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Biomedical subjects

Franco Benazzi

Publications and source records attributed to Franco Benazzi.

At least 55 records · Page 3Linked to original sources
PubMed2005

The HCL-32: towards a self-assessment tool for hypomanic symptoms in outpatients.

BACKGROUND: Bipolar disorders (BP) are frequently diagnosed and treated as pure depression initially; accurate diagnosis often being delayed by 8 to 10 years. In prospective studies, the presence of hypomanic symptoms in adolescence is strongly predictive of later bipolar disorders. As such, an instrument for self-assessment of hypomanic symptoms might increase the detection of suspected and of manifest, but under-treated, cases of bipolar disorders. METHODS: The multi-lingual hypomania checklist (HCL-32) has been developed and is being tested internationally. This preliminary paper reports the performance of the scale in distinguishing individuals with BP (N=266) from those with major depressive disorder (MDD; N=160). The samples were adult psychiatry patients recruited in Italy (N=186) and Sweden (N=240). RESULTS: The samples reported similar clinical profiles and the structure for the HCL-32 demonstrated two main factors identified as "active/elated" hypomania and "risk-taking/irritable" hypomania. The HCL-32 distinguished between BP and MDD with a sensitivity of 80% and a specificity of 51%. LIMITATIONS: Although the HCL-32 is a sensitive instrument for hypomanic symptoms, it does not distinguish between BP-I and BP-II disorders. CONCLUSIONS: Future studies should test if different combinations of items, possibly recording the consequences of hypomania, can distinguish between these BP subtypes.

Ambulatory Care↗
PubMed2005

Agitated depression in bipolar II disorder.

STUDY AIM: To test diagnostic validity or utility of agitated depression (AD) in bipolar II disorder (BP-II). METHODS: Three hundred and twenty BP-II major depressive episode (MDE) outpatients interviewed with the Structured Clinical Interview for DSM-IV, Hypomania Interview Guide (HIG), and Family History Screen. AD defined as MDE with psychomotor agitation. Mixed depression defined as MDE with > or =4 hypomanic symptoms. AD, non-AD, mixed-AD, non-mixed-AD, and mixed-non-AD were compared versus diagnostic validators. RESULTS: AD was present in 35.0%, 75.8% of AD were mixed, while only 14.3% of non-AD were mixed (P=0.0000). AD (n=112), versus non-AD (n=208), had significantly higher age, more females, recurrences, bipolar I family history, and much more concurrent hypomanic symptoms. Mixed-AD (n=85), versus non-mixed-AD (n=27), was not significantly different, apart from more hypomanic symptoms (by definition), but there were clinically significant differences. CONCLUSIONS: Findings may partly support subtyping of AD in BP-II, on the basis of its frequent clustering of hypomanic symptoms, and its different family history. This subtyping may impact on treatment of BP-II depression, as antidepressants alone may increase agitation while mood stabilising agents can treat agitation before using antidepressants.

Adult↗
PubMed2005

Toward a clinical delineation of dysphoric hypomania - operational and conceptual dilemmas.

OBJECTIVE: Unlike dysphoric mania, we are unaware of any formal studies of dysphoric hypomania (DH). For this reason, DH is not formally recognized by DSM-IV and ICD-10. Analogous to the DSM-IV approach in the diagnosis of manic mixed state, in this exploratory study we operationalized DH as coexisting full syndromal hypomanic and major depressive states. METHODS: In an Italian outpatient private practice setting, 320 BP-II outpatients [meeting DSM-IV criteria except for shorter (> or =2 days) floor duration for history of hypomanic episodes] were further interviewed with the modified SCID-CV for the simultaneous presence of hypomanic and depressive signs and symptoms during the index presenting affective episode or its exacerbation. Hypomania always included irritable mood plus at least four hypomanic signs and symptoms. Such non-euphoric hypomania had to last at least 1 week. RESULTS: Only 45 (14.0%) met our proposed criteria for DH. Less stringently defined depressive mixed states (DMX) were excluded from further analyses. When compared with 120 of the 320 (37.5%) 'pure' BP-II (i.e., not meeting mixed state criteria), DH emerged as an irritable affective state, demonstrated a significantly higher rate of females, mood lability, racing/crowded thoughts, distractibility, increased talkativeness, psychomotor agitation, and increased goal-directed drives. Psychomotor agitation/activation had a specificity of 87% and sensitivity of 94%, correctly classifying 92% of cases of DH. CONCLUSIONS: The DSM-IV concept of dysphoric manic mixed state can be extended to DH. In the latter, eutrophic exuberance is replaced by irritable-labile mood, and the hypomanic expansiveness finds expression in mental, psychomotor and behavioral activation that could involve increased drives (e.g., travel, substances, and sex) and social disinhibition. It is useful to contrast the foregoing picture of DH as hypomanic exuberance muted by leaden paralysis, with that of our previous work on DMX as a major depressive mixed state with more subtle excitatory hypomanic intrusions. We discuss methodologic, theoretical and practical implications of categorical (DH) and dimensional (DMX) conceptualizations of mixed states beyond mania.

