Functional assessment short test (FAST): Self-administration in outpatient mental health settings.

The Functional Assessment Short Test (FAST) is a clinician-administered assessment scale of psychosocial dysfunction across various domains typically impacted in individuals with bipolar disorder. The FAST is formally validated as a clinician-administered measure, but support for self-administration would allow its wider use. Therefore, this study aimed to determine whether the FAST could reliably serve as a self-report measure in individuals seeking mental health treatment. Participants completed both the self-report and clinician-administered versions of the FAST as part of their routine outpatient clinical care at the Bipolar Disorders Clinic at The University of Texas Health Austin (UTHA). We investigated correlations between self-report and clinician-administered FAST scores. There were significant positive correlations between self-report and clinician-administered scores in a diverse group of 84 individuals undergoing outpatient mental health treatment (Total FAST scores rS = 0.75; p < .001). These findings support using the FAST as a self-report scale, further increasing its utility to measure functional disability in mental health conditions such as bipolar disorder. Self-report application will increase the utility of the FAST in busy clinical workflows and, therefore, contribute to a more comprehensive clinical assessment of recovery and spur interventions that improve psychosocial functioning and quality of life.

Longitudinal assessment of disability amongst patients of bipolar and unipolar depressive disorders presenting to a tertiary care center in North India.

OBJECTIVES: To assess and compare the changes in disability scores associated with Bipolar Depression (BD) and Unipolar Depression (UD) over 1 year. METHODS: A longitudinal study was taken up in adults diagnosed with unipolar or bipolar depressive disorder with current depressive episode. Diagnosis was made according to Schedule for Clinical Assessment in Neuropsychiatry. Severity scoring was done using Hamilton's Depression (HAM-D) rating scale and Hamilton's Anxiety (HAM-A) rating scale. Disability was assessed using Indian Disability Evaluation and Assessment Scale (IDEAS) and London handicap Scale (LHS) at baseline, 6 and 12 months. RESULTS: Sixty participants were recruited (42 UD and 18 BD). No significant differences were seen in socio-demographic parameters, except higher education levels and males being overrepresented in UD. Significant differences at baseline were seen in HAM-D (p = .001) and HAM-A (p = .003) scores. The extent of disability was seen to correlate with severity of illness only in case of BD at baseline. No significant differences were seen in the IDEAS scores at baseline. IDEAS score improved at each follow-up assessment (p < .001). LHS showed significant improvement over time in UD (p < .001), but not BD (p = .076). Percentage individuals meeting cut-off for benchmark disability (>40%) were comparable at baseline but were significantly more in the BD at 12-months (p = .049). CONCLUSION AND IMPLICATIONS: Disability in psychiatry occurs equally amongst unipolar and bipolar depressive disorders and tends to improve over time, although the level of improvement may differ. It may not always correspond to severity of illness. These factors should be considered while certifying disability.

Pharmaco-Electroencephalography-Based Assessment of Antidepressant Drug Efficacy-The Use of Magnesium Ions in the Treatment of Depression.

Pharmaco-electroencephalography (pharmaco-EEG) is a technique used to assess the effects of psychotropic medications on the bioelectrical activity of the brain. The purpose of this study was to assess the treatment response with the use of the Hamilton Depression Rating Scale (HDRS) and via EEG. Over an 8-week period, we analyzed electroencephalographic tracings of 91 patients hospitalized for major depression at the Medical University of Warsaw. Thirty-nine of those patients received tricyclic antidepressants (TCAs), 35 received fluoxetine, and 17 received fluoxetine augmented with magnesium (Mg) ions. All patients had their serum drug levels monitored. The highest proportion of patients (88.2%) who showed adequate responses to treatment was observed in the fluoxetine+Mg group, whereas the lowest rates of treatment response were observed in the TCA group (58.3%). This difference was statistically significant (p = 0.029, Phi = 0.30). Our study demonstrated a relationship between achieving remission (HDRS ≤ 6 at week 8 of treatment) and obtaining a positive pharmaco-EEG profile 6 h after administration of the first dose in the group receiving fluoxetine augmented with Mg ions (p = 0.035, Phi = 0.63).

