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

134 F. BenazziAgosti and Stewart (2001) found more BP-II in AD versus non-AD, but thefrequency of BP-II found was very low (12%).A prospective study found that AD often progressed to BP spectrum (Ebert et al.,1993). Akiskal et al.(2000) reported that hypersomnic-retarded depression had 88%specificity for predicting BP outcome. Interpersonal sensitivity (an AD symptom)was found to predict the switching of UP to BP-II (Akiskal et al., 1995). Perugi et al.(1998) found that BP-II and BP spectrum were present in 72% of 86 AD outpatients,that BP-II AD (n ¼ 28) versus UP (n ¼ 24) AD had higher family history of BP, butsimilar female frequency, age of onset, and MDE recurrences. The power of thesample was however low. Hantouche et al.(1998) found that hypersomnia was morecommon in BP-II MDE (n ¼ 100) versus UP MDE (n ¼ 113). Angst (1998) foundAD more common in the soft BP spectrum versus UP (28.6% versus 6.8%).Cassano et al. (1992) found a similar high frequency of melancholic featuresbetween BP-II and UP (AD was not assessed, but, according to DSM-IV, ADdiagnosis cannot be made if the criteria of melancholic features are met). In thecommunity study of Levitan et al. (1997), MDE with some AD symptoms (overeating,weight gain, hypersomnia) was found to have higher mania frequency versusMDE without these symptoms (BP-II was not assessed). In the community study ofSullivan et al. (1998), AD (defined by overeating, weight gain, and hypersomnia)had similar BP-I comorbidity and age of onset versus non-AD (BP-II was notassessed). In the community study of Horwath et al. (1992), first onset of maniaat 1-year follow-up in UP AD (defined by overeating and oversleeping) versus non-AD was similar and very low. McGrath et al. (1992) reported that, among 401 AD,only 10% had BP-II. Robertson et al.(1996), comparing 79 UP with 30 BP (I þ II),found similar frequency of AD (28% versus 30%), but only 10 BP-II were included.Posternak and Zimmerman (2002) did not find more BP-II in AD versus non-AD,but, in the 579 sample, almost all were UP (28 patients were BP-II (4.8%)). Thecommunity study of Angst et al. (2003) found that AD versus non-AD had earlieronset, more BP spectrum, females, recurrences, and chronicity. Angst et al. (2002)found that BP-II (n ¼ 89) had more AD than UP (n ¼ 101: 49.5% versus 29.6%).The author’s studiesIn the author’s studies AD means DSM-IV ‘‘atypical features specifier.’’ Thestudies try to answer the following questions.Is AD more common in BP-II versus UP?Frequency of AD was significantly much higher (more than 40%) in BP-II MDEversus UP MDE. In BP-II (n ¼ 251) versus UP (n ¼ 306) MDE, AD was present in