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Biomedical subjects

Franco Benazzi

Publications and source records attributed to Franco Benazzi.

At least 91 records · Page 5Linked to original sources
PubMed2003

The dual factor structure of self-rated MDQ hypomania: energized-activity versus irritable-thought racing.

BACKGROUND: Bipolar II is diagnosed in a clinically depressed patient by documenting history of hypomania. Therefore, it is of great significance for both clinical and research purposes to characterize the factor structure of hypomania. METHODS: Among consecutive depressive outpatients-126 major depressives and 187 bipolar II-diagnosed by the Structured Clinical Interview for DSM-IV (Clinician Version), 181 who had clinically recovered from depression were administered the Mood Disorder Questionnaire (MDQ of. Am. J. Psychiatry 157, 1873). The MDQ is a newly developed, psychometrically validated self-report screening instrument for bipolar spectrum disorders. It screens for lifetime history of manic/hypomanic symptoms by including yes/no items covering all DSM-IV symptoms of mania/hypomania. The MDQ symptom interrelationships were studied by principal component analysis with varimax rotation. RESULTS: Hypomanic symptoms occurring in >50% were racing thoughts, increased energy and social activity, and irritability. Factor analysis revealed two factors: 'Energized-Activity' (eigenvalue=3.1) and 'Irritability-Racing Thoughts' (eigenvalue=1.5). LIMITATIONS: Cross-sectional assessment. CONCLUSIONS: Self-assessment of past hypomanic symptoms by patients, during clinical remission from depression, revealed two independent hypomanic factors, neither of which comprised euphoria. Hypomanic behavior appears to be more fundamental for the diagnosis of hypomania than elated mood accorded priority in DSM-IV; of hypomanic moods, irritability had greater significance than elation. It would appear that self-report of euphoria is less likely when hypomanias are brief (>or=2 vs. >or=4 days). The main implication for busy clinical practice is that energized activity and irritable mood associated with racing thoughts represent the modal experiences of hypomania among bipolar II outpatients; euphoria is neither sensitive, nor pathognomonic, in the diagnosis of these patients. These conclusions accord with recommendations made many years ago for the diagnosis of hypomania among cyclothymic patients [. Am. J. Psychiatry 134, 1227].

Bipolar Disorder↗
PubMed2003

Depressive mixed state: dimensional versus categorical definitions.

BACKGROUND: Recently, there has been a rebirth of studies on depressive mixed state (DMX), defined as a major depressive episode (MDE) plus few concurrent hypomanic symptoms. It is still unclear how to best define DMX. The study's aim was to test a categorical versus a dimensional definition of DMX. METHODS: Consecutive 260 bipolar II disorder and 173 unipolar MDE outpatients were interviewed with the Structured Clinical Interview for DSM-IV, when presenting for MDE treatment (drug-free). Hypomanic symptoms during index MDE were systematically assessed and graded by a hypomania rating scale (Hypomania Interview Guide, HIG). Different cutoffs of the HIG to define DMX were tested versus a categorical definition of DMX (requiring more than two concurrent hypomanic symptoms, DMX3). Sensitivity and specificity for predicting bipolar II diagnosis were compared. The best definition of DMX based on the HIG was also compared to DMX3 versus typical bipolar variables (early onset, many recurrences, atypical features, bipolar family history). RESULTS: An HIG cutoff of 8 had a specificity for predicting bipolar II diagnosis similar to that of DMX3. HIG>8 was strongly associated with bipolar family history (an important external diagnostic validator), and DMX3 was significantly associated with more bipolar variables (including bipolar family history). LIMITATION: The interview was done by a single interviewer. CONCLUSIONS: Similar specificity for predicting bipolar II disorder diagnosis and a similar strong association with bipolar family history suggest that a categorical and a dimensional definition of DMX could have similar validity. However, the dimensional definition (based on the scoring of a hypomania rating scale) could lead to a better assessment of hypomanic symptoms, resulting in more correct diagnoses of DMX.

Adult↗
PubMed2003

Diagnosis of bipolar II disorder: a comparison of structured versus semistructured interviews.

