Falling ill is not something that happens to us, it is a choice we make as a result of things happening to us
Иван Константинович Айвазовский, кораблекрушение, 1876.
A prospective longitudinal study of 86 patients with the bipolar II designation reexamined patients at 6- and 12-month intervals over a mean course of 13.4 years. The patients were symptomatic in 53.9% of all follow-up weeks. Depressive symptoms occurred in 50.3% of the weeks and dominated over hypomanic symptoms (1.3% of weeks) and over cycling or mixed symptoms (2.3% of weeks). The authorsnote that bipolar II, like bipolar I and unipolar depression, is a chronic longitudinal illness with the modal expression dominated by depressive symptoms.
They conclude that ‘‘longitudinally, BP-II is a chronic aVective disorder expressed within each patient as a fluctuating dimensional symptomatic continuum, which includes the full severity range of depressive and hypomanic symptoms, but dominated primarily by minor and subsyndromal depression.’’ Examining the impact of treatments onthe course of the illness, the authors note:
that symptomatic chronicity occurred even in the context of relatively more (rather than less) medication therapy leads us to conclude that we are describing the true naturalistic expression of BP-II as it unfolds across the life cycle.
The same conclusion of a singularity of manic-depressive illness is described in numerous reports by Angst, Benazzi, and Akiskal. In one study, two distinct mixed types of mania and depression were identified in the more severely ill hospitalized patients. Overlaps in criteria for the subtypes of bipolar disorder are reported. A distinct bipolar II disorder was not supported in a sample of 194 bipolar II outpatients.40 Examining the criteria of psychomotor agitation or psychomotor retardation, agitation was more common in bipolar II patients and retardation more common in bipolar I outpatients, a distinction of weak significance. Patients meeting criteria for bipolar II had more atypical features and more evidence of depressive mixed states than those meeting criteria for major depressive disorder, leading the author to conclude: ‘‘finding no zones of rarity supports a
continuity between BPII and MDD (meaning partly overlapping disorders without clear boundaries.)’’ Other iterations of these failures to support a bimodal model are reported.
They conclude that ‘‘longitudinally, BP-II is a chronic aVective disorder expressed within each patient as a fluctuating dimensional symptomatic continuum, which includes the full severity range of depressive and hypomanic symptoms, but dominated primarily by minor and subsyndromal depression.’’ Examining the impact of treatments onthe course of the illness, the authors note:
that symptomatic chronicity occurred even in the context of relatively more (rather than less) medication therapy leads us to conclude that we are describing the true naturalistic expression of BP-II as it unfolds across the life cycle.
The same conclusion of a singularity of manic-depressive illness is described in numerous reports by Angst, Benazzi, and Akiskal. In one study, two distinct mixed types of mania and depression were identified in the more severely ill hospitalized patients. Overlaps in criteria for the subtypes of bipolar disorder are reported. A distinct bipolar II disorder was not supported in a sample of 194 bipolar II outpatients.40 Examining the criteria of psychomotor agitation or psychomotor retardation, agitation was more common in bipolar II patients and retardation more common in bipolar I outpatients, a distinction of weak significance. Patients meeting criteria for bipolar II had more atypical features and more evidence of depressive mixed states than those meeting criteria for major depressive disorder, leading the author to conclude: ‘‘finding no zones of rarity supports a
continuity between BPII and MDD (meaning partly overlapping disorders without clear boundaries.)’’ Other iterations of these failures to support a bimodal model are reported.
publié par C.R. à
9:51 AM
<< Accueil