Comparison of associated features and drug treatment between co-occurring unipolar and bipolar disorders in depressed eating disorder patients

Abstract

BackgroundTo examine the differences of associated characteristics and prescription drug use between co-occurring unipolar and bipolar disorders in patients with eating disorders (EDs).MethodsPatients with EDs and major depressive episode (MDE) were recruited from psychiatric outpatient clinics. They were interviewed and completed self-administered measures assessing eating and general psychopathology. The prescribed drugs at the index outpatient visit were recorded. Clinical characteristics and prescription drugs of groups with major depressive disorder (ED-MDD), MDE with lifetime mania (ED-BP I), and MDE with lifetime hypomania (ED-BP II) were compared. Continuous variables between groups were compared using generalized linear regression with adjustments of age, gender, and ED subtype for pair-wise comparisons. Multivariate logistic regression with adjustments of age, gender, and ED subtype was employed to estimate adjusted odds ratios with 95% confidence intervals between groups.ResultsTwo hundred and twenty-seven patients with EDs had a current MDE. Among them, 17.2% and 24.2% experienced associated manic and hypomanic episodes, respectively. Bipolar I and II patients displayed significantly poorer weight regulation, more severe impulsivity and emotional lability, and higher rates of co-occurring alcohol use disorders than ED-MDD patients. ED-BP I patients were found to have the lowest IQ, poorest working memory, and the most severe depression, suicidality and functional impairment among all patients. Patients with ED-BP II shared affect and behavioral dysregulations with ED-BP I, but had less severe degrees of cognitive and functional impairments than ED-BP I. Patients with ED-BP I were significantly less likely than those in the ED-MDD and ED-BP II groups to be on antidepressant monotherapy, but a great rate (27%) of ED-BP I individuals taking antidepressant monotherapy had potential risk of mood switch during the course of treatment.ConclusionsOur study identified discriminative features of bipolar I and II disorders from MDD among a group of depressed ED patients. We suggest that the associated mania, hypomania, and mood lability are predictors of clinical severity and should be identified from ED patients presented with depressive features. Accurate diagnosis of bipolar disorders may have implications for pharmacotherapy in patients with EDs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-017-1243-0) contains supplementary material, which is available to authorized users.

Obesity in patients with major depression is related to bipolarity and mixed features: evidence from the BRIDGE‐II‐Mix study

“…Antipsychotic agents are known to be associated with obesity, 44 even though other studies have reported that about 40% of drug-naïve BD patients were OB or overweight. 37 As BD-I patients are more likely to be treated with antipsychotic agents/mood stabilizers compared to BD-II patients, 45 in our sample the higher prevalence of a BD-I diagnosis in MDE-OB patients in comparison to a BD-II diagnosis could have been related to the psychotropic medications. However, there are insufficient data to define how much psychotropic treatment is associated with overweight in BD patients.…”

Phonological working memory is adversely affected in adults with anorexia nervosa: a systematic literature review

“…BMI values for the HC were not consistently reported but for the 18 studies that did, the mean BMI was 21.4 (Table 1). 19 of the studies exclusively included female participants, with the exception of the mixed gender groups in five studies [36,[39][40][41][42]. Zegarra-Valdivia and Chino-Vilca [43] did not specify the genders of their sample.…”

“…The literature search yielded 25 studies examining WM capacity in AN across 14 countries, 19 of which were case versus control studies and formed the main analysis. The remaining six studies examined WM within AN-R [ 33 , 34 ], pre-and post-recovered AN [ 35 ], comorbid and medicated ED [ 36 , 37 ] or did not perform statistical comparisons between the clinical ED and non-clinical HC groups [ 38 ] (Table 3 ). The combined sample size included 850 AN participants with a mean age of 23 years and a mean BMI of 15.7.…”

“…In order of prevalence, the following comorbidities were reported: depression [ 36 , 40 , 55 ], anxiety [ 33 , 40 , 41 , 55 ], affective disorder [ 18 , 33 ], suicide risk [ 33 ], stress-related disorders, mood disorder, personality disorder [ 42 ], bipolar disorder [ 36 ], addictive behaviours, attention deficit hyperactivity disorder [ 33 ], autism spectrum disorder and psychotic symptoms [ 18 ] (Table 1 ). Obsessive compulsive disorder (OCD) was also present in the patient cohorts of van Noort et al [ 39 ] and Malagoli et al [ 37 ], but no exact demographic values were given and no links between WM performance and OCD were made despite the high comorbidity risk in AN, and in particular AN-BP [ 78 , 79 ].…”

“…In Tseng et al [ 36 ] mixed ED group (AN, BN, BED, and Eating Disorder Not Otherwise Specified (EDNOS)), the participants with comorbid major depressive disorder (MDD) and bipolar I or II disorder were significantly worse in verbal/auditory arithmetic and digit span tasks, than ED patients with just MDD. Moreover, co-occurring bipolar I disorder was associated with overall impairments in WM and intelligence measures.…”