Unipolar or Bipolar Depression? How to Tell the Difference
Unipolar or Bipolar Depression? How to Tell the Difference
Cassano GB, Rucci P, Benvenuti A, et al
J Clin Psychiatry. 2012;73:22-28
Cassano and colleagues report an analysis of outpatients and inpatients with mood disorders (N = 1158) who participated in 5 studies in the United States and Italy. Diagnostic assessment was carried out using the Structured Clinical Interview for DSM-IV-TR Axis I disorders. Using a classification tree, 5 mania spectrum factors and 6 depression spectrum factors derived from the Mood Spectrum Self-Report Instrument in combination with demographic and clinical characteristics were used to discriminate participants with unipolar vs bipolar disorders. The psychomotor activation factor, assessing the presence of thought acceleration, distractibility, hyperactivity, and restlessness for 1 or more periods of at least 3-5 days in the patient's lifetime, identified subgroups with an increasing likelihood of bipolar disorder diagnosis.
In this study, and consistent with previous published reports, the lifetime psychomotor activation factor proved to be the most potent discriminator of individuals with unipolar vs bipolar depression. For patients with intermediate or low levels of psychomotor activation, the mixed instability factor and elevated mood (the euphoria factor) contributed to discrimination of bipolar from unipolar disorder. The investigators make the point that bipolar disorders are often underrecognized, misdiagnosed, and incorrectly treated. A common clinical problem is how to treat a patient with a major depressive episode when we are not certain whether the patient has unipolar or bipolar depression. This determination has important consequences for suitable pharmacotherapy.
Abstract
The Role of Psychomotor Activation in Discriminating Unipolar From Bipolar Disorders: A Classification-Tree Analysis
Cassano GB, Rucci P, Benvenuti A, et al
J Clin Psychiatry. 2012;73:22-28
Study Summary
Cassano and colleagues report an analysis of outpatients and inpatients with mood disorders (N = 1158) who participated in 5 studies in the United States and Italy. Diagnostic assessment was carried out using the Structured Clinical Interview for DSM-IV-TR Axis I disorders. Using a classification tree, 5 mania spectrum factors and 6 depression spectrum factors derived from the Mood Spectrum Self-Report Instrument in combination with demographic and clinical characteristics were used to discriminate participants with unipolar vs bipolar disorders. The psychomotor activation factor, assessing the presence of thought acceleration, distractibility, hyperactivity, and restlessness for 1 or more periods of at least 3-5 days in the patient's lifetime, identified subgroups with an increasing likelihood of bipolar disorder diagnosis.
Viewpoint
In this study, and consistent with previous published reports, the lifetime psychomotor activation factor proved to be the most potent discriminator of individuals with unipolar vs bipolar depression. For patients with intermediate or low levels of psychomotor activation, the mixed instability factor and elevated mood (the euphoria factor) contributed to discrimination of bipolar from unipolar disorder. The investigators make the point that bipolar disorders are often underrecognized, misdiagnosed, and incorrectly treated. A common clinical problem is how to treat a patient with a major depressive episode when we are not certain whether the patient has unipolar or bipolar depression. This determination has important consequences for suitable pharmacotherapy.
Abstract
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