Bipolar II disorder is frequent in atypical depression

A. Clinical Methods: Consecutive 45 Bipolar I and 141 Bipolar II outpatients, presenting for treatment of a major depressive episode, were interviewed by the author (a senior psychiatrist with a 15-year experience in the diagnosis and treatment of mood disorders: more than 4000 personal visits/year, more than 400 new patients/year) with the Structured Clinical Interview for DSM-IV Often, family members supplemented the clinical information during the interview. The variables studied were age at intake, age at onset, gender, and, as indicators of severity of illness, recurrences, chronicity, and psychosis. Age at onset was not normally distributed,at the Skewness and Kurtosis test: as the use of means and medians may be misleading in this case, and comparison of distributions is a better estimate of a difference in this case (McMahon et al., 1994), age at onset distributions were compared with the Kolmogorov-Smimov equality of distribution test (STATA 5 statistical software). Medians were compared with the nonparametric Mann-Whitney test. Proportions were compared with the Fisher’s exact test. All p values were two-tailed, and the probability level was 0.05. Results: Age at onset distributions were not significantly different between Bipolar I and Bipolar II disorder patients (KS = 0.12, p = 0.67). Age at intake was significantly (p < 0.05) lower in Bipolar I disorder patients, and the proportion of females was not significantly different. Recurrences (95.3% vs 78.0%), chronicity (76.6% vs 40.4%), and psychosis (80.9% vs 5.6%) were significantly (p < 0.01) much more common in Bipolar I disorder patients. A limitation of the study was that age at onset may be subject to recall bias. A structured interview by an experienced psychiatrist, the use of standard criteria for onset, the presence of family members supplementing the clinical information, and the same data collection and ascertainment procedures may have reduced bias. Conclusions: Age at onset may be critical for making inferences about etiology, and differences in age at onset may differentiate subtypes of disorders caused by different genes (McMahon et al., 1994). The finding in the present study of no significant difference in age at onset does not support the separation of Bipolar I and Bipolar II disorders into distinct disorders. Bipolar II disorder may be a less severe variant of Bipolar disorder. References 111 . _ McMabon. F.J.. St&. O.C.. Chase. GA.. Mevers. D.A.. Simoson. Xi.. DePaulo, JR., 1994. I&e&e of clinical s&y& sex, ancl lineal& od age ar onset of major affective disorder in a family sample. Am. J. Psychiatry 151, 210-21s.

IA-131

Bipolar

II disorder

F. Benazzi. Department Forli,

is frequent

of Psychiatq

in atypical

Morgagni

Public

Results: Prevalence of bipolar II disorder among atypical depressed patients was 64.2%. Comparisons between bipolar II and unipolar atypical depressed patients showed that age at intake and age at onset of the first major depressive episode were significantly lower in bipolar II patients. All the other variables studied (duration of illness, severity of depression, female gender, psychotic features, axis I comorbidity, chronic@ of depression, history of more than three major depressive episodes) were not significantly different. Comparisons of MADRS items scores between bipolar II and unipolar atypical depressed patients showed no significant difference. Conclusions: Prevalence of bipolar II disorder among atypical depressed outpatients was high. As differences in age at onset can differentiate subtypes of disorders caused by different genes (McMahon et al, 1994, Am J Psychiatry), the observed difference in age at onset between bipolar II and unipolar atypical depression would support the subdivision of atypical depression into a bipolar II and a unipolar subtype. A subdivision further supported by the presence of hypomania for its therapeutic implications. References [l] Benazi, F., 1997. Prevalence of bipolar II disorder in outpatient depression: a 203-case study. J. Affect. Disord. 43: 163-166.

IA-141

Thyroid hormones treatment-resistant

47100

Italy

Pharmacy

“Carol

Daoila

“, Bucharest.

Background: Treatment-resistant spond insufficiently to treatment

strategy

in

of Medicine

and

Romania

depressions

are depressions

that re-

with the standard antidepressants given long enough and in adequate dosage. Standard modification fail to produce satisfactory improvement in one-quarter to one-third of depressed patients (van Praag HM, 1997). The effect of antidepressant drugs can be reinforced with the use of thyroid hormones. In depression L-triiodothyronine (T3) has been used in preference to thyroxine (T4) because of its rapid onset of action (Prange AJ, 1996) Methods: We decided to use low doses (25-50 micrograms) of T4 in order to diminish the cardiovascular complications due to T3 plasmatic peaks. We selected eutbyroid patients with pathological scores on depression scales HAM-D and MADRS. T4 was introduced after 4 weeks of lack of response to a standard antidepressant. Scores on HAMD and MADRS were assessedevery week; heart function was assessed blood pressure,

heart rate). A control

group

included

similar

patients with treatment-resistant depression that received a standard antidepressant regimen. Results: After the first week of treatment with T4 patients in the study group showed a significant decrease in HAM-D and MADRS scores compared

Atypical depression diagnostic validity is based on its superior response to monoamine oxidase inhibitors compared to tricyclic antidepressants, and on latent class analysis. Studies on atypical depression have often not included bipolar patients. The aim of the present study was to find the prevalence of bipolar II disorder among DSM-IV atypical depression outpatients, and to compare bipolar II with unipolar atypical depression, to find if they are variants of the same disorder, or if they are different disorders. Methods: Consecutive 140 unipolar and bipolar II outpatients presenting for treatment of a DSM-IV atypical major depressive episode, were interviewed by the author (a senior psychiatrist with a 15-year experience in the diagnosis and treatment of mood disorders) with the Structured Clinical Interview for DSM-IV the Montgomery Asberg Depression Rating Scale (MADRS), and the Global Assessment of Functioning Scale. Means were compared with t test, or with Mann Whitney U test for data not normally distributed. Proportions were compared with Chisquare test, or with Fisher’s exact test for small frequencies. All p values were two-tailed. A probability level of 0.01 was chosen to reduce the risk of type I error due to multiple comparisons, without increasing too much the risk of type II error.

as an augmentation depression

A.N. Bizamcer, V Marinescu, S. Fica. University

daily (EKG,

depression Hospital,

s13

Studies

with

those in the control

group,

without

experiencing

any of

the adverse effects of T4 (with the exception of a moderate tachycardia). Conclusion: T4 is effective as an augmentation strategy in the treatment of resistant depression. IA-151

Serum zinc depression

and

copper

concentrations

in unipolar

D. Dudek’, A. Zieba’ , M. Schlegel-Zawadzka2, M. Szymaczek’, M. Krosniak’. G. Nowak3f4. ‘Deoartment of Psychiatry. Colleaium Medicum, Jagt’ellonian University, Kopernika ilb, PL 31-501 Km-&v; ‘Department of Food Chemistry and Nutrition, Collegium Medicum, Jagiellonian University, Medyczna 9, PL 30-688 Kmkdw; ‘Laboratory of Radioligand Research, Colregium Medicum, Jagiellonian University, Medyczna 9, PL 30-688 Krakow; 41nstitute of Pharmacology, Polish Academy of Sciences, Smetna 12, PL 31-343 Krakow, Poland

Some clinical investigations have demonstrated alterations in the blood zinc and copper concentrations in patients with depression, an observation which suggests the use of blood zinc levels as a potential marker of