Not Only Mania or Depression: Mixed States/Mixed Features in Paediatric Bipolar Disorders

Janiri, Delfina; Conte, Eliana; Luca, Ilaria De; Simone, Maria Velia; Moccia, Lorenzo; Simonetti, Alessio; Mazza, Marianna; Marconi, Elisa; Monti, Laura; Chieffo, Daniela Pia Rosaria; Kotzalidis, Georgios D.; Janiri, Luigi; Sani, Gabriele

doi:10.3390/brainsci11040434

Cited by 6 publications

(4 citation statements)

References 52 publications

(80 reference statements)

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“…This findings is in line with previous research (Wozniak et al, 2004). So far, many studies have suggested that illness onset in pediatric bipolar patients have a less common presentation with “the classical” euphoria-like symptoms and is more often characterized by irritability, polarity shifts, and mixed symptoms (Goldstein & Birmaher, 2012; Janiri et al, 2021). In our population, BD patients were 1.7 times more likely to exhibit a first major depressive episode with mixed features than UD patients (BD/UD ratio = 1.70, p = .037, Table 2).…”

Section: Discussionmentioning

confidence: 99%

Childhood Clinical Features Preceding the Onset of Bipolar Versus Major Depressive Disorders During Adolescence

Guidetti,

Serra,

Apicella

et al. 2024

J Atten Disord

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Objective: To identify childhood psychopathological features that predict the onset of adolescent Bipolar (BD) versus Unipolar Major Depressive Disorder (UD) during adolescence. Method: We analyzed clinical data from 495 juveniles diagnosed with DSM-5 UD ( n = 359), and BD ( n = 136), using bivariate analysis and multivariate logistic regression model. Results: BD subjects exhibited earlier onset of any psychiatric feature compared to UD. Antecedents associated with later BD were: oppositional defiant > specific phobias > ADHD > obsessive compulsive (OCD). Antecedents selectively associated with later UD were: social anxiety and separation anxiety. Factors significantly and independently associated with later BD diagnosis were: [a] emotional dysregulation at onset of the mood disorder; [b] first depressive episode with mixed features; [c] antecedent ADHD; [d] antecedent OCD, and [e] antecedent oppositional-defiance. Conclusion: Identifying developmental differences in BD and UD symptoms can aid clinicians in early identification and treatment planning for bipolar disorder in youth.

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Section: Discussionmentioning

confidence: 99%

Childhood Clinical Features Preceding the Onset of Bipolar Versus Major Depressive Disorders During Adolescence

Guidetti,

Serra,

Apicella

et al. 2024

J Atten Disord

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“…In the absence of “decreased need for sleep” (YMRS item 4) symptom, “difficulty with sleep” (CDRS-R item 4) may assess simple insomnia and seems to be associated primarily with a depressive symptom cluster. In contrast, reduced sleep symptoms in bipolar depression youth with manic or hypomanic features may be a by-product of influences of hyperactivity and irritability that characterize the manic state in youth, and who may commonly present with co-occurring attention deficit with hyperactivity [ 2 , 31 ]. Sleep disturbance as a “bridge” symptom may therefore be a useful marker of mixed states [ 8 , 14 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…The co-occurrence of depressive and manic symptoms in the same mood episode presents significant challenges for the diagnosis and treatment of people with bipolar disorder. The presence of subthreshold hypomanic symptoms in pediatric bipolar depression may be associated with significant impairment in functioning, and can complicate the illness course and treatment outcome [ 1 , 2 ]. Recognizing the importance of mixed states during depressive episodes in characterizing the course of illness and response to treatment in either bipolar or unipolar depression, the Diagnostic and Statistical Manual 5 th edition (DSM-5) added “mixed features” specifiers to episodes of major depression, hypomania or mania.…”

Section: Introductionmentioning

confidence: 99%

Sleep Disturbance, Irritability, and Response to Lurasidone Treatment in Children and Adolescents with Bipolar Depression

