Journal
AMERICAN JOURNAL OF PSYCHIATRY
Volume 173, Issue 10, Pages 1015-1023Publisher
AMER PSYCHIATRIC PUBLISHING, INC
DOI: 10.1176/appi.ajp.2016.15091119
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Funding
- Stanley Medical Research Institute
- Merck
- Sunovion
- AztraZeneca
- H Lundbeck
- Elan Pharma International
- NIMH
- VA Cooperative Studies Program
- AssureRx Health
- Janssen
- Mayo Foundation
- Myriad
- National Institute on Alcohol Abuse and Alcoholism
- Pfizer
- Agency for Heatthcare Research and Quality
- Alkermes
- AstraZeneca
- Cephalon
- Eli Lilly
- Forest
- Marriott Foundation
- Naurex
- Orexigen
- Shire
- Takeda
- Transcept
- Johnson Johnson
- National Institute for Health Research
- Medical Research Council
- Northumberland
- Tyne
- Wear National Health Service Foundation Trust
- Otsuka Pharmaceuticals
- American College of Psychiatrists
- GlaxoSmithKline
- Ferrer
- Janssen-Cilag
- Lundbeck
- Otsuka
- Servier
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Objective: DSM-5 introduced the with mixed features specifier for major depressive episodes. The authors assessed the prevalence and phenomenology of mixed depression among bipolar disorder patients and qualitatively compared a range of diagnostic thresholds for mixed depression. Method: In a naturalistic study, 907 adult outpatients with bipolar disorder participating in the Stanley Foundation Bipolar Network were followed longitudinally across 14,310 visits from 1995 to 2002. The Inventory of Depressive Symptomatology-Clinician-Rated Version (IDS-C) and the Young Mania Rating Scale (YMRS) were administered at each visit. Results: Mixed depression, defined as an IDS-C score >= 15 and a YMRS score >2 and <12 at the same visit, was observed in 2,139 visits (14.9% of total visits, and 43.5% of visits with depression) by 584 patients (64.4% of all patients). Women were significantly more Likely than men to experience subthreshold hypomania during visits with depression (40.7% compared with 34.4%). Patients with one or more mixed depression visits had more symptomatic visits and fewer euthymic visits compared with those with no mixed depression visits. DSM-5-based definitions of mixed depression (ranging from narrower definitions requiring >= 3 non overlapping YMRS items concurrent with an IDS-C score >= 15 to broader definitions requiring >= 2 nonoverlapping YMRS items) yielded lower mixed depression prevalence rates (6.3% and 10.8% of visits, respectively) but were found to have similar relationships to gender and longitudinal symptom severity. Conclusions: Among outpatients with bipolar disorder, concurrent hypomanic symptoms observed during visits with depression were common, particularly in women. The DSM-5 diagnostic criteria for depression with mixed features may yield inadequate sensitivity to detect patients with mixed depression.
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