Testing definitions of dysphoric mania and hypomania: prevalence, clinical characteristics and inter-episode stability

Bauer, Mark S.; Whybrow, Peter C.; Gyulai, Laszlo; Gonnel, Jennifer; Yeh, Hong-Shiow

doi:10.1016/0165-0327(94)90019-1

Cited by 86 publications

(36 citation statements)

References 27 publications

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“…Another related problem is that mixed states, represented by the mid-range on the dimension, must consist of less intense mania than when mania is on the extreme pole, and less severe depression than depression at the opposite pole. These statements are without validity because mixed states can involve depression and hypomania/mania of varying levels of intensity [38,39,40,41,42,43]. It might be suggested that placement on the same dimension only pertains to the presence or absence of manic and depressive symptoms, such that the manic symptoms are maximal at that pole and decline to the depressive pole.…”

Section: The Dimensional Nature Of Depressionmentioning

confidence: 99%

“…Kraepelin viewed depression and mania as poles on the same dimension [3]. Mixed states involving both depressive and hypomanic/manic symptoms appear to be the norm and not the exception [38,39,40,41,42,43]. Kraepelin indicated: ‘Very often we meet temporarily with states which do not exactly correspond either to manic excitement or to depression, but represent a mixture of morbid symptoms of both forms of manic-depressive insanity' [44].…”

Section: The Dimensional Nature Of Depressionmentioning

confidence: 99%

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Depression: Discrete or Continuous?

Bowins¹

2014

Psychopathology

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Elucidating the true structure of depression is necessary if we are to advance our understanding and treatment options. Central to the issue of structure is whether depression represents discrete types or occurs on a continuum. Nature almost universally operates on the basis of continuums, whereas human perception favors discrete categories. This reality might be formalized into a ‘continuum principle': natural phenomena tend to occur on a continuum, and any instance of hypothesized discreteness requires unassailable proof. Research evidence for discrete types falls far short of this standard, with most evidence supporting a continuum. However, quantitative variation can yield qualitative differences as an emergent property, fostering the appearance of discreteness. Depression as a continuum is best characterized by duration and severity dimensions, with the latter understood in terms of depressive inhibition. In the absence of some degree of cognitive, emotional, social, and physical inhibition, depression should not be diagnosed. Combining the dimensions of duration and severity provides an optimal way to characterize the quantitative and related qualitative aspects of depression and to describe the overall degree of dysfunction. The presence of other symptom types occurs when anxiety, hypomanic/manic, psychotic, and personality continuums interface with the depression continuum.

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Section: The Dimensional Nature Of Depressionmentioning

confidence: 99%

Section: The Dimensional Nature Of Depressionmentioning

confidence: 99%

Depression: Discrete or Continuous?

Bowins¹

2014

Psychopathology

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“…Debate continues regarding the definition of mixed episodes and the significance of dysphoria during hypomanic or manic episodes (12,13). Most studies treat mixed or dysphoric mania as a subset of mania rather than of depressive episodes in terms of phenomenology (12,14) and treatment response (12,15,16).…”

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confidence: 98%

What Is a “Mood Stabilizer”? An Evidence-Based Response

Bauer

Mitchner²

2004

AJP

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441

101

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“…Such states are rather uncommon and most authors consider that manic episodes associated with depressive symptoms are more frequent (McElroy et al 1992(McElroy et al , 1995Bauer et al 1994;Akiskal et al 1998). The DSM-IV (1994) defi nition of mixed states excludes bipolar II disorder.…”

Section: Introductionmentioning

confidence: 99%

Depressive mixed state: Evidence for a new form of depressive state in type I and II bipolar patients

Henry¹

2008

NDT

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Background: A high proportion of unipolar and bipolar type II patients can present a depressive mixed state (DMX). This state is defi ned by an association of a major depressive episode with at least two specifi c hypomanic symptoms. This state seems underdiagnosed and this could have treatment implications. The aims of our study were: (i) to investigate the frequency of DMX in type I and II bipolar patients hospitalized for a severe or resistant depressive episode and (ii) to assess the therapeutic response in naturalistic conditions. Methods: Forty-two consecutive bipolar patients referred by psychiatrists for a severe or resistant depressive episode were assessed using the French version of the Mini International Neuropsychiatric Interview 5.0 (MINI 5.0), which assesses the suicide risk and provides DSM-IV diagnosis. The intensity of mood episodes was evaluated using the MADRS and Bech-Rafaelsen Mania Scale. One group of patients included patients presenting only depressive symptoms (ie, pure major depressive episode (MDE)), and the second group included patients with a major depressive episode and at least two specifi c hypomanic symptoms (DMX). Results: Twenty-one patients (50%) had a pure MDE and 21 patients (50%) had a DMX. The treatment leading to recovery was very different in the two groups. Antidepressants were effective (77%) in MDE patients, whereas antipsychotics were effective (81%) in DMX. 38% of patients with a MDE also received a mood stabilizer versus 86% in the group of DMX. Five MDE patients (24%) and one DMX patient required electroconvulsive therapy. The suicidal ideations did not differ between the two groups (p = 0.7). Conclusions: Some mood episodes in bipolar patients (type I and II) are characterised by depressive and hypomanic symptoms but do not meet criteria for mixed episode as defi ned by DSM-IV. These episodes are often diagnosed as depressive states, but are worsened by antidepressants and often considered as resistant depression. They rapidly respond to antimanic treatment. New categories of mood disorders should take into account this particular mixed state.

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Testing definitions of dysphoric mania and hypomania: prevalence, clinical characteristics and inter-episode stability

Cited by 86 publications

References 27 publications

Depression: Discrete or Continuous?

Depression: Discrete or Continuous?

What Is a “Mood Stabilizer”? An Evidence-Based Response

Depressive mixed state: Evidence for a new form of depressive state in type I and II bipolar patients

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