Academic journal article Indian Journal of Psychiatry

A Comparative Study on Psycho-Socio-Demographic and Clinical Profile of Patients with Bipolar versus Unipolar Depression

Academic journal article Indian Journal of Psychiatry

A Comparative Study on Psycho-Socio-Demographic and Clinical Profile of Patients with Bipolar versus Unipolar Depression

Article excerpt

Byline: A. Nisha, V. Sathesh, Varghese. Punnoose, P. Varghese

Background: Several studies have revealed significant differences between bipolar (BP) and unipolar depression (UP). Misdiagnosing BP depression results in suboptimal symptom resolution, induction of manic switch, mixed state, or accelerated cycling. This study compares various psycho-socio-demographic, longitudinal course, and phenomenological factors associated with BP and UP depression. Materials and Methods: We compared 30 UP and 30 BP depression patients using a specially designed intake proforma, International Classification of Diseases-10 diagnostic criteria for research, Hamilton Rating Scale for Depression-21 (HAMD-21), Hypomania Checklist-32 Questionnaire (HCL-32), Brief psychiatric rating scale (BPRS), and Kuppuswami's socioeconomic status scale. Results: BP depression group consisted of mostly males, with earlier age of onset of illness, longer illness duration, frequent episodes, hospitalizations and psychotic symptoms. The total HAM-D score and 4 HAM-D item scores–psychomotor retardation, insight, diurnal variation of symptoms and its severity, and paranoid symptoms were significantly higher in this group. Binary logistic regression identified the age of onset, the total duration of illness, frequency of affective episodes, and presence of delusions as predictors of bipolarity (odds ratio = 1.327; 1.517; 0.062; 0.137). Conclusions: Identification of clinical markers of bipolarity from large scale prospective studies is needed.

Introduction

Unipolar (UP) and bipolar (BP) disorders differ in genetics, neurobiology, clinical course, treatment regimens and prognosis. Approximately, 40% of patients with BP affective disorder (BPAD) initially receive an incorrect diagnosis of recurrent depressive disorder (RDD).[sup][1] Accurate diagnosis of BP depression is complicated by three factors - Assumption of similar phenomenology for BP and UP depression, failure of therapists to recognize previous hypomanic symptoms, and failure of patients to report them. Use of antidepressant monotherapy for BP depression increases the risk of manic switch, mixed state, rapid cycling, poor or partial response, and resistance to antidepressant therapy.[sup][2],[3] Conversely, patients with UP depression unnecessarily exposed to mood stabilizers would suffer poorer outcomes. Several studies have focused on longitudinal course factors such as age, gender (female: male ratio higher in UP), age at onset (earlier in BP), episode duration (more in UP), and frequency (more in BP). Postpartum episodes, co-morbidities (substance use, suicide, anxiety disorders), family loading of bipolarity, affective temperament, frequent job changes, marital discord, and hospitalization rates - All were found to be significantly higher in the BP group.[sup][4],[5],[6],[7],[8] Depressive episodes with sudden onset, psychomotor retardation, diurnal mood variation, worthlessness, anhedonia, pathological guilt, suicidal thoughts, psychotic symptoms, atypical features, and labile mood are important markers for bipolarity.[sup][9] A study by Singh et al .[sup][10] found significantly increased frequency of blood group O and lesser frequency of blood group A in BP group compared to normal controls and UP group. UP depression is characterized by excessive self-reproach, somatic complaints, more severe appetite and weight loss, loss of energy, and diminished libido.[sup][11] The primary objective of our study is to compare the phenomenological factors associated with BP and UP depression in in-patients. We also aim to study the psychosocio-demographic and other variables influencing BP and UP depression.

Materials and Methods

This is a cross-sectional comparative study conducted between November 2009 and April 2010. After obtaining the Institutional Review Board approval, 60 consecutive subjects (30 each in BP and UP depression group) who sought in-patient treatment from the Psychiatry Department of a Tertiary Care Medical College were recruited. …

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