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

140 F. BenazziIs psychomotor retardation more common in AD versus non-AD?In 95 AD patients (80% BP-II, 20% UP), 21.0% had psychomotor agitation, while0.0% had retardation. The result may be related to the finding that melancholicfeatures were not more common in BP-II MDE versus UP MDE outpatients(19.2% versus 22.6%, n ¼ 182; 20.6% versus 25.0%, n ¼ 161). MDE with psychomotoragitation (BP-II þ UP: n ¼ 85) versus MDE without psychomotor agitation(n ¼ 292) had a significantly higher frequency of AD (51.7% versus 37.3%), whileAD frequency was not significantly different in BP-II-agitated MDE versus UPagitated MDE (Benazzi, 2000g, 2002b, c; Benazzi, et al., 2002).These results run against previous studies reporting that psychomotor retardationwas more common in AD versus non-AD (Horwath et al., 1992;Kendleret al., 1996;Posternak and Zimmerman, 2002), and that melancholic features were more commonin BP versus UP depression (Parker et al., 2000). Different samples (inpatientversus outpatient, community versus clinical), different study settings (tertiary careversus non-tertiary care), BP-I and BP-II lumping together, and mainly UP samplesin some studies, may be related to the different findings. Himmelhoch (1999)reported that melancholic features were only present in 12 of 1100 BP patients.Prevalence of melancholic features was reported to be higher in the inpatient severeand psychotic MDE (American Psychiatric Association, 2000).Is there a link between recurrences and AD?Comparisons among BP-II MDE (n ¼ 151), highly recurrent UP MDE (> 4MDEs: n ¼ 57), and low recurrent UP MDE (< 5 MDEs: n ¼ 32) found that ADwas significantly more common in BP-II MDE versus highly recurrent UP MDE,but also significantly more common in highly recurrent UP MDE versus lowrecurrent UP MDE. These findings suggest that recurrences may be related toincreased frequency of AD in UP MDE (Benazzi, 2003c).What is the relationship between AD and psychotic features?Frequency of AD was much lower in psychotic BP (I þ II) MDE (6.6%) compared tothe frequency of AD found in other BP-II samples of the author. Psychotic versus nonpsychoticMDE (BP-I þ BP-II þ UP) had significantly less AD (Benazzi, 1999g, h).What is the relationship between AD and menopause?Female MDE (BP-I þ BP-II þ UP) with age before 40 years (n ¼ 283), versusfemale MDE with age at or after 40 years (n ¼ 63) (the 40-year age cut-off gave a