Can dual mobility cups prevent dislocation without increasing revision rates in primary total hip arthroplasty? A systematic review.

BACKGROUND: Dislocation is one of the leading causes for early revision surgery after total hip arthroplasty (THA). To address this problem, the dual mobility (DM) cup was developed in the 1970s by the French. Despite the increased and, in some countries, broad use of DM cups, high quality evidence of their effectiveness compared to traditional unipolar (UP) cups is lacking. There are a few well-conducted literature reviews, but the level of evidence of the included studies was moderate to low and the rates of revision were not specifically investigated. Therefore, we did a systematic review to investigate whether there is a difference in the rate of dislocations and revisions after primary THA with a DM cup or a UP cup. METHODS: We conducted a systematic literature search in PubMed, Embase and Cochrane databases in July 2019. The articles were selected based upon their quality, relevance and measurement of the predictive factor. We used the MINORS criteria to determine the methodological quality of all studies. RESULTS: The initial search resulted in 702 citations. After application of the inclusion and exclusion criteria, eight articles met our eligibility criteria and were graded. Included studies were of medium to low methodological quality with a mean score of 14/24 (11-16) points following the MINORS criteria. In the case-control studies, a total of 549 DM cups and 649 UP cups were included. In the registry studies, a total of 5.935 DM cups and 217.362 UP cups were included. In the case-control studies, one (0.2%) dislocation was reported for the DM cups and 46 (7.1%) for the UP cup (p=0.009, IQR=0.00-7.00). Nine (1.6%) revisions, of which zero due to dislocation, were reported for the DM cup and 39 (6.0%), of which 30 due to dislocation, for the UP cup (p=0.046, CI=-16.93-5.73). In the registry studies 161 (2.7%) revisions were reported for the DM cup, of which 14 (8.7%) due to dislocation. For the UP cup, 3.332 (1.5%) revisions were reported (p=0.275, IQR=41.00-866.25), of which 1.093 (32.8%) due to dislocation (p=0.050, IQR=3.50-293.25). CONCLUSION: This review suggests lower rates of dislocation and lower rates of revision for dislocation in favor of the DM cups. Concluding, DM cups might be an effective solution to reduce dislocation in primary THA. To evaluate the efficacy of DM cups compared to UP cups, an economic evaluation alongside a randomized controlled trial is needed focusing on patient important endpoints. LEVEL OF EVIDENCE: III, systematic review of level III studies.

Scientific Issues Relevant to Improving the Diagnosis, Risk Assessment, and Treatment of Major Depression.

Over the past two decades, research in the biology and treatment of major depression has led to advances in our understanding of the biology of the disorder and to the development of novel treatments. While progress has been made, a number of key issues have emerged regarding diagnosis of the disorder and how we develop and test new therapies. Among these are the potential need to include new dimensions in the diagnostic criteria, the limited utility of clinical predictors of response, the moving away from traditional blinded trials in major depression, and whether preclinical models tell us much about novel drug development. These issues need to be addressed to avoid the field's embarking on trails of research and treatment development that could actually mislead or misdirect our efforts to develop better diagnostic tools and more effective treatments. Possible solutions to these problems are proposed.

Associations of major depressive disorder with chronic physical conditions, obesity and medication use: Results from the PISMA-ep study.

