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

143 Atypical depression and bipolar spectrumTable 6.1 Comparisons between atypical depression (AD) and non-atypical depression(N-AD) (n ¼ 433)AD(n ¼ 182)N-AD(n ¼ 251)Variable: mean (SD), % T/Z df PUnipolar 24.1 51.3 –5.7 0.0000Bipolar II 75.8 48.6 5.7 0.0000Female gender 74.1 58.9 3.2 0.0010Age at index MDE (years) 40.2 (13.5) 46.4 (15.3) –4.3 431 0.0000Age at onset of first MDE (years) 22.2 (10.6) 29.7 (14.0) –6.0 431 0.0000> 4 MDEs 76.3 69.3 1.6 0.1084MDE symptoms > 2 years 44.5 37.0 1.5 0.1161Axis I comorbidity 58.2 45.8 2.5 0.0108MDE severity by GAF 51.3 (7.9) 50.0 (9.8) 1.4 431 0.1409Psychotic features 2.7 11.9 –3.4 0.0005> 2 hypomanic symptoms 63.1 35.8 5.6 0.0000during index MDEBipolar (I þ II) family history 50.8 32.1 3.9 0.0001Irritability 60.4 47.4 2.6 0.0075Psychomotor agitation 31.8 21.5 2.4 0.0156Distractibility 76.3 62.9 2.9 0.0030More talkativeness 22.5 14.7 2.0 0.0369Racing/crowded thoughts 75.2 58.9 3.5 0.0004Mood reactivity 100 74.5Weight gain 36.8 1.9 9.6 0.0000Overeating 46.7 3.1 10.9 0.0000Hypersomnia 63.7 7.1 12.5 0.0000Leaden paralysis 69.2 17.1 10.9 0.0000Interpersonal rejection sensitivity 85.1 40.6 9.3 0.0000MDE, major depressive episode; GAF, Global Assessment of Functioning.days of hypomania were required for BP-II diagnosis, following previous reports(Akiskal et al., 1977; Cassano et al., 1992; Coryell et al., 1995; Akiskal, 1996; Angst,1998; Akiskal et al., 2000; Benazzi, 2001c). Most present-study BP-II patients hadhad more than one episode of hypomania. Often, family members or close friendssupplemented the clinical information during the interview. Study variables arereported in Table 6.1.