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Borderline personality disorders are complex clinical states with highly polymorphic symptoms and signs, leading to delays in their diagnosis and treatment. All international classifications emphasize certain clinical criteria such as unstable identity and interpersonal relationships, feelings of emptiness or boredom, and pathological impulsiveness. The prevalence is about 2%, with a female-male sex ratio of 2 or 3 to 1. Both adolescents and adults may be affected There is a high risk of suicide, addictive behaviors, eating disorders, and criminality. These individuals frequently have a history of trauma in early childhood, such as separation, loss, physical or sexual abuse, or affective privation. Subjective signs and symptoms are particularly important in the diagnostic and therapeutic evaluation, and this requires an empathic and subtle approach. Standardized and semi-structured interviews may help to identify comorbidities such as thymic disorders, anxiety, addiction, eating disorders, and, in some cases, psychotic symptoms. The psychiatric bio-psycho-social model takes into account multiple pathogenic factors, such as trauma during early development, temperamental instability and other emotional disorders, as well as psychosocial, neurobiological (5HT etc.) and genetic vulnerabilities. Treatment requires optimal integration of psychotherapeutic and pharmacotherapeutic approaches. Emergency intervention must be available in case of delirious or suicidal behavior The clinical course is often lengthy and complex, but outcome may be favorable, provided the principal risk--suicide--is correctly managed,
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Transtorno da Personalidade Borderline/diagnóstico , Transtorno da Personalidade Borderline/terapia , Adolescente , Adulto , Transtorno da Personalidade Borderline/epidemiologia , Transtorno da Personalidade Borderline/etiologia , Comorbidade , Emoções , Feminino , Humanos , Comportamento Impulsivo , Relações Interpessoais , Masculino , Modelos Psicológicos , Psicoterapia , Psicotrópicos/uso terapêutico , Avaliação de Sintomas , Prevenção do SuicídioRESUMO
We describe a 55-year-old woman with extensive digestive resection and recurrent depressive disorder resistant to oral clomipramine tablets but not to an oral solution of amitriptyline. In the light of this case report, the potential mechanisms of drug resistance after digestive resection are discussed, including the importance of drug monitoring.
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Amitriptilina/uso terapêutico , Antidepressivos Tricíclicos/uso terapêutico , Clomipramina/uso terapêutico , Transtorno Depressivo/tratamento farmacológico , Trato Gastrointestinal Superior/cirurgia , Monitoramento de Medicamentos , Resistência a Medicamentos , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Depressed patients exhibit cognitive biases, including maladaptive self-focus. In a previous functional magnetic resonance imaging (fMRI) study, the dorsal medial prefrontal cortex (MPFC) activation during self-referential versus semantic processing was unique to patients, as was the left dorsolateral prefrontal cortex (DLPFC) activation. The aim of this pilot study was to examine whether this pattern was stable over the course of depression. METHODS: Sixteen participants (8 depressed inpatients, 8 healthy controls) viewed personality traits during fMRI and judged whether each trait described them or not ('self' condition), or whether it described a socially desirable trait or not ('general' condition). There were 2 scanning sessions with an interval of at least 6weeks, in which patients received an antidepressant treatment. RESULTS: After a mean duration of 9 weeks, depressed patients displayed a more balanced activation of the left DLPFC but a greater activation of the dorsal MPFC in 'self' versus 'general' condition remained. LIMITATIONS: The small sample size and heterogeneous clinical features prevented subgroups analyses between responders and non-responders. CONCLUSIONS: The change of the left DLPFC activation suggests that antidepressants are associated with a more balanced allocation of cognitive control across self-referential and non-self-referential processes. The apparent lack of effect on the dorsal MPFC activity is consistent with the specific effects of antidepressants versus cognitive behavior therapy (CBT) previously demonstrated in depression. Future studies could examine the relationships between the dorsal MPFC activity in depressed patients and the need to reduce self-focus through CBT to achieve remission and prevent relapse.
