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Delineation of the clinical picture of Dysphoric/Mixed Hypomania.
Prog Neuropsychopharmacol Biol Psychiatry. 2007 May 09; 31(4):944-51.PN

Abstract

BACKGROUND

While Mixed Depression (i.e. depression plus subthreshold concurrent manic/hypomanic symptoms) has recently seen a wave of studies, little is known about Dysphoric/Mixed Hypomania (i.e. combination of syndromal hypomania and depression) compared to Bipolar I Disorder Mixed State (i.e. combination of syndromal mania and depression).

STUDY AIM

To delineate the clinical picture of Dysphoric/Mixed Hypomania.

METHODS

Consecutive 441 Bipolar II Disorder (BP-II) Major Depressive Episode (MDE) outpatients were cross-sectionally assessed for depression and concurrent hypomanic symptoms when presenting for treatment of depression, by a mood disorder specialist psychiatrist (FB), using the Structured Clinical Interview for DSM-IV, in a private practice. Consecutive 275 remitted BP-II were also assessed for the clinical picture of past (recalled) Hypomania. Dysphoric Hypomania was defined as the co-occurrence of DSM-IV irritable mood Hypomania and MDE.

RESULTS

Frequency of Dysphoric Hypomania was 17.0%, and it was 66.4% for Mixed Depression. Irritable mood, always present by definition in Dysphoric Hypomania, was present in 65.9% of recalled Hypomania and elevated mood in 81.4%. Dysphoric Hypomania had significantly more racing/crowded thoughts, and much less increased goal-directed activity. Functioning was always impaired in Dysphoric Hypomania (by definition), while it was improved in most recalled Hypomanias. Factor structure was different: recalled Hypomania had three factors ('elevated mood', 'irritability and racing/crowded thoughts', 'goal-directed and risky overactivity'), Dysphoric Hypomania had five factors ('depressive vegetative symptoms', 'low mood and psychomotor agitation', 'risky activities', 'loss of interest', 'racing/crowded thoughts and suicidality').

DISCUSSION

Dysphoric Hypomania was uncommon among depressed outpatients (while Mixed Depression was common). Its clinical picture was closer to depression than to hypomania. If it were seen as a simple depression, antidepressants could be used alone (i.e. not protected by mood stabilising agents), risking the worsening of intra-depression irritable hypomania (which was related to suicidality). Systematic assessment of intra-depression hypomanic symptoms is supported.

Authors+Show Affiliations

Hecker Psychiatry Research Center, University of California at San Diego, USA. FrancoBenazzi@FBenazzi.it

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17391823

Citation

Benazzi, Franco. "Delineation of the Clinical Picture of Dysphoric/Mixed Hypomania." Progress in Neuro-psychopharmacology & Biological Psychiatry, vol. 31, no. 4, 2007, pp. 944-51.
Benazzi F. Delineation of the clinical picture of Dysphoric/Mixed Hypomania. Prog Neuropsychopharmacol Biol Psychiatry. 2007;31(4):944-51.
Benazzi, F. (2007). Delineation of the clinical picture of Dysphoric/Mixed Hypomania. Progress in Neuro-psychopharmacology & Biological Psychiatry, 31(4), 944-51.
Benazzi F. Delineation of the Clinical Picture of Dysphoric/Mixed Hypomania. Prog Neuropsychopharmacol Biol Psychiatry. 2007 May 9;31(4):944-51. PubMed PMID: 17391823.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Delineation of the clinical picture of Dysphoric/Mixed Hypomania. A1 - Benazzi,Franco, Y1 - 2007/03/03/ PY - 2006/12/26/received PY - 2007/02/26/revised PY - 2007/02/27/accepted PY - 2007/3/30/pubmed PY - 2007/8/4/medline PY - 2007/3/30/entrez SP - 944 EP - 51 JF - Progress in neuro-psychopharmacology & biological psychiatry JO - Prog Neuropsychopharmacol Biol Psychiatry VL - 31 IS - 4 N2 - BACKGROUND: While Mixed Depression (i.e. depression plus subthreshold concurrent manic/hypomanic symptoms) has recently seen a wave of studies, little is known about Dysphoric/Mixed Hypomania (i.e. combination of syndromal hypomania and depression) compared to Bipolar I Disorder Mixed State (i.e. combination of syndromal mania and depression). STUDY AIM: To delineate the clinical picture of Dysphoric/Mixed Hypomania. METHODS: Consecutive 441 Bipolar II Disorder (BP-II) Major Depressive Episode (MDE) outpatients were cross-sectionally assessed for depression and concurrent hypomanic symptoms when presenting for treatment of depression, by a mood disorder specialist psychiatrist (FB), using the Structured Clinical Interview for DSM-IV, in a private practice. Consecutive 275 remitted BP-II were also assessed for the clinical picture of past (recalled) Hypomania. Dysphoric Hypomania was defined as the co-occurrence of DSM-IV irritable mood Hypomania and MDE. RESULTS: Frequency of Dysphoric Hypomania was 17.0%, and it was 66.4% for Mixed Depression. Irritable mood, always present by definition in Dysphoric Hypomania, was present in 65.9% of recalled Hypomania and elevated mood in 81.4%. Dysphoric Hypomania had significantly more racing/crowded thoughts, and much less increased goal-directed activity. Functioning was always impaired in Dysphoric Hypomania (by definition), while it was improved in most recalled Hypomanias. Factor structure was different: recalled Hypomania had three factors ('elevated mood', 'irritability and racing/crowded thoughts', 'goal-directed and risky overactivity'), Dysphoric Hypomania had five factors ('depressive vegetative symptoms', 'low mood and psychomotor agitation', 'risky activities', 'loss of interest', 'racing/crowded thoughts and suicidality'). DISCUSSION: Dysphoric Hypomania was uncommon among depressed outpatients (while Mixed Depression was common). Its clinical picture was closer to depression than to hypomania. If it were seen as a simple depression, antidepressants could be used alone (i.e. not protected by mood stabilising agents), risking the worsening of intra-depression irritable hypomania (which was related to suicidality). Systematic assessment of intra-depression hypomanic symptoms is supported. SN - 0278-5846 UR - https://www.unboundmedicine.com/medline/citation/17391823/Delineation_of_the_clinical_picture_of_Dysphoric/Mixed_Hypomania_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0278-5846(07)00074-7 DB - PRIME DP - Unbound Medicine ER -