Short-term variability of mood ratings in unipolar and bipolar depressed patients

doi:10.1016/0165-0327(95)00066-6

Journal of Affective Disorders

Volume 36, Issues 3–4, 22 January 1996, Pages 107-115

https://doi.org/10.1016/0165-0327(95)00066-6 Get rights and content

Abstract

The ability of depressed patients to assess their mood states is controversial. We devised a scale consisting of a global item and 23 multiple visual analog items based on the Carroll/Klein model of depression. Short-term reliability of self-ratings in 13 unipolar and 11 bipolar depressed patients was tested. Subjects completed the scale and were retested 1 h later. Global clinician and self-ratings demonstrated similar episode severity between the groups and global self-ratings were highly reliable at retest for both groups. Unipolar depressed patients demonstrated high retest reliability on individual items of the MVAS. Bipolar patients demonstrated greater variability of responses suggesting greater short-term mood fluctuation in bipolar patients.

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Reliability, validity and psychometric properties of the Greek version of the Altman self rating mania scale
2021, Comprehensive Psychiatry
Although self-rating mania scales have been developed, a lack of such instruments validated for the Greek population is noted. This study aims to examine the validity, reliability and psychometric properties of the Altman Self Rating Mania Scale (ASRM) adapted in Greek (G-ASRM).
A sample of 86 consecutive inpatient and outpatient bipolar patients diagnosed by the DSM-5 criteria and 37 healthy controls were assessed by using the Young Mania Rating Scale (YMRS) and the Montgomery Asberg Depression Rating Scale (MADRS), and self-administered the G-ASRM. Factor analysis, test-retest analysis, measurement invariance tests, mean differences, Pearson's Correlation analysis and ROC analysis were used to confirm the validity of G-ASRM as a scale, test its reliability, study its psychometric properties in different subgroups and establish a cut-off value for indicating the presence of (hypo)mania in BD patients. Also, regression models were built to expose dependencies between YMRS and G-ASRM items.
Monofactoriality of the scale was verified, based on Exploratory Factor Analysis (EFA). Cronbach's alpha was 0.895. G-ASRM is highly correlated with YMRS (r = 0.856, p < 0.0005) and uncorrelated with MADRS (r = −0.051, p = 0.623). Test- retest r-coefficient was calculated at 0.85. The optimal cut-off score, set at ≥6 for (hypo)mania assessment, is in agreement with the results reported for the original version. Limitations of the study are that the scale was not normed on diagnostic groups other than bipolar, nor was it administered longitudinally, so as to assess its sensitivity to symptom changes overtime.
The G-ASRM can be validly and reliably used in the Greek population for the assessment of (hypo)mania in bipolar patients.
Alcohol use and bipolar disorders: Risk factors associated with their co-occurrence and sequence of onsets
2017, Drug and Alcohol Dependence
Little is known about the sequence of onsets in patients affected by comorbid alcohol use and bipolar disorder. This study examines the risk factors associated with their co-occurrence and order of onset.
The demographic, clinical, and temperament characteristics as well as the course of illness were analyzed within our sample of 1090 DSM-IV bipolar I manic patients. Our sample was categorized according to the presence of comorbid alcohol use disorder and the sequence of onsets of bipolar and alcohol use disorders i.e., alcohol first (AUD-BD) and bipolar first (BD-AUD).
Regression analyses revealed that alcohol use disorder (52.5%) was associated with the male gender, additional substance use disorders, as well as an irritable and a hyperthymic temperament. The AUD-BD group (6.6%) was older than the BD-AUD group (45.8%) and showed higher rates of comorbid sedative use, organic, and anxiety disorders with higher levels of irritable temperament, and a bipolar subtype characterized by depressive polarity at onset. The BD-AUD group had high levels of hyperthymic temperament with higher rates of comorbid stimulant use disorder and a manic polarity at onset.
In the AUD-BD group, alcohol might have been used to reduce stress and tension caused by the presence of an irritable temperament as well as anxious and organic disorders, leading to first depressive episode. In the BD-AUD group, stimulant use might have triggered the first manic episode, and alcohol abuse result from mania severity.
Greater variation in affect is associated with lower fasting plasma glucose
2016, Heliyon
Citation Excerpt :