Assuntos
Transtornos Cognitivos/fisiopatologia , Transtorno Depressivo/fisiopatologia , Imageamento por Ressonância Magnética , Córtex Pré-Frontal/fisiopatologia , Autoimagem , Adulto , Mapeamento Encefálico , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/tratamento farmacológico , Transtornos Cognitivos/psicologia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/psicologia , Dominância Cerebral/fisiologia , Feminino , Humanos , Julgamento/efeitos dos fármacos , Julgamento/fisiologia , Masculino , Inventário de Personalidade/estatística & dados numéricos , Projetos Piloto , Córtex Pré-Frontal/efeitos dos fármacos , Psicometria , Desejabilidade Social , Adulto JovemRESUMO
The earlier bipolarity is diagnosed and treated, the better the chances of durable recovery The bipolar spectrum consists of a large panel of clinical syndromes with heterogeneous symptoms. Clinical studies show that, on average, a period of nine years elapses between onset of the first mood symptoms and appropriate prescription of mood stabilizers. Tools such as the bipolarity index can help with earlier and more precise diagnosis of bipolarity, and with the choice of the best treatment to prevent complications of bipolar illness.
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Transtorno Bipolar/diagnóstico , Transtorno Bipolar/terapia , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/etiologia , Comorbidade , Tomada de Decisões , Diagnóstico Precoce , Humanos , Modelos Biológicos , Racionalização , Fatores de TempoRESUMO
Major depression is associated with an excessive self-focus, a tendency to engage oneself in self-referential processing. The medial frontal gyrus (MFG) is central to self-referential processing. This study aimed to explore the neural bases of this excessive self-focus and to disambiguate the role of the MFG in the pathophysiology of major depression. We presented 15 depressed patients and 15 healthy subjects with personality traits during functional magnetic resonance imaging and asked them to judge whether each trait described them ('self' condition) or a generally desirable trait ('general' condition). Both patients and healthy subjects activated the MFG in 'self' vs 'general' condition. However, the activation of the dorsal part of the MFG and of the dorsolateral prefrontal cortex (DLPFC) in 'self' vs 'general' condition was unique to patients. Additionally, patients displayed an increased functional connectivity between the MFG, the dorsal anterior cingulate cortex and the DLPFC. These results provide evidence for an extended medial prefrontal network during self-referential processing in major depression, suggesting the involvement of a greater cognitive control.
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Mapeamento Encefálico , Transtorno Depressivo Maior/fisiopatologia , Transtorno Depressivo Maior/psicologia , Córtex Pré-Frontal/fisiopatologia , Autoimagem , Adulto , Análise de Variância , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Masculino , Vias Neurais/irrigação sanguínea , Vias Neurais/fisiopatologia , Oxigênio/sangue , Córtex Pré-Frontal/irrigação sanguínea , Tempo de Reação/fisiologiaRESUMO
Autobiographical memory (AM) specificity is impaired in depression and post-traumatic stress disorder. Previous studies emphasised the role of cognitive avoidance of intrusive memories in this impairment. This study aimed to examine the association of cognitive avoidance of intrusive memories with specificity, autonoetic consciousness, and self-perspective. A total of 38 healthy participants were given the revised Impact of Event Scale (IES-R) and an AM task designed to assess positive and negative memories regarding specificity, autonoetic consciousness (remember/know procedure), and self-perspective (field/observer procedure). Taking into account age, verbal IQ, mood, harm avoidance, and executive resources, the IES-R avoidance subscale was negatively correlated with specificity and remember responses for positive memories, and with remember and field responses for negative memories. These findings suggest that cognitive avoidance of intrusive memories is associated with a decrease of the episodic components of AM retrieval.
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Cognição/fisiologia , Emoções/fisiologia , Acontecimentos que Mudam a Vida , Memória/fisiologia , Autoimagem , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Inquéritos e Questionários , Adulto JovemRESUMO
Depressed mood and anhedonia are the main symptoms of depressive disorder. With other symptoms, it is responsible for a real break with premorbid patient's way of life. Several clinicals forms, caracterised by melancholia intensity, psychotic symptoms and cognitive troubles, must be identified to adapt treatment and to prevent patients from particular risks. The short and middle term prognosis is linked to the suicidal risk and the socioprofessionnal and familial consequences. Long term risk is the disease chronicisation, recurrence and bipolarity. The existence of other psychiatric comorbidity, such as alcoholism, personality disorder, anxiety disorder, is frequent and must be envisaged, despite the difficulty linked with symptoms intrication.
