XI Congresso della Società Italiana di Psicopatologia Psichiatria ...

Bipolar II Disorder: the link between Bipolar
I Disorder and Major Depressive Disorder?
Z. Rihmer
National Institute for Psychiatry and Neurology, Budapest
The separation of unipolar depression from bipolar (manicdepressive)
disorder has been well accepted for decades,
and the subdivision of bipolar disorder further into Bipolar
I (depression with a history of mania) and Bipolar II (depression
with a history of hypomania but not with mania)
subgroups has been also supported by several clinical and
biological findings. Given the three different levels of mood
and acitivty state in Bipolar II disorder, phenomenologically
it is more close to Bipolar I disorder than to Unipolar depression.
In spite of this, family studies and clinical investigations
(including treatment-response studies) have demonstrated
a significant overlap between Bipolar II disorder and
Unipolar major depression.
Investigating the external bipolar validators (family history
of bipolar disorder, age of onset, depressive mixed states,
DSM-IV atypical features and treatment-associated hypomania)
in Unipolar major depression, the findings strongly
suggest that a subset (around one-third) of Unipolar major
depressives is more close to Bipolar II disorder than to
Unipolar depression, indicating that they belong to the bipolar
spectrum. Bipolar II disorder should be considered as a
bridge between Bipolar I disorder and Unipolar Major Depressive
Disorder.
References
1 Akiskal HS, Benazzi F. J Affect Disord 2003;73:113-22.
2 Benazzi F. World J Biol Psych 2003;4:166-71.
3 Rihmer Z, Pestality P. Psych Clin N Am 1999;22:667-73.
Similarities and differences between
bipolar and depressive disorders
E. Vieta
Bipolar Disorders Program, Hospital Clinic, University of
Barcelona, IDIBAPS, Barcelona
The distinction between unipolar and bipolar forms was first
described by Leonhard (1957) and subsequently validated
by Angst (1966), Perris (1966) and Winokur et al. (1969),
who showed that clinical, familial and course features supported
the nosological differentiation between unipolar and
bipolar disorders (Angst and Marneros, 2001). However,
there are many areas of overlap between those extremes,
pointing up the question of possible clinical subtypes in the
interface of depressive and manic extremes of affective illness
(Akiskal, 2002; Benazzi, 2005).
Bipolar disorder occurs in multiple forms and degrees of
severity. The recognition of the existence of so-called
milder forms of manic-depressive illness has been a major
endeavour in the last decade. The distinctions hinge on the
classification of elated states and this poses some difficulty
because it depends on the arbitrary gradation of severity
and duration. Bipolar disorder with mania and strict unipolar
depression without manic or hypomanic episodes would
represent the extremes of a spectrum (Akiskal, 1983); re-
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SIMPOSI TEMATICI
current depressions with hypomania would occupy a middle
territory (Akiskal, 2002). The exploration of spectrum
models of manic depressive illness would enhance research
on genetic markers and modes of genetic transmission,
would provide an approach for identifying individuals at
risk for the development of bipolar illness, and would permit
the evaluation of treatments for milder forms, including
the question of whether early intervention could lessen the
chance of progression to bipolar illness (Vieta et al., 2005).
In fact, a great number of individuals with the so-called soft
or subsyndromal states belong to the bipolar spectrum by
virtue of their positive family histories, their pharmacological
response and their tendency to progress to full clinical
disorder. All these issues will be discussed in the presentation.
Mixed states: a link between bipolar and
unipolar disorders?
A. Koukopoulos
Centro “Lucio Bini”, Roma
In Kraepelin’s conception mixed states consisted of a mixture
of depressive and excited symptoms i.e they were bipolar
syndroms as we would say today.
With our present nosology a problem arises about the position
of agitated or mixed depressions and its meaning for the
unipolar-bipolar distinction of depressive syndromes.
In a sample of 212 patients suffering from agitated depression
(152 women, 60 men) 56 (27%) were BPI, 66 (31%)
were BPII, 22 (10%) sufferd only from mixed depressio but
68 (32%) of them were unipolar depressive patients i.e they
never had manic/hypomanic episodes before.
In 64 (30%) patients the agitated depression was followed
by a simple inhibited depression without mixed symptoms.
37 (30%) were bipolar patients and 22 (32%) were unipolar
depressives. This type of sequence is similar to the
manic-depressive cycle. The identical proportion of bipolar
and unipolar depressive patients that follow this evolution
gives further support to the thesis that agitated depression
is a mixed state and it can occur in unipolar depressive
patients.
La continuità tra Disturbo Bipolare
e Depressione Ricorrente: implicazioni
terapeutiche
G. Perugi
Dipartimento di Psichiatria, Università di Pisa, Istituto di
Scienze del Comportamento “G. De Lisio”, Pisa
Introduzione: negli ultimi anni a seguito di una definizione
nuova e più ampia di spettro bipolare si è andata delineando
una continuità sintomatologica tra forme bipolari e depressive
ricorrenti. In questa sede ci si propone di valutare le
possibili implicazioni terapeutiche di tale continuità.
Metodologia: ricerca della letteratura su PubMed con parole
chiave spettro bipolare, continuità unipolare-bipolare e ricerca
manuale di capitoli di libri ed articoli su riviste non indicizzate.