BACKGROUND: Reliability of bipolar II (BPII) disorder diagnosis is still a problem. Recent studies have shown that semistructured interviews by clinicians are better than structured interviews by nonclinicians for BPII diagnosis. The aim of the study was to find the degree of agreement in the diagnosis of BPII between the Structured Clinical Interview for DSM-IV (SCID) and a semistructured interview based on DSM-IV criteria done by an expert clinician. METHODS: One hundred eleven remitted major depressive episode (MDE) outpatients were interviewed first with the SCID and soon after that with a semistructured interview following DSM-IV criteria (based on clinical evaluation). Bipolar I (BPI) patients were excluded. RESULTS: By the SCID, 24 patients were diagnosed BPII (21.6%) and 30 were diagnosed BPI (27.0%). By the semistructured interview, 68 patients were diagnosed BPII (61.2% of the entire sample) and none BPI. Agreement between the SCID BPII diagnosis and the semistructured interview BPII diagnosis was 51.3% (meaning one in two missed). Sensitivity and specificity of the SCID BPII diagnosis for the semistructured BPII diagnosis were 29.4% and 90.7%, respectively. Overactivity (increased goal-directed activity) was the most common hypomanic symptom. In the group with overactivity (n=76), a semistructured interview BPII diagnosis was present in 77.6%, while a SCID BPII diagnosis was present in only 22.3%. Sensitivity and specificity of overactivity for BPII diagnosis were 86.7% and 60.4%, respectively, while elevated mood had sensitivity of 60.2% and specificity of 86.0%. CONCLUSIONS: Findings support a diagnosis of BPII based on a semistructured interview by an expert clinician versus a fully structured interview. Overactivity priority level for the diagnosis of hypomania is supported by the present findings.

Adult↗
PubMed2003

Diagnostic issues in bipolar disorder.

Bipolar disorder is a highly recurrent and chronic psychiatric condition that shortens life expectancy, causes functional impairment and disruption to social, work and family life. Several forms of bipolar disorder are recognised, including both bipolar I and bipolar II disorder. Bipolar I is characterised by recurrent episodes of depression and mania whereas bipolar II disorder is characterised by recurrent depression and hypomania, a milder form of mania. There has been debate concerning the definition of hypomania since at least the 1970s. The main areas of argument focus on the minimum duration of hypomania, its stem criteria and the number of symptoms required for diagnosis. Arriving at the correct definition of hypomania is a key diagnostic issue. There is increasing evidence for the existence of a broad spectrum of bipolar disorders, and data demonstrating the clinical validity of modifying some of the criteria for hypomania are reviewed here.

Bipolar Disorder↗
PubMed2003

Testing DSM-IV definition of atypical depression.

The definition of atypical depression (AD) has recently seen a rebirth of studies, as the evidence supporting DSM-IV atypical features criteria is weak. Study aim was to test the validity of DSM-IV definition of AD. Consecutive 202 major depressive disorder (MDD) and 281 bipolar II outpatients were interviewed, during a major depressive episode (MDE), with the Structured Clinical Interview for DSM-IV. The relationships of DSM-IV AD versus variables often reported to distinguish AD and non-AD (gender, age, onset, bipolar II, axis I comorbidity, MDE severity, residual MDE symptoms, depressive mixed state), and versus bipolar family history, were tested. Each DSM-IV AD symptom's relationship with the variables found significantly associated to DSM-IV AD was then tested, in order to assess the degree of concordance among all AD symptoms. Associations were tested by univariate logistic regression (STATA 7). Frequency of DSM-IV AD was 42.8%. DSM-IV AD was significantly more common in bipolar II versus MDD (53.7% vs. 27.7%, p = 0.0000). DSM-IV AD significant associations were the following: bipolar II, female gender, lower age, lower age of onset, residual MDE symptoms, axis I comorbidity, psychotic features, depressive mixed state, and bipolar family history. Testing associations of each DSM-IV AD symptom versus the variables found associated to DSM-IV AD showed high concordance. All AD symptoms were significantly associated with DSM-IV AD, and with most study variables. Results support the current DSM-IV definition of AD.

Adult↗
PubMed2003

Unipolar depression with bipolar family history: links with the bipolar spectrum.

The aim of the present paper was to find if unipolar major depressive disorder (MDD) with bipolar family history could be included in the bipolar spectrum, by comparing it to unipolar MDD without bipolar family history, and to bipolar II disorder, on typical bipolar variables. A sample of 280 consecutive bipolar II outpatients, and a sample of 135 consecutive unipolar MDD outpatients, presenting for major depressive episode (MDE) treatment, were interviewed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (4th edn). Hypomanic symptoms during the MDE were systematically assessed. Clinical variables used to validate the inclusion of unipolar MDD with bipolar family history in the bipolar spectrum were young age of onset, many MDE recurrences, atypical features, and depressive mixed state (DMX; an MDE plus >2 concurrent hypomanic symptoms), following many previous studies reporting that these variables were typical features of bipolar disorders. Means were compared by t-test and frequencies by chi2 test (stata 7). Two-tailed P < 0.05 was chosen. Unipolar MDD with bipolar family history was present in 20% of MDD patients. Comparisons among unipolar MDD with bipolar family history (UP+BPFH), unipolar MDD without bipolar family history (UP-BPFH), and bipolar II (BPII), found that UP+BPFH versus UP-BPFH had a significantly lower age, lower age of onset, fewer recurrences, and more DMX; that UP+BPFH versus BPII had no significant differences (apart from recurrences); and that UP-BPFH versus BPII had significantly different age, age of onset, recurrences, atypical features, and DMX. Findings suggest that UP+BPFH shows many bipolar signs, and that it could therefore be included in the bipolar spectrum. Unipolar MDD with bipolar family history had a clinically significant 20.0% frequency in the unipolar MDD sample, supporting the clinical usefulness of this depression subtype. The subtyping of MDD based on bipolar family history could have treatment implications.

