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

150 F. BenazziThe results of these analyses suggest that AD is related to BP-II, and that thereare other indicators of bipolarity that are more strongly related to BP-II than AD.However, AD is a cross-sectional sign of BP-II which is more reliable and easy toassess during MDE assessment than onset, family history, and number of recurrences(all variables dependent on memory). AD and DMX can be useful crosssectionalmarkers of BP-II for the clinician (Benazzi, 2001d), leading to carefulprobing for past hypomania, and to the search for collateral information fromfamily, close friends, medical records, and previous clinicians. AD may have somespecific features, like more females, low age of onset, and DMX, which may beindependent of its association with BP-II. The strong association between DMXand BP-II (Benazzi, 2001d; Benazzi and Akiskal, 2001; Akiskal and Benazzi, 2003)and AD and DMX strengthen the link of AD with BP-II.Mood reactivity was significantly associated with all DSM-IV AD symptoms,apart from leaden paralysis (4/5), in the whole sample. All the other AD symptomswere significantly associated with each other (10/10) in the whole sample.However, when the analysis was made separately in the BP-II and UP subsamples,results were partly different. In the BP-II subsample, mood reactivity was significantlyassociated with 3/5 AD symptoms, while in the UP subsample it wassignificantly associated with no AD symptom (0/5). In the two subsamples theother AD symptoms were often, but not always, significantly associated with eachother (7/10, 8/10). Given the strong association between BP-II and AD found inthe present study and in previous studies (Angst, 1998; Perugi et al., 1998; Agostiand Stewart, 2001; Angst et al., 2002, 2003; Benazzi studies in this paper), theassociation between BP-II and mood reactivity was tested by logistic regression,finding a strong association. The results of the present study in the BP-II subsampleare in line with the finding of Angst et al.(2002) of a significant associationbetween mood reactivity and the other DSM-IV AD symptoms. The results of thepresent study in the UP subsample are also in line with Posternak and Zimmerman(2002), who found a lack of correlation between mood reactivity and the other ADsymptoms. In these two studies UP and BP-II patients were combined in theanalysis, as shown in Table 6.6. An important difference between these two studiesis the number of BP-II patients included, which was very small in the study byPosternak and Zimmerman (2002). In the present study, a large number of BP-IIpatients were included, making it more comparable to the study by Angst et al.(2002). However, in contrast to these two studies, UP and BP-II subsamples werealso studied separately (Tables 6.7 and 6.8), leading to findings which couldexplain the opposite findings of the above two studies.The results of the present study seem to suggest that the inclusion of moodreactivity among the symptoms of AD may be different in BP-II versus UP. In BP-II,mood reactivity could be included in AD, while in UP it could not be included.