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Transtorno Depressivo , Adulto , Fatores Etários , Idoso , Alcoolismo/epidemiologia , Transtornos de Ansiedade/epidemiologia , Transtornos Cognitivos/diagnóstico , Comorbidade , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/epidemiologia , Humanos , Pessoa de Meia-Idade , Transtornos da Personalidade/epidemiologia , Prognóstico , Recidiva , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Suicídio/psicologiaRESUMO
Research on autobiographical memory (AM) and the ability to retrieve specific autobiographical events in euthymic depressed patients yielded divergent results. The main goal of the present study was to further explore episodic specificity of AM among fully remitted depressed patients. Twenty euthymic depressed patients and 20 matched healthy controls were given a semi-structured interview, which assesses episodic specificity of positive and negative autobiographical memories regarding event and details' specificity, autonoetic consciousness (remember/know procedure) and visual perspective (field/observer procedure). Results showed an impairment of episodic specificity of AM in euthymic depressed patients. This impairment was explained by a field perspective deficit for positive memories only. These results suggest that euthymic patients continue to exhibit discrepancy between their current self and their self for positive past behaviors, which maintains an unfavorable view of their current self. Specific cognitive interventions may improve the self-relevance of their positive memories.
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Transtorno Depressivo/psicologia , Transtornos da Memória/etiologia , Rememoração Mental , Adulto , Estudos de Casos e Controles , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Indução de Remissão , AutoimagemRESUMO
Babinski made important contributions to both psychiatry and neurology. He disagreed with Charcot's theatrical interpretation of hysteria and made a subtle distinction between Suggestion and Persuasion, thereby differentiating Hysteria from Pithiatism. This paper examines Charcot's concepts and the way in which Babinski refined and honed his master's theories.
Assuntos
Histeria/história , Neurologia/história , Psiquiatria/história , Autossugestão , Diagnóstico Diferencial , Emoções , Feminino , História do Século XIX , História do Século XX , Humanos , Hipnose , Masculino , Simulação de Doença/diagnóstico , Modelos Neurológicos , Modelos Psicológicos , Paris , Comunicação Persuasiva , Transtornos Psicofisiológicos/diagnóstico , Transtornos Psicofisiológicos/fisiopatologia , Transtornos Psicofisiológicos/psicologia , SugestãoRESUMO
BACKGROUND: Few studies have been undertaken to ascertain the feasibility of using the bipolar (BP) spectrum in clinical practice. The only systematic national study is the French EPIDEP Study of consecutive inpatients and outpatients presenting with major depressive episodes (MDE). The protocol was developed in 1994 and implemented in 1995; publication of its first data began in 1998. This report provides the complete data set of the EPIDEP. METHODS: Forty-eight psychiatrists, practicing in 15 sites in four regions of France (Paris, Besançon, Bordeaux and Marseille), were all trained on a common protocol based on DSM-IV criteria for MDE (n=537) subdivided into BP-I (history of mania), BP-II (history of hypomania), as well as extended definitions of the "softer spectrum" beyond BP-I and BP-II. Measures tapping into this spectrum included the Hypomania Checklist (HCA), the cyclothymic (CT), depressive (DT) and hyperthymic (HT) temperament scales. These measures and course permitted post-hoc assignment of MDE in the bipolar spectrum, based in part on the Akiskal, H.S., Pinto, O., 1999. [The evolving bipolar spectrum: Prototypes I, II, III, IV. Psychiatr. Clin. North Am. 22, 517-534] proposal: depression with history of spontaneous hypomanic episodes (DSM-IV, BP-II), cyclothymic depressions (BP-II(1/2)), antidepressant-associated hypomania (BP-III) and hyperthymic depressions (BP-IV). <
Assuntos
Transtorno Bipolar , Adolescente , Adulto , Idoso , Transtorno Bipolar/classificação , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Seguimentos , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Transtornos Psicomotores/epidemiologia , Índice de Gravidade de DoençaRESUMO
Autobiographical memory (AM) and the self are closely linked. AM retrieval in depression is characterized by a lack of specificity, suggesting an impairment of episodic AM. Autonoetic consciousness and self-perspective, which are critical to episodic AM, have never been addressed in depression. Twenty-one depressed inpatients and 21 matched controls were given an episodic AM task designed to assess positive and negative memories regarding specificity, autonoetic consciousness (remember/know procedure), and self-perspective (field/observer procedure). For specificity, "remember", and "field" responses, ANOVAs revealed a main group effect and a group x valence interaction. Between groups, patients showed lower scores than controls for positive memories. Within groups, patients showed greater scores for negative memories, and controls showed greater scores for positive memories. There is a global episodic AM impairment of positive memories in depression regarding specificity, autonoetic consciousness, and self-perspective. Our results suggest new cognitive interventions to improve the self-relevance of positive memories in depression.
