Clinical subtypes of severe bipolar mixed states

Perugi, Giulio; Medda, Pierpaolo; Reis, João; Rizzato, Salvatore; Mariani, Michela Giorgi; Mauri, Mauro

doi:10.1016/j.jad.2013.08.037

Cited by 30 publications

(18 citation statements)

References 41 publications

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“…Given the high number of variables to cluster (ie, 63 items) we performed an Exploratory Factor Analysis (EFA) with all those items aimed at exploring specific psychopathological domains. We therefore excluded those items not relevant (Perugi et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Dimensional structure of first episode psychosis

Tonna

Ossola

Marchesi

et al. 2019

Early Intervention Psych

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Aim Current diagnostic systems, DSM‐5 and ICD‐10, still adopt a categorical approach to classify psychotic disorders. The present study was aimed at investigating the structure of psychotic symptomatology in both affective and non‐affective psychosis from a dimensional approach. Methods Participants with a first episode psychosis (FEP) were recruited from a cluster‐randomized controlled trial (GET‐UP PIANO TRIAL), offered to all Community Mental Health Centres (CMHCs) located across two northern Italian regions. After clinical stabilization, patients were assessed with a comprehensive set of psychopathological measures including the Positive and Negative Syndrome Scale, the Hamilton Depression Rating Scale and the Bech‐Rafaelsen Mania Rating Scale. A two‐step cluster analysis was performed. Results Overall, 257 FEP patients (male, n = 171, 66.5%; mean age = 24.96 ± 4.56) were included in the study. The cluster analysis revealed a robust four‐cluster solution: delusional‐persecutory (n = 82; 31.9%), depressed (n = 95; 37%), excited (n = 26; 10.1%) and negative‐disorganized (n = 54; 21%), thus suggesting a quadripartite structure with both affective and non‐affective dimensions. Among non‐affective dimensions, negative and disorganization symptoms constituted a unique construct apart from positive symptoms. Conclusions Symptom dimensions may represent a useful tool for dissecting the indistinct and non‐specific psychopathology of FEP in order to better target specific interventions.

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Section: Discussionmentioning

confidence: 99%

Dimensional structure of first episode psychosis

Tonna

Ossola

Marchesi

et al. 2019

Early Intervention Psych

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“…At the end of the ECT course, 41.6% responded to ECT, and 30.5% were in remission [25]. In particular, the subgroup with agitated-irritable mixed depression showed the highest remission rate after ECT than any of the other subgroups with psychotic-retarded mixed depression, psychoticmixed mania and anxious-irritable-psychotic mixed mania [24]. ECT therefore shows promise as a treatment option for treatment-resistant cases with depressed mixed state.…”

Section: Therapeutic Considerations In Depressive Mixed Statementioning

confidence: 95%

“…Third, atypical antipsychotics, like olanzapine, quetiapine and aripiprazole, may be considered for the urgent stabilization of depressive mixed state, especially in acute-phase therapy [19][20][21]. Also, asenapine [22] and lurasidone [23] [24,25]. At the end of the ECT course, 41.6% responded to ECT, and 30.5% were in remission [25].…”

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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“…Mutants showed fluctuations in both manic-and depressive-like behavior, recapitulating aspects of a mixed state in BPD patients, defined by co-occurrence of manic and depressive symptoms (McElroy et al, 1995;Perugi et al, 2013). However, most of the mutants did not switch between manic-and depressive-like symptoms over time.…”

Section: Validity and Limitations Of En1 þ /Otx2 Mutants As Model Formentioning

confidence: 93%

Abnormal Development of Monoaminergic Neurons Is Implicated in Mood Fluctuations and Bipolar Disorder

Jukić

Carrillo-Roa

Bar

et al. 2014

Neuropsychopharmacol

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Subtle mood fluctuations are normal emotional experiences, whereas drastic mood swings can be a manifestation of bipolar disorder (BPD). Despite their importance for normal and pathological behavior, the mechanisms underlying endogenous mood instability are largely unknown. During embryogenesis, the transcription factor Otx2 orchestrates the genetic networks directing the specification of dopaminergic (DA) and serotonergic (5-HT) neurons. Here we behaviorally phenotyped mouse mutants overexpressing Otx2 in the hindbrain, resulting in an increased number of DA neurons and a decreased number of 5-HT neurons in both developing and mature animals. Over the course of 1 month, control animals exhibited stable locomotor activity in their home cages, whereas mutants showed extended periods of elevated or decreased activity relative to their individual average. Additional behavioral paradigms, testing for manic- and depressive-like behavior, demonstrated that mutants showed an increase in intra-individual fluctuations in locomotor activity, habituation, risk-taking behavioral parameters, social interaction, and hedonic-like behavior. Olanzapine, lithium, and carbamazepine ameliorated the behavioral alterations of the mutants, as did the mixed serotonin receptor agonist quipazine and the specific 5-HT2C receptor agonist CP-809101. Testing the relevance of the genetic networks specifying monoaminergic neurons for BPD in humans, we applied an interval-based enrichment analysis tool for genome-wide association studies. We observed that the genes specifying DA and 5-HT neurons exhibit a significant level of aggregated association with BPD but not with schizophrenia or major depressive disorder. The results of our translational study suggest that aberrant development of monoaminergic neurons leads to mood fluctuations and may be associated with BPD.

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Clinical subtypes of severe bipolar mixed states

Cited by 30 publications

References 41 publications

Dimensional structure of first episode psychosis

Dimensional structure of first episode psychosis

Diagnostic and Therapeutic Considerations in Depressive Mixed State

Abnormal Development of Monoaminergic Neurons Is Implicated in Mood Fluctuations and Bipolar Disorder

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