Possible explanations for the observed paradoxical inverse association between variability of mood and diabetes risk emerge when one considers the literature on atypical depression. People with bipolar disorder show greater short-term mood fluctuations when depressed than people with unipolar depression (e.g. Aheam and Carroll, 1996), while nearly three quarters of people with atypical major depression meet the criteria for bipolar disorders (Perugi et al., 1998). Thus, atypical depression appears to be associated with more labile and reactive mood.
Depression and bipolar illness are associated with a 2–3 fold increase in the prevalence of diabetes. However, it is unknown whether variation in mood affects glucose metabolism. The aim of this study was to assess whether changes in affect were related to fasting plasma glucose and glycated haemoglobin.
379 men and 441 women who took part in the 2003 Health Survey for England and had valid data for GHQ12 and fasting blood glucose were included. Mood variability was assessed by the General Health Questionnaire 12 (GHQ12). Fasting plasma glucose and glycated haemoglobin (HbA_1c) were measured by standard laboratory methodology and their relationship to variability assessed using linear regression.
There was a significant inverse relationship between fasting blood glucose, but not HbA_1c, and variability score (R² = 0.327, p = 0.02) after adjusting for sociodemographic factors, anthropometric measurements, lifestyle, and use of medication.
This study has shown an inverse association between changes in affect and fasting plasma glucose. This unexpected finding suggests that the association between affect and glucose is more complex than previously thought. Fasting blood glucose may reflect the operation of homeostatic mechanisms that are disturbed in certain mental states and are associated, therefore, with altered risk of diabetes and related metabolic conditions. This may have implications for the management of those with such conditions and with mental disorders.
Characteristics of depressive patients according to family history of affective illness: Findings from a French national cohort
2016, Journal of Affective Disorders
Literature is scarce about the characteristics of mood disorder patients with a family history (FH) of affective illness. The aim of the current study was to compare the prominent features of depressive patients with a FH of mania (FHM), those of depressive patients with a FH of depression (FHD), and those of depressive patients with no FH of affective illness (FHO).
As part of the EPIDEP National Multisite French Study of 493 consecutive DSM-IV major depressive patients evaluated in at least two semi-structured interviews 1 month apart, 45 (9.1%) were classified as FHM, 210 (42.6%) as FHD, and 238 (48.3%) as FHO.
The main characteristics of FHM patients were a cyclothymic temperament, the presence of mixed features and diurnal variations of mood during depression, early sexual behaviour, a high number of mood episodes and hypomanic switches, high rates of suicide attempts and rapid cycling; diagnosis of bipolar disorder was more frequent in this group as well as comorbid obsessive compulsive disorder, posttraumatic stress disorder, bulimia, attention deficit/hyperactivity disorder and impulse control disorders. The FHD patients had more depressive temperament, generalized anxiety disorder, and anorexia nervosa. Compared to FHO, FHM and FHD showed an earlier age at onset, more comorbid anxiety disorders, as well as more psychotic features.
The following are the limitations of this study: retrospective design, recall bias, and preferential enrolment of bipolar patients with a depressive predominant polarity.
In light of genetic studies conducted in affective disorder patients, our findings may support the hypothesis of genetic risks factors common to affective disorders and dimensions of temperament, that may extend to comorbid conditions specifically associated with bipolar or unipolar illness.
Prevalence and correlates of bipolar disorders in patients with eating disorders
2016, Journal of Affective Disorders
Citation Excerpt :
Moreover, comorbid bipolar disorder showed increased risks of weight gain, mood lability, poor impulse control, and had more psychiatric co-morbidities. A previous comparison of currently depressed unipolar and bipolar patients revealed no differences in terms of symptom severity or social impairment (Dorz et al., 2003), with the exception that bipolar depressed patients might exhibit greater mood variability (Ahearn and Carroll, 1996) and experience hyperphagia or weight gain (Mitchell et al., 2008). Investigations of community samples demonstrate that those with major depression and subthreshold bipolar disorder show greater comorbidity with anxiety, impulse control, and alcohol/substance use disorders (Angst et al., 2010; Merikangas et al., 2011; Zimmermann et al., 2009).
To investigate the prevalence and correlates of bipolar disorders in patients with eating disorders (EDs), and to examine differences in effects between major depressive disorder and bipolar disorder on these patients.