Adult↗
PubMed2005

Unipolar depression with racing thoughts: a bipolar spectrum disorder?

Major depressive disorder (MDD) with racing/crowded thoughts is understudied. Kraepelin classified 'depression with flight of ideas' in the mixed states of his manic-depressive insanity. The aim of the study was to test whether MDD with racing/crowded thoughts was close to bipolar disorders. Consecutive 379 bipolar-II disorder (BP-II) and 271 MDD depressed outpatients were interviewed using the Structured Clinical Interview for DSM-IV, the Hypomania Interview Guide, and the Family History Screen, by a senior psychiatrist in a private practice. Intra-depression hypomanic symptoms were systematically assessed. Mixed depression was defined as a major depressive episode (MDE) plus three or more intra-MDE hypomanic symptoms. MDD with racing/crowded thoughts was compared to MDD without racing/crowded thoughts on classic bipolar validators (young onset age, many recurrences, atypical and mixed depression, bipolar family history). Frequency of MDD with racing/crowded thoughts was 56.4%. MDD with racing/crowded thoughts, versus MDD without racing/crowded thoughts, had significantly lower age at onset, more MDE severity, more psychotic, melancholic, atypical, and mixed depressions, and more bipolar family history. Of the intra-MDE hypomanic symptoms, irritability, psychomotor agitation and distractibility were significantly more common in MDD with racing/crowded thoughts. Compared to BP-II on bipolar validators, validators were less common in MDD with racing/crowded thoughts. MDD with racing/crowded thoughts seemed to be a severe variant of MDD. MDD with racing/crowded thoughts versus MDD without racing/crowded thoughts, and versus BP-II, had significant differences on bipolar validators, suggesting that it may lie along a continuum linking MDD without racing/crowded thoughts and BP-II.

Adult↗
PubMed2005

Assessing the community prevalence of bipolar spectrum symptoms by the mood disorder questionnaire.

BACKGROUND: The goal of this study was to assess the frequency and spectrum of symptoms related to bipolar disorders in a community sample by means of a self-rating questionnaire. METHOD: The Mood Disorder Questionnaire, a self-rating scale which evaluates DSM-IV manic/hypomanic symptoms, was administered to a community sample of 1,034 individuals recruited through advertisements. Symptom interrelationships were studied by factor analysis. RESULTS: 275 individuals (26.6%) reported moderate or severe impairment due to the symptoms. Manic/hypomanic symptoms were present in a high proportion of individuals. Factor analysis found a two-factor structure of bipolar spectrum symptoms (an elevated mood overactivity factor, and an irritable behavior factor). CONCLUSION: The findings of this study highlight the need of complementing clinical investigations on the bipolar spectrum with community studies. Subclinical manic-hypomanic symptoms may be present also in allegedly unipolar patients and may have implications on the course of illness.

Adolescent↗
PubMed2005

Optimizing the detection of bipolar II disorder in outpatient private practice: toward a systematization of clinical diagnostic wisdom.