BACKGROUND: Life expectancy of people with depression is on average 15 years less than that of the general population. This excess of mortality is largely attributed to a deteriorated physical health. Evidence about the association between major depressive disorder (MDD) and physical health is still lacking in some areas. The aim of this study was to explore the association between MDD and physical health-related variables in southern Spain. METHODS: The PISMA-ep is a cross-sectional study based on community-dwelling adult population. Our main outcome was current prevalence of MDD. Independent variables explored were: lifetime prevalence of twenty-one chronic physical conditions (CPCs), anthropometric measures (height, weight, body max index, and hip and waist circumferences), general health status, and medication use. RESULTS: MDD was significantly associated with any CPC (OR = 2.60; 95% CI: 2.01-3.35; p < 0.001). Increases in BMI were associated with MDD in women (OR=1.08; 95% CI: 1.05-1.11; p < 0.001), but not in men (OR=0.99; 95% CI: 0.95-1.05; p = 0.916). Variables associated with MDD in the multivariate model were: female gender, obesity, general health status, cancer, peptic ulcer, tinnitus and vertigo. 21.4% of participants with MDD received antidepressant treatment. CONCLUSIONS: MDD is associated with CPCs, obesity, and increased use of medication. The high rates of comorbidity between MDD and CPCs call for a more holistic management of patients in the clinical practice. The low rate of antidepressant use may be indicating underdiagnosis. Anthropometric variables were differently associated with MDD depending on gender, suggesting a strong influence of psychosocial factors.

The excess costs of depression: a systematic review and meta-analysis.

AIMS: Major depressive disorders are highly prevalent in the world population, contribute substantially to the global disease burden and cause high health care expenditures. Information on the economic impact of depression, as provided by cost-of-illness (COI) studies, can support policymakers in the decision-making regarding resource allocation. Although the literature on COI studies of depression has already been reviewed, there is no quantitative estimation of depression excess costs across studies yet. Our aims were to systematically review COI studies of depression with comparison group worldwide and to assess the excess costs of depression in adolescents, adults, elderly, and depression as a comorbidity of a primary somatic disease quantitatively in a meta-analysis. METHODS: We followed the PRISMA reporting guidelines. PubMed, PsycINFO, NHS EED, and EconLit were searched without limitations until 27/04/2018. English or German full-text peer-reviewed articles that compared mean costs of depressed and non-depressed study participants from a bottom-up approach were included. We only included studies reporting costs for major depressive disorders. Data were pooled using a random-effects model and heterogeneity was assessed with I2 statistic. The primary outcome was ratio of means (RoM) of costs of depressed v. non-depressed study participants, interpretable as the percentage change in mean costs between the groups. RESULTS: We screened 12 760 articles by title/abstract, assessed 393 articles in full-text and included 48 articles. The included studies encompassed in total 55 898 depressed and 674 414 non-depressed study participants. Meta-analysis showed that depression was associated with higher direct costs in adolescents (RoM = 2.79 [1.69-4.59], p < 0.0001, I2 = 87%), in adults (RoM = 2.58 [2.01-3.31], p < 0.0001, I2 = 99%), in elderly (RoM = 1.73 [1.47-2.03], p < 0.0001, I2 = 73%) and in participants with comorbid depression (RoM = 1.39 [1.24-1.55], p < 0.0001, I2 = 42%). In addition, we conducted meta-analyses for inpatient, outpatient, medication and emergency costs and a cost category including all other direct cost categories. Meta-analysis of indirect costs showed that depression was associated with higher costs in adults (RoM = 2.28 [1.75-2.98], p < 0.0001, I2 = 74%). CONCLUSIONS: This work is the first to provide a meta-analysis in a global systematic review of COI studies for depression. Depression was associated with higher costs in all age groups and as comorbidity. Pooled RoM was highest in adolescence and decreased with age. In the subgroup with depression as a comorbidity of a primary somatic disease, pooled RoM was lower as compared to the age subgroups. More evidence in COI studies for depression in adolescence and for indirect costs would be desirable.

No Support for Historical Candidate Gene or Candidate Gene-by-Interaction Hypotheses for Major Depression Across Multiple Large Samples.

