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Franco Benazzi - One of the best experts on this subject based on the ideXlab platform.

  • does psychomotor agitation in major depressive episodes indicate bipolarity evidence from the zurich study
    European Archives of Psychiatry and Clinical Neuroscience, 2009
    Co-Authors: Jules Angst, Franco Benazzi, Alex Gamma, Vladeta Ajdacic, Wulf Rossler
    Abstract:

    Background Kraepelin’s partial interpretation of Agitated Depression as a mixed state of “manic-depressive insanity” (including the current concept of bipolar disorder) has recently been the focus of much research. This paper tested whether, how, and to what extent both psychomotor symptoms, agitation and retardation in Depression are related to bipolarity and anxiety.

  • Agitated unipolar Depression re conceptualized as a depressive mixed state implications for the antidepressant suicide controversy
    Journal of Affective Disorders, 2005
    Co-Authors: Hagop S Akiskal, Franco Benazzi, Giulio Perugi, Zoltan Rihmer
    Abstract:

    Abstract Background The nosologic status of Agitated Depression is unresolved. Are they unipolar (UP) or bipolar (BP)? Are they mixed states? Even more controversial is the notion that antidepressants might play some role in the suicidality of such patients ( Akiskal and Mallya, 1987 ) [Akiskal, H.S., Mallya, G., 1987. Criteria for the “soft” bipolar spectrum: treatment implications. Psychopharmacol Bull. 23, 68–73]. Methods After excluding all patients with history of hypomanic episodes occurring outside the frame of a major depressive episode (MDE), even those with a shorter duration of hypomanic symptoms than stipulated in DSM-IV, the remaining consecutive 254 unipolar major depressive disorder (MDD) private adult (>21 years old) outpatients were interviewed (off psychoactive drugs for 2 weeks) with the Structured Clinical Interview for DSM-IV (SCID-CV), the Hypomania Interview Guide (HIGH-C), and the Family History Screen. Intra-MDE hypomanic symptoms were systematically assessed, with ≥3 such symptoms required for a diagnosis of depressive mixed state (DMX). Agitated Depression was defined as an MDE with HIGH-C psychomotor agitation score ≥2. Logistic regression was used to study associations and control for confounding variables. Results In this strictly defined unipolar sample, Agitated Depression was present in 19.7%. Compared with its non-Agitated counterpart, it had significantly fewer recurrences, less chronicity, higher rate of family history for bipolar disorder, and DMX; and, among the intra-depressive non-euphoric hypomanic symptoms (in decreasing order of frequency), distractibility, racing/crowded thoughts, irritable mood, talkativeness, and risky behavior. The most striking finding was the robust association between Agitated Depression and DMX (OR=36.9). Furthermore, patients with psychomotor agitation had significantly higher rate of weight loss and suicidal ideation. Of DMX symptoms, we found an association between suicidal ideation, psychomotor activation, and racing thoughts. Agitated Depression was tested by forward stepwise logistic regression versus all variables significantly different in the pairwise comparisons, yielding DMX, talkativeness, and suicidal ideation as the independent significant positive predictors. Limitations No suicidal ideation scale was used. Conclusions Agitated Depression emerges as a distinct affective syndrome with weight loss, pressure of speech, racing thoughts and suicidal ideation. Psychomotor activation and racing thoughts during MDD independently predicted suicidal ideation. In this “unipolar” MDD sample, Agitated Depression had a strong clustering of intra-episode non-euphoric hypomanic symptoms (i.e. DMX) which, coupled with its association with bipolar family history, support its link with the bipolar spectrum. Agitated Depression is therefore best regarded as “pseudo-unipolar.” These findings overall accord with classical German concepts of Agitated Depression as a mixed state. Given that these patients are typically activated along the lines of risk-taking behavior, Kraepelin's rubric of “excited (mixed) Depression” appears to us the preferred terminology over “Agitated Depression”. Clinical implications The data reported herein, placed in the setting of the literature reviewed in the discussion suggest that the reports of increased risk of suicidal ideation and/or behavior in some depressed patients treated by antidepressant monotherapy or combinations thereof might be attributed to baseline psychomotor activation/agitation as part of an unrecognized bipolar mixed state. Whether antidepressants induce de novo suicidality in MDD cannot be answered without adequately powered prospective double-blind studies, unlikely to be conducted because of ethical constraints. Nonetheless, we submit that Agitated, activated, or otherwise excited Depressions (which we consider as depressive mixed states) overlap considerably with the so-called antidepressant “activation syndrome.” Furthermore, the rare occurrence of suicidality on antidepressants should not obscure the fact that the advent of the new antidepressants is associated with worldwide decline in suicide rates. We finally wish to point out that our formal nosology (i.e. DSM-IV and ICD-10), in its failure to recognize the bipolar nature of depressive mixed states, thereby fails to shield pseudo-unipolar patients from antidepressant monotherapy, which is inappropriate for such patients.

  • Agitated Depression in bipolar ii disorder
    World Journal of Biological Psychiatry, 2005
    Co-Authors: Franco Benazzi
    Abstract:

    Study aim: To test diagnostic validity or utility of Agitated Depression (AD) in bipolar II disorder (BP-II).Methods: Three hundred and twenty BP-II major depressive episode (MDE) outpatients interviewed with the Structured Clinical Interview for DSM-IV, Hypomania Interview Guide (HIG), and Family History Screen. AD defined as MDE with psychomotor agitation. Mixed Depression defined as MDE with ≥4 hypomanic symptoms. AD, non-AD, mixed-AD, non-mixed-AD, and mixed-non-AD were compared versus diagnostic validators.Results: AD was present in 35.0%, 75.8% of AD were mixed, while only 14.3% of non-AD were mixed (P=0.0000). AD (n=112), versus non-AD (n=208), had significantly higher age, more females, recurrences, bipolar I family history, and much more concurrent hypomanic symptoms. Mixed-AD (n=85), versus non-mixed-AD (n=27), was not significantly different, apart from more hypomanic symptoms (by definition), but there were clinically significant differences.Conclusions: Findings may partly support subtyping o...