BACKGROUND: We review a clinical diagnostic approach to validate a redefinition of bipolar II disorder (BPII), which bypasses several conservative steps in the DSM-IV Mood Module of the Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV) to make detection of BPII more "clinician-friendly." METHOD: 563 consecutive private outpatients presenting with a DSM-IV-diagnosed major depressive episode (MDE) were included in the analyses. We used a modified SCID-CV in a semistructured way, used a duration of hypomania > or =2 days (rather than the 4-day floor cutoff recommended), did not follow the SCID-CV's stem (mood) skip-out instruction, focused more on past history of overactive behavior rather than mood change, and assessed hypomanic features both outside and during index MDE. Validation of BPII so-defined against major depressive disorder (MDD) was undertaken in the Washington University tradition. The study was conducted from June 1999 to December 2003. RESULTS: BPII occurred in 56.8% of patients. Compared with MDD, BPII had a significantly earlier index age and age at onset of first MDE and higher rates of atypical features, depressive recurrences, hypomanic symptoms during MDE, trait mood lability, and bipolar family history (p = .0000 for all variables). CONCLUSIONS: Our experience suggests that when probing history for past hypomanic episodes, behavioral activation should be inquired first, thereby facilitating the patient's subsequent recall of euphoria and/or irritability during such activated periods. Information from significant others or past records is also crucial. In light of these clinical procedures, BPII emerged as more prevalent than MDD. We submit that clinicians have the distinct advantage of intimate knowledge of their patients, which, coupled with the procedures outlined herein, can maximize the yield of BPII diagnoses.

Adult↗
PubMed2004

Depressive mixed state: a feature of the natural course of bipolar II (and major depressive) disorder?

BACKGROUND: Depressive mixed state (DMX), i.e., a combination of hypomanic and depressive symptoms during the same episode, has recently seen a rebirth of studies after Kraepelin's description. Kraepelin observed, in an inpatient sample, that DMX was related to the number of episodes and to duration of manic-depressive insanity (illness). STUDY AIM: The aim was to test Kraepelin's observations in a very different sample. METHODS: 563 consecutive outpatients with major depressive episode (MDE)--320 with bipolar II disorder and 243 with major depressive disorder--were interviewed, in a private practice, by the Structured Clinical Interview for DSM-IV as modified by Benazzi and Akiskal (2003). Hypomanic symptoms during MDE were systematically assessed in patients while off psychoactive drugs. DMX was dimensionally defined, following Akiskal and Benazzi (2003), as an MDE plus 3 or more combined hypomanic symptoms. Kraepelin's examples of DMX, i.e., agitated depression (MDE plus psychomotor agitation) and depression with flight of ideas (MDE plus racing thoughts) were also tested. Univariate and multivariate logistic regression was used to study associations. RESULTS: DMX was present in 49.5% of the patients. Multiple logistic regression of DMX versus MDE recurrences and duration of illness, controlled for age, found a strong and significant association only between DMX and duration of illness. The same association was found between agitated depression and duration of illness (but not in depression with racing thoughts). LIMITATION: There was only a single interviewer. DISCUSSION: The findings support Kraepelin's observation of a link between DMX and durations of illness, but not that between DMX and recurrences. Onset of DMX could be more related to the natural course of manic-depressive illness than to a kindling process.

Adult↗
PubMed2004

Mixed states in bipolar II disorder: should full hypomania always be required?

The aim of the study was to test whether the definition of depressive mixed states (DMX) in bipolar II disorder should require satisfaction of full criteria for hypomania or if only a few hypomanic symptoms should be required. Consecutive outpatients with bipolar II major depressive episode (MDE) (n=260) were assessed with the Structured Clinical Interview for DSM-IV. Presence of hypomanic symptoms during MDE was systematically assessed, and symptoms were graded by rating scale. The following three definitions of DMX were compared: (1) MDE plus full criteria for hypomania, (2) MDE plus three or more hypomanic symptoms (DMX3), and (3) MDE plus one or two hypomanic symptoms (DMX1-2). DMX definitions were compared on variables typically associated with bipolar disorders (young age of onset, many recurrences, atypical features of depression, and bipolar family history). The distributions of hypomanic symptom scores, age, and age of onset were studied by Kernel density estimation curves and by histograms. Bimodality would support distinct disorders, whereas lack of bimodality would support continuity among the different DMX definitions. The frequency of DMX+full hypomania was 12.3%, that of DMX3 was 46.9%, and that of of DMX1-2 was 38.8%. Comparisons among the groups on bipolar validators found that most differences were not significant. Kernel density estimation curves and histograms did not show bimodality, and had near normal distribution shapes. The findings do not support a categorical definition of bipolar II DMX like that of DSM-IV for bipolar I mixed state but are consistent with a dimensional definition of bipolar II DMX. The high frequency of DMX in bipolar II MDE supports the need for controlled studies to test the effects of antidepressants on depressive mixed state (as clinical observations suggest possible negative effects).