OBJECTIVE: Interest in candidate gene and candidate gene-by-environment interaction hypotheses regarding major depressive disorder remains strong despite controversy surrounding the validity of previous findings. In response to this controversy, the present investigation empirically identified 18 candidate genes for depression that have been studied 10 or more times and examined evidence for their relevance to depression phenotypes. METHODS: Utilizing data from large population-based and case-control samples (Ns ranging from 62,138 to 443,264 across subsamples), the authors conducted a series of preregistered analyses examining candidate gene polymorphism main effects, polymorphism-by-environment interactions, and gene-level effects across a number of operational definitions of depression (e.g., lifetime diagnosis, current severity, episode recurrence) and environmental moderators (e.g., sexual or physical abuse during childhood, socioeconomic adversity). RESULTS: No clear evidence was found for any candidate gene polymorphism associations with depression phenotypes or any polymorphism-by-environment moderator effects. As a set, depression candidate genes were no more associated with depression phenotypes than noncandidate genes. The authors demonstrate that phenotypic measurement error is unlikely to account for these null findings. CONCLUSIONS: The study results do not support previous depression candidate gene findings, in which large genetic effects are frequently reported in samples orders of magnitude smaller than those examined here. Instead, the results suggest that early hypotheses about depression candidate genes were incorrect and that the large number of associations reported in the depression candidate gene literature are likely to be false positives.

Gender differential in social and economic predictors of incident major depressive disorder in the Ibadan Study of Ageing.

PURPOSE: Working on the hypothesis that the social and economic factors associated with onset of late-life depression operate differently for men and women, we investigated the impact of current social relationships and lifetime occupational attainment on incident major depressive disorder (MDD) assessed in three follow-up waves over a period of 5 years. METHODS: Participants were part of a household multistage probability sample of 2149 Nigerians who were aged 65 years and above. The presence of current and lifetime MDD was assessed using the World Health Organization (WHO) Composite International Diagnostic Interview. Participants' highest occupational attainment was categorised based on the International Standard Classification of Occupations, while socio-economic positions were estimated using asset-based measures relevant to low-income settings. Current social contacts and participation were assessed using items from the WHO Disability Assessment Schedule. RESULTS: We found an incidence rate of 120.9 per 1000 persons years (95% CI = 110.4-132.5) among 1394 persons who were free of lifetime MDD and dementia at baseline. Incidence rates were 94.7 (95% CI = 82.5-108.7) and 153.8 (136.3-173.6) per 1000 person years, in men and women respectively. In analyses comparing gender and adjusting for the effect of age, we found that while a lifetime of unskilled occupation (trade: HR = 1.4, 95% CI = 1.0-2.0, and elementary occupations: HR = 1.5, 95% CI = 1.1-2.1) was significantly associated with incident MDD in men (but not in women), living in a rural location (HR = 1.3, 95% CI = 1.0-1.7) and having no regular contact with family (HR = 2.2, 95% CI = 1.0-4.7) at baseline significantly predicted subsequent onset of MDD in women. CONCLUSION: There was a gender differential in the association of social and economic factors with incident MDD in this sample. These findings have implications for the design of early prevention strategies for late-life depression in sub-Saharan Africa.

Patterns of association of chronic medical conditions and major depression.

