipolar Population

Cited by 227 publications

References 28 publications

Is There a Continuity between Bipolar and Depressive Disorders?

Is There a Continuity between Bipolar and Depressive Disorders?

The Lithium Ion: A Foundation for Psychopharmacological Specificity

Trastorno bipolar y trastorno por uso de sustancias. Estudio Madrid sobre prevalencia de patología dual

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