Adult↗
PubMed2004

Toward better probing for hypomania of bipolar-II disorder by using Angst's checklist.

The reliability of the diagnosis of bipolar-II disorder (BP-II) is still a problem. Semi-structured interviews by clinicians might partly overcome this problem. The aims of this study were to find the degree of agreement in the diagnosis of BP-II between the Structured Clinical Interview for DSM-IV (SCID) and a semi-structured interview based on Angst's hypomania checklist (Angst et al., 2003), and to assess the priority among hypomanic symptoms for the diagnosis of BP-II. Remitted depression outpatients (N = 102) were interviewed during a follow-up visit using th Structured Clinical Interview for DSM-IV (SCID), and then with Angst's semi-structured interview, following DSMIV criteria. Bipolar I (BP-I) patients were excluded. Using the SCID, 29 patients were diagnosed BP-II, 26 BP-I, and 47 major depressive disorder (MDD). By the semi-structured interview 69 patients were diagnosed BP-II, 33 MDD, and none BP-I. Agreement for the diagnosis of BP-II between the two interviews was 53.9% (k = 0.18). Re-analysis, after deleting the SCID question on the impact on functioning (DSM-IV unclear boundary between BP-I and BP-II), increased agreement to 78.4% (k = 0.55). Elevated mood and overactivity (increased goal-directed activity) had th lowest agreement (k = 0.46 0.49). For predicting BP-II, overactivity had the highest sensitivity (94.2%), whil elevated mood had a sensitivity of 84.0%. Multivariate analysis for predicting BP-II (diagnosed by semi-structured interview), including all DSM-IV hypomanic symptoms, found that mood change and overactivity were the only independent predictors. Overactivity plus at least three symptoms (as suggested by Angst and Gamma, 2002) were present in 71 patients, of whom 91.5% also met DSM-IV criteria for hypomania. Overactivity and elevated mood were strongly associated (but not overactivity and irritability). Findings may support a diagnosis of BP-II based on Angst's semi-structured interview versus the fully structured SCID interview. While DSM-IV always requires mood change for the diagnosis of hypomania, the present findings may suggest that overactivity could have the same priority, as suggested by Angst et al. (2003) and by Akiskal et al. (1977, 2001, 2003).

Adult↗
PubMed2004

Validating Angst's "ups & downs" personality trait as a new marker of bipolar II disorder.

BACKGROUND: Angst has recently found an association between the bipolar spectrum and a personality trait called "ups & downs", defined by the question "would you say you were one of those people who have frequent ups and downs?". Study aim was to find the frequency of "ups & downs" in a large sample of bipolar II (BPII) and major depressive disorder (MDD),and to test its association with BPII. METHODS: Consecutive 89 MDD and 89 BPII outpatients were interviewed, during a major depressive episode (MDE),with the Structured Clinical Interview for DSM-IV, as modified by Benazzi and Akiskal (2003). Hypomanic symptoms during MDE were systematically assessed. The association between "ups & downs" (defined by Angst's question) and BPII was tested versus bipolar validators (young onset, many recurrences, atypical depression, depressive mixed state [MDE plus 3 or more concurrent hypomanic symptoms, following Akiskal and Benazzi's definition (2003)], and bipolar family history. Associations were tested by univariate and multivariate logistic regression (STATA 7). RESULTS: "ups & downs" was present in 62.9% of BPII and in 33.7% of MDD (ratio = 1.86, p = 0.0001). All bipolar validators were significantly more common in BPII versus MDD. Sensitivity and specificity of bipolar validators for predicting BPII, including "ups & downs", showed that "ups & downs" had a balanced combination of sensitivity (62.9 %) and specificity (66.2 %) (i. e., sensitivity not too low compared to specificity and vice versa) for predicting BPII, and that it was strongly associated with BPII (odds ratio = 3.3, 95% CI 1.8-6.1). Multivariate analyses found that "ups & downs" independently and significantly predicted BPII among the other bipolar validators. Patients did not confuse "ups & downs" with many past MDEs, as the association with BPII did not change when controlled for recurrences. CONCLUSIONS: Findings suggest that Angst's "ups and downs" might be a new marker of BPII. Its simple question might be useful to clinicians to better detect the highly underdiagnosed BPII during assessment of depression.

