Chaos, panic and disorder- my work here is done.
Δομήνικος Θεοτοκόπουλος , La visión del Apocalipsis, 1614.
In yet another study seeking to reinforce the image of a bipolar mixed state to encompass psychotic agitated depression, 336 outpatients with major depressive episodes without a history of mania were identified. Based on evidence of hypomania, 206 were assigned to bipolar II and 130 to major depressive disorder.
The investigators found numerous permutations of major depressive episodes in the bipolar I patients and concluded that bipolar depression is melancholia: Agitated depression is validated as a dysphorically excited form of melancholia, which should tip clinicians to think of such a patient belonging to or arising from a bipolar substrate. Our data support the Kraepelinian position . . .
Other investigators have had similar diYculties in supporting a mood disorder dichotomy. In a sample of 117 subjects with recurrent unipolar depression and 106 with bipolar I disorder, the authors of a large multisite Italian study identified those who had achieved partial or complete remission of their index episode.44 They assessed 140 items in an extensive psychopathology interview and could not distinguish two groups in the distribution of the overall scores or in the number or severity of depressive or manic items. Paranoid ideation, auditory hallucinations, and suicide attempts were, however, more common in the lifetime experience of patients defined as bipolar I.
The authors discuss their experience:
Cumulatively our empirical findings support a continuous view of the mood spectrum as a unitary phenomenon that is best understood from a longitudinal perspective. Our data suggest that unipolar disorder and bipolar disorder are not two discrete and dichotomous phenomena but that mood fluctuations – up and down – are common to both conditions . . .
Considering the extent of the studies seeking a distinction between unipolar depression and the two subtypes of bipolar depression, the two disorders are best considered variations of a single disorder.
The investigators found numerous permutations of major depressive episodes in the bipolar I patients and concluded that bipolar depression is melancholia: Agitated depression is validated as a dysphorically excited form of melancholia, which should tip clinicians to think of such a patient belonging to or arising from a bipolar substrate. Our data support the Kraepelinian position . . .
Other investigators have had similar diYculties in supporting a mood disorder dichotomy. In a sample of 117 subjects with recurrent unipolar depression and 106 with bipolar I disorder, the authors of a large multisite Italian study identified those who had achieved partial or complete remission of their index episode.44 They assessed 140 items in an extensive psychopathology interview and could not distinguish two groups in the distribution of the overall scores or in the number or severity of depressive or manic items. Paranoid ideation, auditory hallucinations, and suicide attempts were, however, more common in the lifetime experience of patients defined as bipolar I.
The authors discuss their experience:
Cumulatively our empirical findings support a continuous view of the mood spectrum as a unitary phenomenon that is best understood from a longitudinal perspective. Our data suggest that unipolar disorder and bipolar disorder are not two discrete and dichotomous phenomena but that mood fluctuations – up and down – are common to both conditions . . .
Considering the extent of the studies seeking a distinction between unipolar depression and the two subtypes of bipolar depression, the two disorders are best considered variations of a single disorder.
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