Mania and bipolar depression: complementing not opposing poles—a post-hoc analysis of mixed features in manic and hypomanic episodes

Abstract Background Depending on the classification system used, 5–40% of manic subjects present with concomitant depressive symptoms. This post-hoc analysis evaluates the hypothesis that (hypo)manic subjects have a higher burden of depression than non-(hypo)manic subjects. Methods Data from 806 Bip...

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Autores principales: Christoph Born, Heinz Grunze, Robert M. Post, Lori L. Altshuler, Ralph Kupka, Susan L. McElroy, Mark A. Frye, Trisha Suppes, Paul E. Keck, Willem A. Nolen, Lars Schaerer
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spelling oai:doaj.org-article:2b8b1de03a4d4f1e9666088c64894eab2021-11-21T12:12:03ZMania and bipolar depression: complementing not opposing poles—a post-hoc analysis of mixed features in manic and hypomanic episodes10.1186/s40345-021-00241-52194-7511https://doaj.org/article/2b8b1de03a4d4f1e9666088c64894eab2021-11-01T00:00:00Zhttps://doi.org/10.1186/s40345-021-00241-5https://doaj.org/toc/2194-7511Abstract Background Depending on the classification system used, 5–40% of manic subjects present with concomitant depressive symptoms. This post-hoc analysis evaluates the hypothesis that (hypo)manic subjects have a higher burden of depression than non-(hypo)manic subjects. Methods Data from 806 Bipolar I or II participants of the Stanley Foundation Bipolar Network (SFBN) were analyzed, comprising 17,937 visits. A split data approach was used to separate evaluation and verification in independent samples. For verification of our hypotheses, we compared mean IDS-C scores ratings of non-manic, hypomanic and manic patients. Data were stored on an SQL-server and extracted using standard SQL functions. Linear correlation coefficients and pivotal tables were used to characterize patient groups. Results Mean age of participants was 40 ± 12 years (range 18–81). 460 patients (57.1%) were female and 624 were diagnosed as having bipolar I disorder (77.4%) and 182 with bipolar II (22.6%). Data of 17,937 visits were available for analyses, split into odd and even patient numbers and stratified into three groups by YMRS-scores: not manic < 12, hypomanic < 21, manic < 30. Average IDS-C sum scores in manic or hypomanic states were significantly higher (p < .001) than for non-manic states. (Hypo)manic female patients were likely to show more depressive symptoms than males (p < .001). Similar results were obtained when only the core items of the YMRS or only the number of depressive symptoms were considered. Analyzing the frequency of (hypo)manic mixed states applying a proxy of the DSM-5 mixed features specifier extracted from the IDS-C, we found that almost 50% of the (hypo)manic group visits fulfilled DSM-5 mixed features specifier criteria. Conclusion Subjects with a higher manic symptom load are also significantly more likely to experience a higher number of depressive symptoms. Mania and depression are not opposing poles of bipolarity but complement each other.Christoph BornHeinz GrunzeRobert M. PostLori L. AltshulerRalph KupkaSusan L. McElroyMark A. FryeTrisha SuppesPaul E. KeckWillem A. NolenLars SchaererSpringerOpenarticleBipolar disorderDepressionHypomaniaManiaMixed statesNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurophysiology and neuropsychologyQP351-495ENInternational Journal of Bipolar Disorders, Vol 9, Iss 1, Pp 1-12 (2021)
institution DOAJ
collection DOAJ
language EN
topic Bipolar disorder
Depression
Hypomania
Mania
Mixed states
Neurosciences. Biological psychiatry. Neuropsychiatry
RC321-571
Neurophysiology and neuropsychology
QP351-495
spellingShingle Bipolar disorder
Depression
Hypomania
Mania
Mixed states
Neurosciences. Biological psychiatry. Neuropsychiatry
RC321-571
Neurophysiology and neuropsychology
QP351-495
Christoph Born
Heinz Grunze
Robert M. Post
Lori L. Altshuler
Ralph Kupka
Susan L. McElroy
Mark A. Frye
Trisha Suppes
Paul E. Keck
Willem A. Nolen
Lars Schaerer
Mania and bipolar depression: complementing not opposing poles—a post-hoc analysis of mixed features in manic and hypomanic episodes
description Abstract Background Depending on the classification system used, 5–40% of manic subjects present with concomitant depressive symptoms. This post-hoc analysis evaluates the hypothesis that (hypo)manic subjects have a higher burden of depression than non-(hypo)manic subjects. Methods Data from 806 Bipolar I or II participants of the Stanley Foundation Bipolar Network (SFBN) were analyzed, comprising 17,937 visits. A split data approach was used to separate evaluation and verification in independent samples. For verification of our hypotheses, we compared mean IDS-C scores ratings of non-manic, hypomanic and manic patients. Data were stored on an SQL-server and extracted using standard SQL functions. Linear correlation coefficients and pivotal tables were used to characterize patient groups. Results Mean age of participants was 40 ± 12 years (range 18–81). 460 patients (57.1%) were female and 624 were diagnosed as having bipolar I disorder (77.4%) and 182 with bipolar II (22.6%). Data of 17,937 visits were available for analyses, split into odd and even patient numbers and stratified into three groups by YMRS-scores: not manic < 12, hypomanic < 21, manic < 30. Average IDS-C sum scores in manic or hypomanic states were significantly higher (p < .001) than for non-manic states. (Hypo)manic female patients were likely to show more depressive symptoms than males (p < .001). Similar results were obtained when only the core items of the YMRS or only the number of depressive symptoms were considered. Analyzing the frequency of (hypo)manic mixed states applying a proxy of the DSM-5 mixed features specifier extracted from the IDS-C, we found that almost 50% of the (hypo)manic group visits fulfilled DSM-5 mixed features specifier criteria. Conclusion Subjects with a higher manic symptom load are also significantly more likely to experience a higher number of depressive symptoms. Mania and depression are not opposing poles of bipolarity but complement each other.
format article
author Christoph Born
Heinz Grunze
Robert M. Post
Lori L. Altshuler
Ralph Kupka
Susan L. McElroy
Mark A. Frye
Trisha Suppes
Paul E. Keck
Willem A. Nolen
Lars Schaerer
author_facet Christoph Born
Heinz Grunze
Robert M. Post
Lori L. Altshuler
Ralph Kupka
Susan L. McElroy
Mark A. Frye
Trisha Suppes
Paul E. Keck
Willem A. Nolen
Lars Schaerer
author_sort Christoph Born
title Mania and bipolar depression: complementing not opposing poles—a post-hoc analysis of mixed features in manic and hypomanic episodes
title_short Mania and bipolar depression: complementing not opposing poles—a post-hoc analysis of mixed features in manic and hypomanic episodes
title_full Mania and bipolar depression: complementing not opposing poles—a post-hoc analysis of mixed features in manic and hypomanic episodes
title_fullStr Mania and bipolar depression: complementing not opposing poles—a post-hoc analysis of mixed features in manic and hypomanic episodes
title_full_unstemmed Mania and bipolar depression: complementing not opposing poles—a post-hoc analysis of mixed features in manic and hypomanic episodes
title_sort mania and bipolar depression: complementing not opposing poles—a post-hoc analysis of mixed features in manic and hypomanic episodes
publisher SpringerOpen
publishDate 2021
url https://doaj.org/article/2b8b1de03a4d4f1e9666088c64894eab
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