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It is well established that the presence of prominent anxiety within depressive episodes portends poorer outcomes. Important questions remain as to which anxiety features are important to outcome and how sustained their prognostic effects are over time.
Aims
To examine the relative prognostic importance of specific anxiety features and to determine whether their effects persist over decades and apply to both unipolar and bipolar conditions.
Method
Participants with unipolar (n = 476) or bipolar (n = 335) depressive disorders were intensively followed for a mean of 16.7 years (s.d. = 8.5).
Results
The number and severity of anxiety symptoms, but not the presence of pre-existing anxiety disorders, showed a robust and continuous relationship to the subsequent time spent in depressive episodes in both unipolar and bipolar depressive disorder. The strength of this relationship changed little over five successive 5-year periods.
Conclusions
The severity of current anxiety symptoms within depressive episodes correlates strongly with the persistence of subsequent depressive symptoms and this relationship is stable over decades.
Most psychotropics are highly protein bound and are influenced by fluctuations in protein levels. Specific drug-binding proteins include albumin and globulin, which generally bind to acidic (e.g. valproic acid) and basic (e.g. tricyclic antidepressant) psychotropic drugs, respectively. Although anticonvulsants are used in psychiatry for stabilization of bipolar disorder, alcohol withdrawal, and aggression, medically ill patients may also receive these drugs during treatment for epilepsy, neuropathic pain, and migraines. Lithium has multiple systemic effects and can precipitate or exacerbate underlying medical illness. Antidepressant use within the psychiatric setting has greatly expanded to include treatment of eating disorders, premenstrual dysphoric disorder, chronic aggression and impulsivity, and impulse control disorders. The serotonin antagonist reuptake inhibitor (SARI) trazodone is commonly used for sleep because of sedating properties. Antipsychotics are also used at times as antinauseants and for the treatment of refractory hiccups. Psychostimulants improve depression and fatigue in the medically ill.
Much remains unknown about the phenomenology of bipolar I disorder.
Aims
To determine the type of bipolar I mood episodes that occur over time, and their relative frequency.
Method
A total of 219 individuals with Research Diagnostic Criteria bipolar I disorder were prospectively followed for up to 25 years (median 20 years). Psychopathology was assessed with the Longitudinal Interval Follow-up Evaluation.
Results
Overall, 1208 mood episodes were prospectively observed. The episodes were empirically classified as follows: major depression, 30.9% (n = 373); minor depression, 13.0% (n = 157); mania, 20.4% (n = 246); hypomania, 10.4% (n = 126); cycling, 17.3% (n = 210); cycling plus mixed state, 7.8% (n = 94); and mixed, 0.2% (n = 2).
Conclusions
Cycling episodes constituted 25% of all episodes. Work groups revising ICD–10 and DSM–IV should add a category for bipolar I cycling episode.
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