Sequential attendees were invited to participate in a two-phase survey for EDs at the general psychiatric outpatient clinics. Patients diagnosed with EDs (n=288) and controls of comparable age, sex, and educational level (n=81) were invited to receive structured interviews for psychiatric co-morbidities, suicide risks, and functional level. All participants also completed several self-administered questionnaires assessing general and eating-related pathology and impulsivity. Characteristics were compared between the control, ED-only, ED with major depressive disorder, and ED with bipolar disorder groups.
Patients with all ED subtypes had significantly higher rates of major depressive disorder (range, 41.3–66.7%) and bipolar disorder (range, 16.7–49.3%) than controls did. Compared to patients with only EDs, patients with comorbid bipolar disorder and those with comorbid major depressive disorder had significantly increased suicidality and functional impairments. Moreover, the group with comorbid bipolar disorder had increased risks of weight dysregulation, more impulsive behaviors, and higher rates of psychiatric comorbidities.
Participants were selected in a tertiary center of a non-Western country and the sample size of individuals with bipolar disorder in some ED subtypes was small.
Bipolar disorders were common in patients with EDs. Careful differentiation between bipolar disorder and major depressive disorder in patients with EDs may help predict associated psychopathology and provide accurate treatment.
Predominant polarity in bipolar disorders: Further evidence for the role of affective temperaments
2015, Journal of Affective Disorders
Citation Excerpt :
This instrument is a semi-structured interview which is suitable for clinical studies as it permits clinical judgment to bear on the DSM-IV schema for major depression and other Axis I disorders. Intensity of depression was assessed by the Hamilton Depression Rating Scale (HDRS) (Hamilton, 1960); mood disturbances were self-reported by assessing the Multiple Visual Analog Scales of Bipolarity (MVAS-BP) (Ahearn and Carroll, 1996; Hantouche et al., 2001a; Azorin et al., 2012). In phase 2, scheduled an average of 4 weeks after the first visit, a systematic search for lifetime DSM-IV hypomanic episodes was made through the SCID-P (First et al., 1996) and the checklist of hypomania (Angst, 1992).
Literature suggests bipolars may differ in several features according to predominant polarity, but the role of temperaments remains controversial.
The EPIDEP study was designed to identify bipolar patients among a large sample of major depressives. Only bipolars were included in the current study. Patients were subtyped as predominantly depressive (PD) and predominantly manic and hypomanic (PM) according to a broad (more episodes of a given polarity) and a narrow (2/3 of episodes of one polarity over the other) definition, and compared on their characteristics.
Among 278 bipolars, 182 (79.8%) could be subtyped as PD and 46 (20.2%) as PM (broad definition); the respective proportions were of 111 (81.6%) and 25 (18.4%) using narrow definition. Expanding the definition added little in detecting differences between groups. Compared to PDs, PMs showed more psychosis, rapid cycling, stressors at onset, family history of affective illness, and manic first episode polarity; they also received more antipsychotics and lithium. The PDs showed more chronic depression, comorbid anxiety, and received more antidepressants, anticonvulsants and benzodiazepines. The following independent variables were associated with manic/hypomanic predominant polarity: cyclothymic temperament, first hospitalization≤25 years, hyperthymic temperament, and alcohol use (only for broad definition).
Cross-sectional design, recall bias.
Study findings are in accord with literature except for suicidality and mixicity which were related to predominant mania, and explained by higher levels of cyclothymic and hyperthymic temperaments. Temperaments may play a key role in the subtyping of bipolar patients according to predominant polarity, which warrants confirmation in prospective studies.

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Research reportShort-term variability of mood ratings in unipolar and bipolar depressed patients

Abstract

Independent assessment of manic and depressive symptoms by self-rating

Arch. Gen. Psychiatry

The clinical picture of bipolar affective disorder in its depressed phase: a report from London and Chicago

Br. J. Psychiatry

Psychopathology and neurobiology of manicdepressive disorders

Depression rating scales: a critical review

Arch. Gen. Psychiatry

Somatic symptoms in primary affective disorder: presence and relationship to the classification of depression

Arch. Gen. Psychiatry

Rating depression in normals and depressives: observer versus self-rating scales

J. Affect. Disord.

Research report
Short-term variability of mood ratings in unipolar and bipolar depressed patients