Bipolar and atypical depression: weblog about psychopharmacology

The PCA was performed on groups 1, 2 and 3, which contained scored clinical bipolar disorder symptoms , together with the three biolog­ical variables, platelet monoamine oxidase (MAO) serum melatonin and post-dexamethasone serum cortisol. 

Normal human beings show marked mood fluctuations and obviously there is a continuum from sustained ela­tion to mildly pathological states or traits. This has been frequently maintained in the literature, for instance, by Jung (1904), Schneider (1932), Wertham (1929a, b), and more recently by Kendell (1985). As early as 1910 Reiss had stressed that every distinction between normal and pathological mood is to a certain extent artificial.

In pursuing the validity of individual bipolar disorder symptoms, these methods eschew the demonstration of statistically different criteria rates between diagnostic groups, because such differences will hold for symptoms that are not useful for the diagnostician. Instead, the focus is on a conditional prob­ability analysis which computes the sensitivity, specific­ity, positive predictive power and negative predictive power symptoms of bipolar disorder and combinations of symptoms of bipolar disorder as predictors of diagnoses. 

One of methods moves one step closer to a true psychiatric genetic nosology. Instead of using pre­defined categories, these methods attempt to define new phenotypes that maximally correspond to the genetic component of bipolar disorder symptoms. 

Bipolar disorder is a mental condition, which presents in radical mood shifts. Commonly, patients have to pass through periods of elevated mood (mania) alternating with depression.

There is now mounting evidence that the pathophysio­logy of melancholia and the mechanism of action of anti­depressive treatments involve both alterations in circa­dian rhythms as well as changes in central noradrenergic sen­sitivity.

Obsessive-compulsive symptoms frequently occur in the general population and are fundamental features of ob­sessive-compulsive personalities. Obsessive-compulsive disorder (OCD), characterized by high chronicity, how­ever, is considered a rare psychiatric disorder. 

A first major depressive episode (MDE) that does not recur during follow-up has been reported to be relatively uncommon. Thus, at the first episode, the clinician is expected to assess which disorder (recurrent unipolar or bipolar) the depressive episode will ultimately belong to. 

When separately evaluating patients with "Bipolar Disorder" according to DSM- III-R and the group of patients with heterogeneous disorders such as “Bipolar Disorder NOS", “Major Depression”, “Schizophrenia”, “Schizophreniform Disorder", “Schizo-affective Disorder" and “Psychotic Disorder NOS", again the results support the hypothesis of a different treatment response.

Using the terms “unipolar diseases” and “bipolar diseases” instead of “affective disorders” or “schizoaffective disorders” would make sense only if the well-known differences between unipolar and bipolar affective disorders and unipolar and bipolar schizoaffective disorders still remain after building these two voluminous groups and if they can clearly be separated on several levels.