Bipolar Disorders: Mixed States, Rapid-Cycling, and Atypical Forms

115 Recurrent brief depressioncorresponding to the seven items of DPD in DSM–IV); unlike DSM–IV werequired not just five but all seven items to be present at least sometimes.Anxious personality features were assumed to be present if the subject answeredyes to both of the following questions:1. As a child or adolescent were you more anxious than your peers?2. Do you feel your anxieties impaired your development?Neuroticism (N), extroversion (E) and aggression (A) were measured by theFreiburg Personality Inventory (FPI) of Fahrenberg and Selg (1970) using aquestionnaire with 212 items given at the fourth and fifth interviews (ages:males, 29/30; females, 34/35). These three factors – aggression, extroversion, andneuroticism – were derived from large Swiss population samples (6315 males, 1381females).Impulsivity/irritability was represented by subfactor 4 of the FPI.StatisticsSAS for Windows version 8.01 was used. For group comparisons, chi-squaredtests, Fisher’s exact tests, and Kruskal–Wallis tests were applied. Prevalence ratesand standard errors were computed by Stata 7.0 with adjustment for samplestratification. Cumulative prevalence rates refer to the sum of 1-year prevalencerates across all interviews. For certain analyses, logistic regression and biserialcorrelations were computed.ResultsRecurrent brief psychiatric syndromes and their overlapThe main focus of this chapter is the relationship of the two mood spectra withrecurrent brief psychiatric syndromes (RBD, RBM, and RBA), with particularemphasis on RBD. An association is very frequent: Table 5.1 demonstratesthat 44% of BP-II cases and 39% of MDD cases received an additional diagnosisof RBD; in addition 71% of MinBP cases were associated with RBD. Furthermore,over one-third of mood-disorder cases also received a diagnosis of RBA.This raises the question of the interrelationship between RBD, RBM, and RBA.Figure 5.3 shows their overlap computed as odds ratios: it is intriguing that thehighest associations were found between RBA and RBD (OR ¼ 5.2) and RBA andRBM (OR ¼ 3.8). However, RBM was more closely associated with RBA than withRBD (OR ¼ 2.9), which underlines the important role of anxiety in brief hypomaniaand bipolar disorders in general, as shown in Table 5.1. The associations arevery similar in the case of RBMS.Figure 5.3 shows the overlap on the basis of prevalence rates.