Adult↗
PubMed2003

Bipolar II disorder and major depressive disorder: continuity or discontinuity?

AIM: To find if bipolar II disorder (BPII) and major depressive disorder (MDD) were distinct categories or overlapping syndromes. METHODS: 308 BPII and 236 MDD outpatients, presenting for major depressive episode (MDE) treatment, were interviewed with the Structured Clinical Interview for DSM-IV. History of mania and hypomania, and hypomanic symptoms present during MDE, were systematically investigated. Presence of zones of rarity between BPII and MDD depressive syndromes was assessed. Atypical and hypomanic symptoms were chosen because atypical features and depressive mixed state (ie, MDE plus more than 2 concurrent hypomanic symptoms, according to Akiskal and Benazzi 2003) were often reported to distinguish BPII from MDD depressive syndromes (more common in BPII). If BPII were a distinct category, distributions of these symptoms should show zones of rarity between BPII and MDD depressive syndromes. Histograms and Kernel density estimate were used to study distributions of these symptoms. RESULTS: BPII had significantly more atypical features and depressive mixed state than MDD. Histograms and Kernel density estimate curves of distributions of atypical and hypomanic symptoms in the entire sample did not show zones of rarity. CONCLUSIONS: Finding no zones of rarity supports a continuity between BPII and MDD (meaning partly overlapping disorders without clear boundaries).

Adult↗
PubMed2002

Psychomotor changes in melancholic and atypical depression: unipolar and bipolar-II subtypes.

Psychomotor changes are reported to be 'nearly always present' in the melancholic subtype of major depressive episode (MDE) in DSM-IV-TR, and are believed by some researchers to be markers of melancholia. The aim of this study was to compare melancholic and atypical forms of MDE and to determine whether psychomotor changes are core features of melancholic MDE. The Structured Clinical Interview of DSM-IV was used to consecutively assess 107 unipolar and 164 bipolar-II MDE outpatients. The criteria used to define melancholic and atypical MDE followed DSM-IV-TR. Melancholic MDE was present in 17.7% of patients; atypical MDE, in 35.0%. The group of patients with melancholic MDE had the following differences from the atypical group: higher age, higher age at onset, fewer females, more unipolar cases, fewer bipolar-II cases, lower Global Assessment of Functioning scores, more MDE symptoms, and more psychotic features. Percentages of observable and marked psychomotor changes (agitation and retardation combined) did not differ significantly between the two groups, though the melancholic group tended to have more symptoms. Retardation was significantly more common in melancholic MDE, but its frequency was very low in both melancholic and atypical cases (12.5 vs. 0.0%). Logistic regression controlling for age, gender and illness duration had little effect on the findings, which suggests that psychomotor changes are not core features of melancholic MDE.

Adult↗
PubMed2002

Should mood reactivity be included in the DSM-IV atypical features specifier?

BACKGROUND: The definition of atypical depression is still an unsolved issue. DSM-IV atypical features specifier criteria always require mood reactivity, but why mood reactivity should be included is unclear. The study aim was to test whether mood reactivity should be included in DSM-IV atypical features specifier. METHODS: Consecutively, 164 unipolar and 241 "soft" bipolar II major depressive episode (MDE) outpatients were interviewed with the Structured Clinical Interview for DSM-IV. The DSM-IV criteria for atypical features specifier were strictly followed. Associations were tested by univariate logistic regression. RESULTS: MDE with atypical features was present in 41.4 % of patients. Bipolar II disorder was significantly more common in patients with atypical features. MDE with atypical features was significantly associated with bipolar II, female gender, lower age of onset, more axis I comorbidity, fewer psychotic features, and more depressive mixed states. In the whole sample, mood reactivity was significantly associated with all the atypical symptoms, apart from leaden paralysis, and all the other atypical symptoms were significantly associated with each other. In the bipolar II sub-sample, mood reactivity was associated with many, but not all, atypical symptoms, while in the unipolar sub-sample it was associated with no atypical symptom. Atypical symptoms were significantly more common in mood reactive than in non-mood reactive patients, apart from leaden paralysis. Bipolar II disorder and mood reactivity were strongly associated. CONCLUSIONS: Results may support the inclusion of mood reactivity in the DSM-IV atypical features specifier for bipolar II disorder, but not for unipolar depression.

Adult↗
PubMed2002

Can only reversed vegetative symptoms define atypical depression?