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Estado de Consciência , Transtorno Depressivo/psicologia , Memória/fisiologia , Autoimagem , Adulto , Autobiografias como Assunto , Feminino , Humanos , Inteligência , Masculino , Pessoa de Meia-IdadeRESUMO
Several neuroimaging studies have reported 'hypofrontality' in depressed patients performing a cognitive challenge compared to control subjects. Hypofrontality in depression is likely associated with an impaired behavioral performance. It is unclear whether this impaired performance is the consequence or the cause of hypofrontality. Consequently, we proposed to compare the cerebral activity of depressed patients and healthy subjects while controlling for the level of performance. Ten individuals meeting DSM-IV criteria for Major Depression and 10 healthy controls were tested with a verbal version of the n-back task during fMRI scanning. The working memory load was manipulated across the experiment (1,2,3-back) to increase the cognitive demands. fMRI data were acquired on a 1.5-T GE scanner and analyzed using SPM99 software. We did not find any difference between groups in both performance and reaction times for each level of complexity of the n-back task. Depressed patients and control subjects showed bilateral activation of the lateral prefrontal cortex, anterior cingulate and parietal cortex. Activation of these regions was modulated by the complexity of the task. Within this n-back neural network, depressed patients showed greater activation of the lateral prefrontal cortex and the anterior cingulate compared to healthy subjects. This study provides evidence that depressed patients need greater activation within the same neural network to maintain a similar level of performance as controls during a working memory task. Our findings suggest that depression may impair the cognitive capacity of depressed patients by recruiting more brain resources than controls during cognitive control.
Assuntos
Encéfalo/fisiopatologia , Cognição/fisiologia , Transtorno Depressivo Maior/fisiopatologia , Adolescente , Adulto , Circulação Cerebrovascular/fisiologia , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Estimulação Luminosa , Córtex Pré-Frontal/fisiopatologia , Escalas de Graduação Psiquiátrica , Desempenho Psicomotor/fisiologiaRESUMO
Recent studies of neuroplasticity in stress and depression have given rise to new hypotheses on the neural bases of these disorders. Based on data from imaging studies, cellular and molecular biology, and animal models, this approach could help to understand certain clinical findings, and especially cognitive impairments. Some antidepressants have effects on neuroplasticity, in addition to their symptomatic effects on depression.
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Depressão/fisiopatologia , Plasticidade Neuronal/fisiologia , Estresse Psicológico/fisiopatologia , Animais , Antidepressivos/farmacologia , Antidepressivos/uso terapêutico , Depressão/terapia , Humanos , Estresse Psicológico/terapiaRESUMO
Until recently, bipolar disorder was viewed as a relatively rare condition characterized by periods of euphoric excitement and depressive retardation which was easy to diagnose, and easy to treat thanks with lithium and new prophylactic treatments. In fact, bipolar disorder encompasses a variety of conditions, whose overall lifetime prevalence in the general population may be between 5 and 8%. Long term with lithium and other compounds are very effective but must be combined with non pharmacological therapies. Over the past two decades, advances in genetic, brain imagings, and biochemical have improved our knowledge on the pathophysiological mechanisms underlying these disorders.
