Manic symptoms and impulsivity during bipolar depressive episodes.

Full Abstract

OBJECTIVES:
In contrast to the extensive literature on the frequent occurrence of depressive symptoms in manic patients, there is little information about manic symptoms in bipolar depressions. Impulsivity is a prominent component of the manic syndrome, so manic features during depressive syndromes may be associated with impulsivity and its consequences, including increased risk of substance abuse and suicidal behavior. Therefore, we investigated the prevalence of manic symptoms and their relationships to impulsivity and clinical characteristics in patients with bipolar depressive episodes.

METHODS:
In 56 bipolar I or II depressed subjects, we investigated the presence of manic symptoms, using Mania Rating Scale (MRS) scores from the Schedule for Affective Disorders and Schizophrenia (SADS), and examined its association with other psychiatric symptoms (depression, anxiety, and psychosis), age of onset, history of alcohol and/or other substance abuse and of suicidal behavior, and measures of impulsivity.

RESULTS:
MRS ranged from 0 to 29 (25th-75th percentile, range 4-13), and correlated significantly with anxiety and psychosis, but not with depression, suggesting the superimposition of a separate psychopathological mechanism. Impulsivity and history of substance abuse, head trauma, or suicide attempt increased with increasing MRS. Receiver-operating curve analysis showed that MRS could divide patients into two groups based on history of alcohol abuse and suicide attempt, with an inflection point corresponding to an MRS score of 6.

DISCUSSION:
Even modest manic symptoms during bipolar depressive episodes were associated with greater impulsivity, and with histories of alcohol abuse and suicide attempts. Manic symptoms during depressive episodes suggest the presence of a potentially dangerous combination of depression and impulsivity.

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Author information

Author/s: Swann, Alan C (AC); Gerard Moeller, F (F); Steinberg, Joel L (JL); Schneider, Laurie (L); Barratt, Ernest S (ES); Dougherty, Donald M (DM);

Affiliation: Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX 77030, USA. alan.c.swann@uth.tmc.edu

Grants: K02 DA00403 (Agency:United States NIDA) ; R01 AA12046 (Agency:United States NIAAA) ; R01 DA08425 (Agency:United States NIDA) ; R01 MH 69944 (Agency:United States NIMH)

Journal and publication information

Publication Type: Journal Article; Research Support, N.I.H., Extramural

Journal: Bipolar disorders (Bipolar Disord), published in Denmark. (Language: eng)

Reference: 2007-May; vol 9 (issue 3) : pp 206-12

Dates: Created 2007/04/13; Completed 2007/07/10; Revised 2007/12/03;

PMID: 17430294, status: MEDLINE (last retrieval date: 11/6/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adult
Anxiety Disorders - diagnosis; epidemiology; psychology
Bipolar Disorder - diagnosis; epidemiology; psychology
Comorbidity
Depression - diagnosis; epidemiology; psychology
Diagnostic and Statistical Manual of Mental Disorders
Humans

Impulse Control Disorders - diagnosis; epidemiology; psychology
Prevalence
Psychotic Disorders - diagnosis; epidemiology; psychology
Questionnaires
Schizophrenia - epidemiology
Severity of Illness Index
Substance-Related Disorders - epidemiology

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