Suicide attempts in major depressive episode: evidence from the <scp>BRIDGE</scp>‐<scp>II</scp>‐Mix study

Popović, Dina; Vieta, Eduard; Azorin, J.-M.; Angst, Jules; Bowden, Charles L.; Sn, Mosolov; Young, Allan H.; Perugi, Giulio

doi:10.1111/bdi.12338

Cited by 92 publications

(64 citation statements)

References 45 publications

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“…Our results showed similar depression rates to those seen in the general population; only the gender ratio was 1:1 suggesting a lower than expected depression rate in females and a higher in males. However, only 1.71% of patients had simultaneously mixed manic and depressive symptoms, a much lower rate than seen in bipolar disorders (Bauer et al 2005, Perugi et al 2015, Popovic et al 2015. Manic, but not depressive symptoms, were related to gender, higher overall psychopathology, treatment with higher antipsychotic doses and more extrapyramidal side effects.…”

Section: Discussionmentioning

confidence: 88%

Mood Symptoms in Stabilized Patients With Schizophrenia: A Bipolar Type With Predominant Psychotic Features?

et al. 2017

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Section: Discussionmentioning

confidence: 88%

Mood Symptoms in Stabilized Patients With Schizophrenia: A Bipolar Type With Predominant Psychotic Features?

et al. 2017

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“…[6][7][8] Mixed states are associated with elevated rates of relapse, suicide, comorbidity, and treatment resistance. [9][10][11][12] This review article invites the need for adequately powered clinical trials that seek to determine the efficacy, safety, and tolerability of psychotropic agents in mania, hypomania, or depression with mixed features. At the current time, only a limited number of studies has assessed the efficacy of treatments specifically for mood disorders with DSM-5-defined mixed features.…”

Section: Resultsmentioning

confidence: 99%

“…[6][7][8] Moreover, mixed features are associated with more severe symptomatology, mood episode recurrence, higher rates of comorbidity, poorer clinical outcomes, and suicidality. [9][10][11][12] Given the relative recency of this new nosological entity (May 2013), only a limited number of studies has directly examined the efficacy of treatments for mood states with DSM-5-defined mixed features. [13][14][15][16][17][18][19][20][21][22] Further, to date, only the Florida Medicaid Guidelines have specifically addressed the treatment of mixed features.…”

Section: Introductionmentioning

confidence: 99%

Treatment of mixed features in bipolar disorder

Rosenblat

McIntyre

2016

CNS Spectr.

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Mood episodes with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)-defined mixed features are highly prevalent in bipolar disorder (BD), affecting~40% of patients during the course of illness. Mixed states are associated with poorer clinical outcomes, greater treatment resistance, higher rates of comorbidity, more frequent mood episodes, and increased rates of suicide. The objectives of the current review are to identify, summarize, and synthesize studies assessing the efficacy of treatments specifically for BD I and II mood episodes (ie, including manic, hypomanic, and major depressive episodes) with DSM-5-defined mixed features. Two randomized controlled trials (RCTs) and 6 post-hoc analyses were identified, all of which assessed the efficacy of second-generation antipsychotics (SGAs) for the acute treatment of BD mood episodes with mixed features. Results from these studies provide preliminary support for SGAs as efficacious treatments for both mania with mixed features and bipolar depression with mixed features. However, there are inadequate data to definitively support or refute the clinical use of specific agents. Conventional mood stabilizing agents (eg, lithium and divalproex) have yet to have been adequately studied in DSM-5-defined mixed features. Further study is required to assess the efficacy, safety, and tolerability of treatments specifically for BD mood episodes with mixed features.

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“…In fact, suicide attempters with major depressive episodes showed higher prevalence in any mixed symptoms according to the Research-Based Diagnostic Criteria (RBDC) [17]. Furthermore, there was a significant correlation between the number of lifetime suicide attempts and RBDC depressive mixed state.…”

Section: Therapeutic Considerations In Depressive Mixed Statementioning

confidence: 98%

“…Since mixed depression often accompanies risky behavior including impulsive suicide attempts [7,17], early detection and urgent treatment of these unstable conditions is necessary. In fact, suicide attempters with major depressive episodes showed higher prevalence in any mixed symptoms according to the Research-Based Diagnostic Criteria (RBDC) [17].…”

Section: Therapeutic Considerations In Depressive Mixed Statementioning

confidence: 99%

Diagnostic and Therapeutic Considerations in Depressive Mixed State

Kondo

Shinzato

Koda

2016

CNPT

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Although the definition of depressive mixed state, more commonly known as mixed depression, is still controversial, about one-third of major depressive episodes are held to contain mixed components. The most frequent manifestations of mixed depression are irritability, distractibility and psychomotor agitation, although these symptoms are not included in the mixed features during a major depressive episode according to the DSM-5 criteria, which is therefore unlikely to cover the full scope of mixed depression in real-world settings. Mixed depression often accompanies risky behavior including impulsive suicide attempts. The early detection and treatment of these unstable conditions is therefore necessary. Also, sufficiently sensitive and specific screening methods for depressive mixed state are needed to avoid both under-and over-diagnosis. Antidepressants should be avoided since these drugs often worsen irritability, agitation and impulsivity, and increase risky behavior. Instead, combination therapy with mood stabilizer(s) to prevent the relapse of the depressive mixed state and atypical antipsychotics for rapid stabilization in the acute phase should be considered. Because there is very little evidence for effective pharmacotherapy in mixed depression, the efficacy of various mood-stabilizing agents, either as monotherapy or in combination therapies, should be extensively examined in the future using quantitative assessments of the psychopathology of mixed depression in patients with confirmed diagnoses of mixed depression.

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Suicide attempts in major depressive episode: evidence from the BRIDGE‐II‐Mix study

Abstract: Important differences between MDE-SA and MDE-NSA patients have emerged. Early identification of symptoms such as risky behavior, psychomotor agitation, and impulsivity in patients with MDE, and treatment of mixed depressive states could represent a major step in suicide prevention.

Cited by 92 publications

References 45 publications

Mood Symptoms in Stabilized Patients With Schizophrenia: A Bipolar Type With Predominant Psychotic Features?

Mood Symptoms in Stabilized Patients With Schizophrenia: A Bipolar Type With Predominant Psychotic Features?

Treatment of mixed features in bipolar disorder

Diagnostic and Therapeutic Considerations in Depressive Mixed State

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