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

146 F. BenazziTable 6.3 Comparisons between bipolar II atypical depression (BP-II AD) and unipolar(UP) ADBP-II(n ¼ 138)UP(n ¼ 44)Variable: mean (SD), % T/Z df PFemale gender 73.9 75.0 –0.1 0.8846Age at index MDE (years) 39.9 (13.0) 41.1 (14.9) –0.5 180 0.6077Age at onset of first MDE (years) 21.3 (9.8) 25.2 (12.4) –2.1 180 0.0329> 4 MDEs 81.8 59.0 3.0 0.0020MDE symptoms > 2 years 50.0 27.2 2.6 0.0080Axis I comorbidity 59.4 54.5 0.5 0.5661MDE severity by GAF 50.9 (7.9) 52.7 (7.8) –1.3 180 0.1885Psychotic features 3.6 0.0 1.2 0.2019> 2 hypomanic symptoms 68.8 45.4 2.8 0.0051during index MDEBipolar (I þ II) family history 59.7 27.2 3.7 0.0002Irritability 66.6 40.9 3.0 0.0024Psychomotor agitation 33.3 27.2 0.7 0.4494Distractibility 79.7 65.9 1.8 0.0606More talkativeness 25.3 13.6 1.6 0.1054Racing/crowded thoughts 78.2 65.9 1.6 0.0998Mood reactivity 100 100Weight gain 39.8 27.2 1.5 0.1313Overeating 47.8 43.1 0.5 0.5863Hypersomnia 62.3 68.1 –0.6 0.4860Leaden paralysis 71.7 61.3 1.3 0.1933Interpersonal rejection sensitivity 84.0 88.6 –0.7 0.4554n atypical symptoms 4.0 (1.0) 3.8 (0.9) 1.1 180 0.2386MDE, major depressive episode; GAF, Global Assessment of Functioning.ConclusionsFrequency of AD was 42.0%, in line with the findings of Nierenberg et al.(1998)ina large UP sample. AD versus non-AD had significantly more BP-II, more females,lower age of onset, more axis I comorbidity, fewer psychotic features, more DMX,more BP family history, more hypomanic and atypical symptoms, in line withprevious reports (Kendler et al., 1996; Rabkin et al., 1996; Levitan et al., 1997;Sullivan et al., 1998; Sotsky and Simmens, 1999; McGrath et al., 2000; Williamsonet al., 2000; Benazzi and Akiskal, 2001). More BP-II in AD was reported in somerecent studies (Angst, 1998; Perugi et al., 1998; Agosti and Stewart, 2001; Angst