AIMS: Age and sex-related patterns of association between medical conditions and major depressive episodes (MDE) are important for understanding disease burden, anticipating clinical needs and for formulating etiological hypotheses. General population estimates are especially valuable because they are not distorted by help-seeking behaviours. However, even large population surveys often deliver inadequate precision to adequately describe such patterns. In this study, data from a set of national surveys were pooled to increase precision, supporting more precise characterisation of these associations. METHODS: The data were from a series of Canadian national surveys. These surveys used comparable sampling strategies and assessment methods for MDE. Chronic medical conditions were assessed using items asking about professionally diagnosed medical conditions. Individual-level meta-analysis methods were used to generate unadjusted, stratified and adjusted prevalence odds ratios for 11 chronic medical conditions. Random effects models were used in the meta-analysis. A procedure incorporating rescaled replicate bootstrap weights was used to produce 95% confidence intervals. RESULTS: Overall, conditions characterised by pain and inflammation tended to show stronger associations with MDE. The meta-analysis uncovered two previously undescribed patterns of association. Effect modification by age was observed in varying degrees for most conditions. This effect was most prominent for high blood pressure and cancer. Stronger associations were found in younger age categories. Migraine was an exception: the strength of association increased with age, especially in men. Second, especially for conditions predominantly affecting older age groups (arthritis, diabetes, back pain, cataracts, effects of stroke and heart disease) confounding by age was evident. For each condition, age adjustment resulted in strengthening of the associations. In addition to migraine, two conditions displayed distinctive patterns of association. Age adjusted odds ratios for thyroid disease reflected a weak association that was only significant in women. In epilepsy, a similar strength of association was found irrespective of age or sex. CONCLUSIONS: The prevalence of MDE is elevated in association with most chronic conditions, but especially those characterised by inflammation and pain. Effect modification by age may reflect greater challenges or difficulties encountered by young people attempting to cope with these conditions. This pattern, however, does not apply to migraine or epilepsy. Neurobiological changes associated with these conditions may offset coping-related effects, such that the association does not weaken with age. Prominent confounding by age for several conditions suggests that age adjustments are necessary in order to avoid underestimating the strength of these associations.

Is nonverbal behavior in patients and interviewers relevant to the assessment of depression and its recovery? A study with Dutch and Brazilian patients.

Nonverbal behaviors exhibited by patients with depression in their interactions with others may reflect social maladjustment and depression maintenance. Investigations of associations between unipolar depression and both patients' and interviewers' behaviors have been scarce and restricted to European samples. This study examined whether nonverbal behavior in patients and their interviewers is associated with depression severity and recovery. Cultural differences were explored. Seventy-eight depressed outpatients (28 Brazilians, 50 Dutch) were evaluated before and after 8-week pharmacological treatment. Patients were videotaped during the Hamilton Depression Scale interview before treatment, and the Brazilians were also videotaped after treatment. Nonverbal behaviors (patients' speaking effort and interviewers' encouragement) were analyzed using a two-factor ethogram. Results revealed that speaking effort was associated with encouragement and both are not influenced by baseline depression severity. However, from before to after treatment, whereas encouragement remained unchanged, speaking effort increased among unrecovered patients. Speaking effort was associated with patients' culture: Brazilians exhibited higher speaking effort than Dutch. These findings highlight that whereas the supportive nonverbal behavior of the interviewer may be stable, the set of nonverbal behaviors composed by head movements, eye contact and gestures displayed by the patients during their speaking in clinical interviews reflects depression persistence after treatment.

Economic evidence for the clinical management of major depressive disorder: a systematic review and quality appraisal of economic evaluations alongside randomised controlled trials.

AIMS: The aim of this systematic review of economic evaluations alongside randomised controlled trials (RCTs) was to provide a comprehensive overview of the evidence concerning cost-effectiveness analyses of common treatment options for major depression. METHODS: An existing database was used to identify studies reporting cost-effectiveness results from RCTs. This database has been developed by a systematic literature search in the bibliographic databases of PubMed, PsychINFO, Embase and Cochrane library from database inception to December 2014. We evaluated the quality of economic evaluations using a 10-item short version of the Drummond checklist. Results were synthesised narratively. The risk of bias of the included RCTs was assessed, based on the Cochrane risk of bias assessment tool. RESULTS: Fourteen RCTs were included from the 5580 articles screened on titles and abstracts. The methodological quality of the health economic evaluations was relatively high and the majority of the included RCTs had low risk of bias in most of Cochrane items except blinding of participants and personnel. Cognitive behavioural therapy was examined in seven trials as part of a variety of treatment protocols and seems cost-effective compared with pharmacotherapy in the long-term. However cost-effectiveness results for the combination of psychotherapy with pharmacotherapy are conflicting and should be interpreted with caution due to limited comparability between the examined trials. For several treatments, only a single economic evaluation was reported as part of a clinical trial. This was the case for comparisons between different classes of antidepressants, for several types of psychotherapy (behavioural activation, occupational therapy, interpersonal psychotherapy, short-term psychotherapy, psychodynamic psychotherapy, rational emotive behavioural therapy, solution focused therapy), and for transcranial magnetic stimulation v. electroconvulsive therapy. The limited evidence base for these interventions means generalisations, based on economic evaluation alongside clinical trials, cannot easily be made. CONCLUSIONS: There is some economic evidence underpinning many of the common treatment options for major depression. Wide variability was observed in study outcomes, probably attributable to differences in population, interventions or follow-up periods. For many interventions, only a single economic evaluation alongside clinical trials was identified. Thus, significant economic evidence gaps remain in the area of major depressive disorder.