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Transtorno Bipolar , Transtorno Bipolar/classificação , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/terapia , Humanos , PrognósticoRESUMO
Depression is usually associated with episodic memory impairment. The main clinical features of depression associated with that memory impairment are not clearly defined. The main goal of that study was to assess the role of the diagnostic subtypes and the number of depressive episodes on the memory performance of acute unipolar (UP) and bipolar (BP) depressed patients.Twenty-three patients with a first major depressive episode (FE), 28 patients meeting DSM-IV criteria for UP recurrent depression (UR) and 18 BP patients with recurrent depression were compared with 88 healthy subjects on a verbal episodic memory task. Patients suffering from a first depressive episode did not show verbal memory impairment as compared to normal controls. Unlike FE patients, UR and BP patients exhibited verbal memory deficits with impaired free recall and normal cued recall and recognition. The memory deficits of the UR and BP patients was present in the first free recall trial. Depressed patients improved their memory performance across the three trials of the task at the same rate than normal controls. Our results suggest that the number of depressive episodes has a negative influence on verbal memory performance of acute depressed patients. The effects of the repetition of the depressive episodes are not modulated by the subtypes of depression and may reflect sensitization to the cognitive impact of depression associated with increasing prefrontal dysfunction.
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Transtorno Bipolar/complicações , Transtorno Bipolar/psicologia , Transtorno Depressivo/complicações , Transtorno Depressivo/psicologia , Transtornos da Memória/etiologia , Adulto , Idoso , Transtorno Depressivo/diagnóstico , Feminino , Humanos , Idioma , Masculino , Transtornos da Memória/fisiopatologia , Pessoa de Meia-Idade , Periodicidade , Recidiva , Índice de Gravidade de DoençaAssuntos
Disfunções Sexuais Fisiológicas , Sexualidade , Coito/fisiologia , Dispareunia/diagnóstico , Dispareunia/etiologia , Dispareunia/terapia , Disfunção Erétil/diagnóstico , Disfunção Erétil/etiologia , Disfunção Erétil/terapia , Feminino , Humanos , Masculino , Orgasmo/fisiologia , Psicoterapia , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Fisiológicas/psicologia , Disfunções Sexuais Fisiológicas/terapiaRESUMO
The present study investigates the impact of emotional deficits on implicit and explicit memory for musical stimuli in patients with Alzheimer's disease and elderly depressed patients. Results showed that unlike Alzheimer's patients, depressed patients were unable to develop a positive affective bias of judgment for previously heard melodies.
Assuntos
Doença de Alzheimer/fisiopatologia , Transtorno Depressivo/fisiopatologia , Emoções/fisiologia , Música/psicologia , Reconhecimento Psicológico/fisiologia , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/psicologia , Transtorno Depressivo/psicologia , HumanosRESUMO
The aim of this study was to analyze qualitative aspects of verbal fluency in depression. Phonemic and semantic output was scored for word clustering and switching between clusters in depressed patients and normal control subjects. Depressed patients (n=25) and normal control subjects (n=19) were administered both phonemic and semantic fluency tasks. All patients were also evaluated with executive card sorting tests. Patients with depression produced fewer words on the semantic fluency task than controls and showed normal performance on the phonemic fluency tasks. The deficit on semantic fluency of depressed patients was related to a reduced number of switches with normal cluster sizes. The number of switches in depression was associated with a reduced ability to shift mental set on card sorting tests, suggesting that verbal fluency impairment reflects general executive problems in depression.
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Transtorno Depressivo Maior/diagnóstico , Comportamento Verbal , Adulto , Atenção , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos/estatística & dados numéricos , Fonética , Resolução de Problemas , Psicometria , Valores de Referência , Semântica , Enquadramento Psicológico , Medida da Produção da FalaRESUMO
BACKGROUND: In the present report deriving from the French national multi-site EPIDEP study, we focus on the characteristics of Bipolar II (BP-II), divided on the basis of cyclothymic temperament (CT). In our companion article (Hantouche et al., this issue), we found that this temperament in its self-rated version correlated significantly with hypomanic behavior of a risk-taking nature. Our aim in the present analyses is to further test the hypothesis that such patients-assigned to CT on the basis of clinical interview-represent a more "unstable" variant of BP-II. METHODS: From a total major depressive population of 537 psychiatric patients, 493 were re-examined on average a month later; after excluding 256 DSM-IV MDD and 41 with history of mania, the remaining 196 were placed in the