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

138 F. BenazziIs there any difference between early-onset and late-onset AD?Early-onset (before 18 years) versus late-onset AD (BP-II þ UP sample) wassignificantly associated with female gender (þ), number of MDE recurrences(þ), BP-II (þ), UP ( ). Early-onset BP-II AD versus late-onset LO BP-II ADwas significantly associated with female gender (þ), number of MDE recurrences,depression chronicity (þ). The same analysis in UP did not find these associations.Findings suggest that there are differences between BP-II AD and UP AD (Benazzi,2000e), further supporting the distinction between BP-II AD and UP AD.What is the relationship between AD and chronic depression?No significant difference in AD frequency was found between BP-II (n ¼ 67) andUP (n ¼ 69) chronic depression (chronic MDE and MDE without full interepisoderecovery, lasting more than 2 years from index MDE). BP-II (chronic and nonchronic:n ¼ 95) depression versus non-chronic UP depression (n ¼ 81) had significantlymore AD. Chronic UP could be a link between BP-II and non-chronicUP, a finding in line with reports suggesting that chronic depression may berelated to BP-II (Akiskal et al., 1995; Coryell et al., 1995). Frequency of depressionchronicity was not significantly different (46.3% versus 40.5%) between AD(n ¼ 164, BP-II 64.6% of the sample) and non-AD (n ¼ 162, BP-II 35.8% of thesample). UP AD had significantly more depression chronicity than UP non-ADand BP-II AD. Chronicity was not significantly different in BP-II AD comparedwith BP-II non-AD. Chronic AD versus non-chronic AD had significantly moreUP. Findings suggest that depression chronicity in AD is mainly related to UP, andmay explain why AD was often reported to be chronic (as most previous studiesmainly included UP samples; Rabkin et al., 1996). In BP-II, depression chronicityfindings related to AD seem different in comparison to UP. In BP-II chronicdepression (n ¼ 87), early onset was associated with higher AD frequency. Chronicdepression in old (> 60 years) versus young (< 60 years) (199 BP-II þ 200 UP)found the frequency of AD to be significantly higher in young patients (59.5%versus 27.6%), but when the comparison was controlled for age (ANCOVA), thedifference was no longer significant, suggesting that it was related to age (Benazzi,1999c, d, 2000d, f, 2001f).Are females more common in AD versus non-AD?In BP-II MDE (n ¼ 251) versus UP (n ¼ 306) MDE, AD was present in 45.4% versus25.4% (P ¼ 0.0000). AD was significantly more common in BP-II females versusmales, in UP females versus males, in BP-II females versus UP females, and in