Physical activity and energy expenditure during depressive episodes of major depression.

BACKGROUND: Recent data suggest a substantial association between physical activity and depressive symptoms, but there is a lack of research evaluating the physical activity levels in patients suffering from unipolar depression across different stages of disease in an objective way. The aim of the present pilot study was to objectively examine physical activity levels of this patient group compared to healthy controls. METHODS: Physical activity performance of 19 patients with major depressive episode and 19 healthy controls was assessed at three different time points using a multisensory armband device (SenseWear® Pro3 Armband) and was reported as total energy expenditure (TEE), active energy expenditure (EE), metabolic equivalents (METs), physical activity (PA) and time of lying down (LD), in each case over 24h. RESULTS: Over all measurements, depressive patients presented a significantly lower mean TEE and EE over 24h. Moreover, the patient group showed significantly shorter duration of PA and lower average MET over 24h. When depressive symptoms abated, physical activity parameters significantly increased in the patient group. Correlation analyses demonstrated a significant relation between depressive status/anhedonia and parameters of physical activity, especially in healthy subjects. LIMITATIONS: Results represented valid data for inpatients only. CONCLUSION: Acute unipolar depression was associated with a significantly lower level of physical activity and showed a significant increase in parallel to clinical improvement. Electronic monitoring of physical activity may be an additional tool for evaluating and controlling therapeutic effects.

Clinical and socio-demographic determinants of psychological health and burden in family caregivers of patients with unipolar depression.

INTRODUCTION: Depression affects nearly 350 million people worldwide and is currently among the most disabling diagnosis in the world. Caregiver burden can be immense in unipolar depression. The present study seeks to fill the knowledge gap by evaluating sociodemographic factors affecting psychological health and burden in caregivers of patients with unipolar depression. METHOD: Eighty outpatients with unipolar depression and their primary caregivers were included in the study. The patients were evaluated using clinical interview, DSM-IV TR criteria for Major Depressive Episode, Hamilton Depression Rating Scale (HDRS), Global Assessment of Functioning Scale (GAF) and Multidimensional Scale for Perceived Social Support (MSPSS). The caregivers were evaluated using HDRS and Zarit Burden Interview (ZBI). RESULTS: Caregiver burden was significantly higher in female spouse, employed caregivers and spouse caregivers married within the last one year as compared to caregivers other than wife, those unemployed and those married for more than one year. Caregiver burden in moderate as well as severe depressive episode did not show significant difference, although the more prolonged and non-responsive episodes placed a higher degree of burden on the caregivers. CONCLUSION: Early psychosocial intervention especially in the vulnerable family caregivers of depressed patients is an unmet need of mental health services which should be addressed by the clinician early to improve outcome and reduce caregiver burden in unipolar depression.

Utility Values for Adults with Unipolar Depression: Systematic Review and Meta-Analysis.