BP-II spectrum. As mounting international evidence indicates that hypomania associated with antidepressants belongs to this spectrum, such association per se did not constitute a ground for exclusion. CT was assessed by clinicians using a semi-structured interview based on in its French version; as two files did not contain full interview data on CT, the critical clinical variable in the present analyses, this left us with an analysis sample of 194 BP-II. Socio-demographic, psychometric, clinical, familial and historical parameters were compared between BP-II subdivided by CT. Psychometric measures included self-rated CT and hypomania scales, as well as Hamilton and Rosenthal scales for depression. RESULTS: BP-II cases categorically assigned to CT (n=74) versus those without CT (n=120), were differentiated as follows: (1). younger age at onset (P=0.005) and age at seeking help (P=0.05); (2). higher scores on HAM-D (P=0.03) and Rosenthal (atypical depressive) scale (P=0.007); (3). longer delay between onset of illness and recognition of bipolarity (P=0.0002); (4). higher rate of psychiatric comorbidity (P=0.04); (5). different profiles on axis II (i.e., more histrionic, passive-aggressive and less obsessive-compulsive personality disorders). Family history for depressive and bipolar disorders did not significantly distinguish the two groups; however, chronic affective syndromes were significantly higher in BP-II with CT. Finally, cyclothymic BP-II scored significantly much higher on irritable-risk-taking than "classic" driven-euphoric items of hypomania. CONCLUSION: Depressions arising from a cyclothymic temperament-even when meeting full criteria for hypomania-are likely to be misdiagnosed as personality disorders. Their high familial load for affective disorders (including that for bipolar disorder) validate the bipolar nature of these "cyclothymic depressions." Our data support their inclusion as a more "unstable" variant of BP-II, which we have elsewhere termed "BP-II 1/2." These patients can best be characterized as the "darker" expression of the more prototypical "sunny" BP-II phenotype. Coupled with the data from our companion paper (Hantouche et al., 2003, this issue), the present findings indicate that screening for cyclothymia in major depressive patients represents a viable approach for detecting a bipolar subtype that could otherwise be mistaken for an erratic personality disorder. Overall, our findings support recent international consensus in favoring the diagnosis of cyclothymic and bipolar II disorders over erratic and borderline personality disorders when criteria for both sets of disorders are concurrently met.
Assuntos
Transtorno da Personalidade Borderline/diagnóstico , Transtorno Ciclotímico/psicologia , Depressão/psicologia , Assunção de Riscos , Adulto , Transtorno da Personalidade Borderline/psicologia , Transtorno Ciclotímico/classificação , Transtorno Ciclotímico/genética , Depressão/etiologia , Diagnóstico Diferencial , Saúde da Família , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
BACKGROUND: According to DSM-IV and ICD-10, hypomania which occurs solely during antidepressant treatment does not belong to the category of bipolar II (BP-II). METHODS: As part of the EPIDEP National Multisite French Study of 493 consecutive DSM-IV major depressive patients evaluated in at least two semi-structured interviews 1 month apart, 144 (29.2%) fulfilled the criteria for bipolar II with spontaneous hypomania (BP-II Sp), and 52 (10.5%) had hypomania associated solely with antidepressants (BP-H AA). RESULTS: BP-II Sp group had earlier age at onset, more hypomanic episodes, and higher ratings on cyclothymic and hyperthymic temperaments, and abused alcohol more often. The two groups were indistinguishable on the hypomania checklist score (12.2+/-4.0 vs. 11.4+/-4.4, respectively, P=0.25) and on rates of familial bipolarity (14.1% vs. 11.8%, respectively, P=0.68). But BP-H AA had significantly more family history of suicide, had higher ratings on depressive temperament, with greater chronicity of depression, were more likely to be admitted to the hospital for suicidal depressions, and were more likely to have psychotic features; finally, clinicians were more likely to treat them with ECT, lithium and mood stabilizing anticonvulsants. LIMITATION: Naturalistic study, where treatment was uncontrolled. CONCLUSION: BP-H AA emerges as a disorder with depressive temperamental instability, manifesting hypomania later in life (and, by definition, during pharmacotherapy only). By the standards of clinicians who have taken care of these patients for long periods of time, BP-H AA appears as no less bipolar than those with prototypical BP-II. We submit that familial bipolarity ('genotypic' bipolarity) strongly favors their inclusion within the realm of bipolar II spectrum, as a prognostically less favorable depression-prone phenotype of this disorder, and which is susceptible to destabilization under antidepressant treatment. These considerations argue for revisions of DSM-IV and ICD-10 conventions. BP-HAA may represent a genetically less penetrant expression of BP-II; phenotypically; it might provisionally be categorized as bipolar III.