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  • mercurialmind 8:35 pm on July 28, 2013 Permalink | Reply
    Tags: , diagnosis, ,   

    Temperament could predict diagnosis and presenting symptoms 

    Your temperament could affect your diagnosis, presenting symptoms, and psychopathologic conditions. The results of a recent study indicate that distinguishing between the various temperaments of irritable, depressive, hyperthymic, and cyclothymic might be helpful.

    The study researchers report that in their study of 129 patients, hyperthymic temperament showed a preferential association with bipolar I disorder (BD-I) and bipolar disorder not otherwise specified diagnoses (BD-NOS), whereas depressive temperament was more frequent in patients with bipolar II disorder (BD-II) and major depressive disorder (MDD).

    Anxious and depressive temperaments were more frequent in current depressive and mixed episodes compared with manic ones, while irritable temperaments were most frequent in mixed episodes and in patients suffering from alcohol dependence compared with nondependent patients.

    Additionally the study showed that hyperthymic temperaments protected against depressive and anxiety symptoms while it increased the temperamentssusceptibility towards manic symptoms. In contrast depressive, irritable, and cyclothymic temperaments increased the susceptiblity towards psychopathologic sysmptoms such as somatization, and interpersonal sensitivity.
    The authors conclude by suggesting that temperament be taken into consideration when diagnosing and treating. Given the small size of the study and cross sectional design, the study needs to be replicated by others.

     
    • mercurialandquixotic 5:17 pm on August 2, 2013 Permalink | Reply

      I was told I have Bipolar Type 1 but I only had Hyperthymic characteristics while on anti-depressants, and one a year the two years I was on them. I am mostly melancholic, introverted, and depressed. Is it possible you got the type1 and type 2 mixed? Or is my doc completely wrong?

      • indigomind 6:33 pm on August 2, 2013 Permalink | Reply

        This study was on the small side so the association could be different when replicated in a larger study. I’m not clear whether you experienced mania while just on antidepressants or not? People that just experience mania/hypomania while on antidepressants are referred by some bipolar experts as Bipolar IV while people who experience mania without anitdepressants as Bipolar I.
        Here is a link to a site that explains the various types. http://www.webmd.com/bipolar-disorder/guide/bipolar-spectrum-categories

  • mercurialmind 5:28 am on July 15, 2013 Permalink | Reply
    Tags: , diagnosis, DSM, , Nassir Ghaemi   

    Reassessing mood disorders 

    New research is causing researchers to reassess the DSM’s view of mood disorders. Recently a Canadian researcher by the name of McIntyre performed a study that challenges the DSM model. McIntyre gave a neuroleptic, lurasidone, to two groups of bipolar patients. One group consisted of depressed individuals while the other consisted of those in a mixed state. Somewhat surprisingly the drug helped both equally which implies the two states aren’t all that different.17

    Additional research by John Geddes, chairman of Oxford University’s Department of Psychiatry at Oxford also supports the idea that the various states in bipolar disorder are more similar than different and that instability is the key feature. The idea of pure depression or pure mania in the DSM is idealistic and limits our understanding. In reality mood episodes usually consist of depressive and manic symptoms imposed on top of an unstable temperament instead of a completely euthymic mood.

    This constant mood lability throws into doubt the entire DSM-based distinction between “bipolar” and “major depressive” disorders. It is instead consistent with Kraepelin‘s original view of manic-depressive insanity as a broad illness of recurrent mood episodes, irrespective of polarity (in other words, recurrent depression is manic-depressive illness even without classic manic episodes), in contrast to the current faith in bipolar disorder (mania is required) vs major depressive disorder (mania is absent).

    Nassir Ghaemi concluded his article by suggesting that metanalysis on antidepressants efficacy are obscured by the fact that major depression is categorized too broadly and consequently there is too much heterogeneity. I believe he is suggesting that if depression is subcategorized to a greater degree the efficacy issue will be come much clearer. Perhaps antidepressants are more efficacious in one subtype than another? Additionally he suggests the opposite of most critics which is that bipolar disorder is too narrowly defined. I have had similar thoughts regarding the heterogeneity of depression and consequently I am in agreement.

     
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