BACKGROUND: Unipolar depression is a mental illness with a substantial health-related and economic burden. Health interventions for depression predominately focus on improving sufferers' health-related quality of life (HRQoL). Utility is a measure of HRQoL that is required for use in model-based cost-utility analyses to assess the added value of health interventions. This review aimed to identify, summarize, and where feasible, synthesize published utilities for unipolar depression. METHODS: A structured electronic search combining common terms for unipolar depression and utility was conducted in MEDLINE, EMBASE, and PsycINFO. Utility values identified were summarized, and the study designs were appraised in terms of the patient population and valuation method used to generate utilities. Random-effect meta-analyses were applied to pool mean utilities identified for 3 depressive health states (mild, moderate, and severe) elicited from direct and indirect valuation methods separately. RESULTS: Thirty-five studies were identified that reported utilities for various levels of depression severity. The most commonly used direct valuation method for eliciting utilities was standard gamble (SG) (n = 5), and the most commonly used indirect valuation method was EQ-5D (n = 20). The pooled mean (standard deviation) utilities from studies using SG as a direct valuation method were mild = 0.69 (0.14), moderate = 0.52 (0.28), and severe = 0.27 (0.26). The pooled utilities from studies using EQ-5D as an indirect valuation method were mild = 0.56 (0.16), moderate = 0.45 (0.18), and severe = 0.25 (0.15). CONCLUSIONS: This systematic review is a useful resource for decision analysts who need health-related utility values to populate model-based cost-utility analyses of health interventions for the management of unipolar depression. Further research is necessary to understand whether direct or indirect valuation methods are the most robust sources for utilities in depression.

A multinational study to pilot the modified Hypomania Checklist (mHCL) in the assessment of mixed depression.

BACKGROUND: Mixed depression is a common, dimensional phenomenon that is increasingly recognized in unipolar and bipolar disorders. We piloted a modified version of the Hypomania Checklist (mHCL-32) to assess the prevalence and clinical correlates of concurrent manic (hypo) symptoms in depressed patients. METHODS: The mHCL-32, Young Mania Rating Scale (YMRS) and Hamilton Rating Scale for Depression (HAMD-24) were utilized in the assessment of unipolar (UP=61) and bipolar (BP=44) patients with an index major depressive episode confirmed by the Structured Clinical Interview for DSM-IV (SCID). Differential mHLC-32 item endorsement was compared between UP and BP. Correlation analyses assessed the association of symptom dimensions measured by mHCL-32, YMRS and HAMD-24. RESULTS: There was no significant difference between mood groups in the mean mHCL-32 and YMRS scores. Individual mHLC-32 items of increased libido, quarrels, and caffeine intake were endorsed more in BP vs. UP patients. The mHCL-32 active-elevated subscale score was positively correlated with the YMRS in BP patients and negatively correlated with HAMD-24 in UP patients. Conversely, the mHCL-32 irritable-risk taking subscale score was positively correlated with HAMD-24 in BP and with YMRS in UP patients. LIMITATIONS: Small sample size and cross-sectional design. CONCLUSION: Modifying the HCL to screen for (hypo) manic symptoms in major depression may have utility in identifying mixed symptoms in both bipolar vs. unipolar depression. Further research is encouraged to quantify mixed symptoms with standardized assessments.

Mania and bipolar disorder: Current concepts on assessment, diagnosis and management.

Mania is a common psychiatric syndrome characterized by pathological mood elevation, grandiose thinking and motor overactivity. Although current consensus upholds a true distinction between unipolar depression and bipolar disorders, the distinction between various bipolar sub-categories is still a matter for debate, as is the exact distinction between schizophrenia and mania. Most cases are functional in origin but many organic causes have been identified as well as iatrogenic causes from prescribed medication, particularly in susceptible individuals. The underlying aetiology is still poorly understood, although a number of biochemical abnormalities have recently been identified, and the evidence for a genetic role is strong. Its prevalence is universal, with some differences between gender and ethnicity reported, and it displays marked Axis I and II comorbidity. Treatment, both acute and long term, still relies on various traditional combinations of neuroleptics, benzodiazepines and mood stabilisers, particularly Lithium, which now appears to be less effective than previously thought and a shift towards using other mood stabilisers from the anticonvulsant class is now apparent. The exact role for psychological treatment remains unclear with more research required. Good medical management includes; adequate treatment, physical and laboratory investigations, dedicated follow-up and supervision by hospital psychiatrists and community-based care agencies.