BACKGROUND: The definition of atypical depression (AD) has recently seen a rebirth of studies, as the evidence supporting the current DSM-IV atypical features criteria is weak. Study aim was to compare a definition of AD requiring only oversleeping and overeating (reversed vegetative symptoms) to the DSM-IV AD definition (always requiring mood reactivity, plus overeating/weight gain, oversleeping, leaden paralysis, and interpersonal sensitivity [at least 2]). METHODS: Consecutive 202 major depressive disorder (MDD) and 281 bipolar II outpatients were interviewed, during a major depressive episode (MDE), with the Structured Clinical Interview for DSM-IV. The DSM-IV criteria for AD were compared to a new AD definition based only on oversleeping and overeating, which was the one often used in community studies. Associations were tested by univariate logistic regression. RESULTS: The frequency of DSM-IV AD was 42.8 %, and that of the new AD definition was 38.7 %. DSM-IV AD, and the new AD definition, had almost all the same significant associations: bipolar II, female gender, lower age, lower age of onset, axis I comorbidity, depressive mixed state, MDE symptoms lasting more than 2 years, and bipolar family history. DSM-IV AD was present in 86 % of the new AD definition sample. The new definition of AD was significantly associated with all the other DSM-IV AD symptoms not included in it. The new AD definition was strongly associated with DSM-IV AD (odds ratio = 17.8), and had sensitivity = 77.7 %, specificity = 90.5 %, positive predictive value = 86.1 %, negative predictive value = 84.4 %, and ROC area curve = 0.85, for predicting DSM-IV AD. CONCLUSIONS: Results support a simpler definition of AD, requiring only oversleeping and overeating, and support the similar AD definition previously used in community studies. This definition is easier and quicker to assess by clinicians than the DSM-IV definition (mood reactivity and interpersonal sensitivity are more difficult to assess). Some pharmacological studies support this new AD definition (by showing better response to MAOI than to TCA, as shown in DSM-IV AD).

Affect↗
PubMed2002

Which could be a clinically useful definition of depressive mixed state?

UNLABELLED: Depressive mixed state (DMX) (major depressive episode [MDE] with few superimposed hypomanic symptoms) was reported to be common among depressed outpatients. Study aim was to find if the best clinically useful definition of DMX was one based on a minimum number of hypomanic symptoms, or instead one based on the combination of specific hypomanic symptoms. METHODS: Consecutive 138 bipolar II and 83 unipolar MDE outpatients were interviewed with DSM-IV Structured Clinical Interview. DMX definitions tested were: MDE with three or more hypomanic symptoms (DMX3) and MDE with hypomanic symptoms irritability, distractibility and racing thoughts. RESULTS: DMX3, and the combination of racing thoughts, irritability and distractibility, had the same significant and nonsignificant associations with study variables. DMX3, and the combination of the specific hypomanic symptoms, significantly predicted bipolar II diagnosis. For predicting bipolar II diagnosis, DMX3 had higher specificity (86.7% vs. 50.6%), while the combination of the specific hypomanic symptoms had higher sensitivity (76.8% vs. 51.4%). CONCLUSIONS: A DMX definition with higher specificity (DMX3) for predicting bipolar II diagnosis may be more clinically useful because it may reduce misdiagnosis.

Adult↗
PubMed2002

Agitated depression: unipolar? Bipolar? Or both?

The classification of agitated depression (major depressive episode (MDE) plus psychomotor agitation) in mood disorders is unclear. DSM-IV is neutral on this point. As antidepressants may increase agitation, a better understanding of agitated depression is important for clinical practice. Study aim was to find if agitated depression was closer to bipolar or to unipolar disorders, by studying its association with variables typically related to bipolar disorders (early onset, many recurrences, more atypical features, more bipolar family history), and by studying its association with bipolar II disorder. Consecutive 151 unipolar and 226 bipolar II psychoactive drug-free MDE outpatients were interviewed with the Structured Clinical Interview for DSM-IV, when presenting for MDE treatment. Agitated MDE patients were compared with nonagitated MDE patients. Statistics were t test for means, two-sample test of proportion, and logistic regression (STATA 7). Agitated MDE was present in 85 patients (22.5%). It had significantly more bipolar II disorder patients (80.0% vs. 54.1%, p = 0.0000), more females, lower age at onset, longer duration of illness, more MDE recurrences, more atypical features, more MDE symptoms, and more family history of bipolar disorders, than nonagitated MDE. To control for the possible confounding effect of bipolar II disorder, logistic regression was used. All the significant differences became nonsignificant. Results might suggest that agitated MDE might be closer to the bipolar spectrum than to unipolar disorder, because it was associated with variables typically distinguishing bipolar from unipolar disorders, and with bipolar II disorder. Further studies on this topic are needed.

Adult↗