Adult↗
PubMed2004

Is depressive mixed state a transition between depression and hypomania?

BACKGROUND: Depressive mixed states (DMX), described systematically by Kraepelin, have recently been found common among depressed outpatients, with possible important impact on treatment. Study aim was to find if DMX in bipolar II disorder was often a transition period between depression and hypomania, as suggested by Kraepelin. METHODS: 194 consecutive bipolar II major depressive episode (MDE) outpatients were interviewed with the Structured Clinical Interview for DSM-IV. Hypomanic symptoms during the index MDE were systematically assessed. DMX was defined as a MDE plus > 2 hypomanic symptoms appearing during the MDE (not before it), following Akiskal and Benazzi (2003). History of depression-hypomania cycles and vice versa (without symptom-free intervals) was assessed. If DMX were a transition period, cycles should have been more common in bipolar II with DMX than in bipolar II without DMX. To test if there were differences between DMX with history of cycles and DMX without history of cycles, the two subgroups were compared on many clinical, family history, and temperamental variables. To test if there were differences between bipolar II with DMX and bipolar II without DMX, comparisons between the two subgroups were done on variables often reported to be typically found in bipolar disorders and to be diagnostic validators (young onset, many recurrences, atypical features of depression, bipolar family history, temperamental mood lability, gender). RESULTS: DMX was present in 70.1%, and history of cycles in 79.8%. In bipolar II without index DMX (n = 58) history of cycles was present in 86.2%; in bipolar with index DMX (n = 136) history of cycles was present in 77.2% (p = 0.175). DMX with cycles was not significantly different from DMX without cycles on all study variables (apart from agitation). Bipolar II with index DMX, versus bipolar II MDE without index DMX, had significantly more depressions with atypical features, temperamental mood lability, and more females, while age of onset, recurrences, and bipolar family history were not significantly different. LIMITATIONS: Single interviewer, cross-sectional assessment. CONCLUSIONS: Findings do not support Kraepelin's view of DMX as a transition period between depression and hypomania, and a distinction between DMX with and without cycles. Findings only partly support DMX as a distinct subtype of bipolar II, which seems to require temperamental mood lability for its onset during a bipolar II MDE.

Adult↗
PubMed2004

Melancholic outpatient depression in Bipolar-II vs. unipolar.

BACKGROUND: DSM-IV melancholic major depressive episode (MDE) in bipolar II disorder (BP-II) is understudied. Study aim was to compare melancholic MDE in BP-II vs. unipolar major depressive disorder (MDD) on diagnostic validators and clinical features. METHODS: Consecutive 39 BP-II and 34 unipolar MDD outpatients in a private practice were interviewed (off psychopharmacotherapy) with the Structured Clinical Interview for DSM-IV, as modified by Benazzi and Akiskal [J. Affect. Disord. 73 (2003) 1], when presenting for treatment of MDE. DSM-IV criteria of melancholic features specifier were followed. Variables studied were index age, gender, age at onset of the first MDE, number of MDE recurrences, severity (measured by GAF, index MDE psychotic features, index MDE symptoms lasting more than 2 years, Axis I comorbidity), index MDE and melancholic symptoms, bipolar family history. Diagnostic validators were onset, family history, course of illness, and clinical picture. RESULTS: BP-II melancholic MDE, vs. MDD melancholic MDE, had significantly lower age at onset and more bipolar family history. Psychomotor agitation was significantly more common in BP-II melancholic MDE, but was present only in 43.5%. Psychomotor retardation was more common in MDD melancholic MDE at a trend level, but was present only in 20.5%. CONCLUSIONS: Psychomotor agitation was more common in BP-II melancholic MDE vs. unipolar MDD, while previous studies on bipolar I (BP-I) had usually found more retardation. The difference could be related to BP-I and BP-II being at least partly distinct disorders. The relatively low frequency of psychomotor change does not seem to support the view that this is the core feature of melancholia. Differences on diagnostic validators (most importantly family history) further support the distinction of melancholic MDE between BP-II and MDD, and support DSM-IV classification.

Adult↗