Singh

Siu

Tocco

et al. 2023

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The presence of mixed (subsyndromal hypomanic) symptoms may influence treatment outcomes in pediatric bipolar depression. This post-hoc analysis investigated “bridge” symptoms that have cross-sectional and predictive associations with depressive and manic symptom clusters. The effects of these bridge symptoms on the response to lurasidone 20–80 mg/d compared to placebo treatment was analyzed in children and adolescents with bipolar I depression in a six-week, placebo-controlled, double-blind study followed by a 2-year, open- label extension study of lurasidone. Sleep disturbances, assessed by “difficulty with sleep” Children’s Depression Rating Scale, Revised (CDRS-R) item-4 and “decreased need for sleep” Young Mania Rating Scale (YMRS) item-4, and “irritability” (CDRS-R item-8, YMRS item-5) were identified as “bridge” symptoms and found to have replicable causal associations with depressive (CDRS-R total) and manic symptom clusters (YMRS total) at baseline and week-6. A Ggreater improvement in overall depression severity at week 6 with lurasidone (vs. placebo) treatment was observed in the presence (vs. absence) of a“decreased need for sleep” at the baseline, mediated in part by significant reductions from study baseline in a“decreased need for sleep” and manic symptom severity. The absence of sleep disturbance and irritability in patients at open-label extension study baseline was associated with higher rates of sustained recovery (symptomatic and functional remission) for 6 months compared to patients with those symptoms at baseline (68% vs. 50%, Number Needed to Treat=6). Our findings suggest that sleep disturbance and irritability are cardinal symptoms that “bridge” between depressive and manic symptom clusters and influence treatment outcomes in youth with bipolar depression.

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“…[ 13 ] Another meta-analysis of 11 studies that included studies involving pediatric bipolar patients ( n = 1365) reported a pooled prevalence of 55.2% (95% CI: 40.1–70.3) (mostly assessed on Structured Clinical Interview for-DSM-IV TR criteria) and those with mixed states having high rates of comorbidities, mostly Attention Deficit Hyperkinetic Disorder. [ 14 ] When one looks at these meta-analyses, it is evident that most of the data on mixed features as defined by DSM-5 is for patients with BD, with limited data on patients with depression. Further, the studies that evaluated the prevalence of mixed features in patients with depression have not specified whether this has been studied in patients with first-episode depression (FED) or recurrent depressive disorder.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of mixed features in patients with first-episode depression: An exploratory multicentric study

Grover,

Sahoo,

Mishra

et al. 2023

Indian Journal of Psychiatry

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Background and Aim: There is limited literature on the prevalence of mixed features in patients with depression, especially from countries in Asia. Our aim was to evaluate the prevalence of “mixed features” in patients with first-episode depression. Materials and Methods: Patients with first-episode depression were evaluated for the presence of mixed features as per the Diagnostic and Statistical Manual (DSM)-5 criteria. They were additionally evaluated on Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS). Results: About one-sixth (16%) of the patients fulfilled the DSM-5 criteria for the mixed features specifier. The most common manic/hypomanic clinical feature was increased talkativeness or pressure of speech, followed by elevated expansive mood (12.5%), and inflated self-esteem or grandiosity was the least common feature (8.7%). Those with mixed features had higher prevalence of comorbid tobacco dependence and psychotic symptoms. In terms of frequency of depressive symptoms as assessed on HDRS, compared to those without mixed features, those with mixed features had higher frequency of symptoms such as depressed mood, insomnia during early hours of morning, work and activities, agitation, gastrointestinal somatic symptoms, genital symptoms, hypochondriasis, and poorer insight. Conclusion: Mixed features specifier criteria were fulfilled by 16% patients with first-episode depression. This finding suggests that the extension of this specifier to depression can be considered as a useful step in understanding the symptom profile of patients with depression.

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Not Only Mania or Depression: Mixed States/Mixed Features in Paediatric Bipolar Disorders

Cited by 6 publications

References 52 publications

Childhood Clinical Features Preceding the Onset of Bipolar Versus Major Depressive Disorders During Adolescence

Childhood Clinical Features Preceding the Onset of Bipolar Versus Major Depressive Disorders During Adolescence

Sleep Disturbance, Irritability, and Response to Lurasidone Treatment in Children and Adolescents with Bipolar Depression

Prevalence of mixed features in patients with first-episode depression: An exploratory multicentric study

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