  • Agitated Depression a valid Depression subtype
    Progress in Neuro-psychopharmacology & Biological Psychiatry, 2004
    Co-Authors: Franco Benazzi
    Abstract:

    Purpose The diagnostic validity of Agitated Depression (AD, a major depressive episode (MDE) with psychomotor agitation) is unclear. It is not classified in DSM-IV and ICD-10 classification of mental and behavioural disorder (ICD-10). Some data support its subtyping. This study aims to test the subtyping of AD. Methods Consecutive 245 bipolar-II (BP-II) and 189 major depressive disorder (MDD) non-tertiary-care MDE outpatients were interviewed (off psychoactive drugs) with Structured Clinical Interview for DSM-IV Axis I Disorders--Clinician Version (SCID-CV), Hypomania Interview Guide (HIGH-C), and Family History Screen. Intra-MDE hypomanic symptoms were systematically assessed. AD was defined as an MDE with psychomotor agitation. Mixed AD was defined as an MDE with four or more hypomanic symptoms (including agitation). Findings AD was present in 34.7% of patients. AD was mixed in 70.1% of AD patients. AD, vs. non-AD, had significantly (at alpha = 0.05) lower age at onset, more BP-II, females, atypical Depressions, bipolar-I (BP-I) and BP-II family history, and was more mixed; racing/crowded thoughts, irritability, more talkativeness, and risky behaviour were significantly more common. Mixed AD, vs. non-AD, had significantly (at alpha = 0.01) lower age at onset, more intra-MDE hypomanic symptoms, BP-II, females, atypical Depressions, BP-II family history, and specific hypomanic symptoms (distractibility, racing thoughts, irritable mood, more talkativeness, risky activities). Mixed AD, vs. non-mixed AD, had significantly more intra-MDE hypomanic symptoms (by definition), more recurrences, and more specific hypomanic symptoms (by definition). Non-mixed AD, vs. non-AD, had significantly more intra-MDE hypomanic symptoms and more talkativeness. Conclusions AD was common in non-tertiary-care Depression outpatients, supporting its diagnostic utility. AD and many bipolar diagnostic validators were associated, supporting its link with the bipolar spectrum. Mixed AD, but not non-mixed AD, had differences vs. non-AD similar to those of AD, suggesting that psychomotor agitation by itself may not be enough to identify AD as a subtype. Findings seem to support the subtyping of mixed AD. This subtyping may have important treatment impact, as antidepressants alone might increase agitation.

  • toward a validation of a new definition of Agitated Depression as a bipolar mixed state mixed Depression
    European Psychiatry, 2004
    Co-Authors: Franco Benazzi, Athanasios Koukopoulos, Hagop S Akiskal
    Abstract:

    Abstract Purpose. – As psychotic Agitated Depression is now a well-described form of mixed state during the course of bipolar I disorder, we sought to investigate the diagnostic validity of a new definition for Agitated (mixed) Depression in bipolar II (BP-II) and major depressive disorder (MDD). Materials and methods. – Three hundred and thirty six consecutive outpatients presenting with major depressive episodes (MDE) but without history of mania were evaluated with the Structured Clinical Interview for DSM-IV when presenting for the treatment of MDE. On the basis of history of hypomania they were assigned to BP-II ( n  = 206) vs. MDD ( n  = 130). All patients were also examined for hypomania during the current MDE. Mixed Depression was operationally defined by the coexistence of a MDE and at least two of the following excitatory signs and symptoms as described by Koukopoulos and Koukopoulos (Koukopoulos A, Koukopoulos A. Agitated Depression as a mixed state and the problem of melancholia. In: Akiskal HS, editor. Bipolarity: beyond classic mania. Psychiatr Clin North Am 1999;22:547–64): inner psychic tension (irritability), psychomotor agitation, and racing/crowded thoughts. The validity of mixed Depression was investigated by documenting its association with BP-II disorder and with external variables distinguishing it from unipolar MDD (i.e., younger age at onset, greater recurrence, and family history of bipolar disorders). We analyzed the data with multivariate regression (STATA 7). Results. – MDE plus psychic tension (irritability) and agitation accounted for 15.4%, and MDE plus agitation and crowded thoughts for 15.1%. The highest rate of mixed Depression (38.6%) was achieved with a definition combining MDE with psychic tension (irritability) and crowded thoughts: 23.0% of these belonged to MDD and 76.9% to BP-II. Moreover, any of these permutations of signs and symptoms defining mixed Depression was significantly and strongly associated with external validators for bipolarity. The mixed irritable-Agitated syndrome Depression with racing-crowded thoughts was further characterized by distractibility (74–82%) and increased talkativeness (25–42%); of expansive behaviors from the criteria B list for hypomania, only risk taking occurred with some frequency (15–17%). Conclusions. – These findings support the inclusion of outpatient-Agitated Depressions within the bipolar spectrum. Agitated Depression is validated herein as a dysphorically excited form of melancholia, which should tip clinicians to think of such a patient belonging to or arising from a bipolar substrate. Our data support the Kraepelinian position on this matter, but regrettably this is contrary to current ICD-10 and DSM-IV conventions. Cross-sectional symptomatologic hints to bipolarity in this mixed/Agitated depressive syndrome are virtually absent in that such patients do not appear to display the typical euphoric/expansive characteristics of hypomania—even though history of such behavior may be elicited by skillful interviewing for BP-II. We submit that the application of this diagnostic entity in outpatient practice would be of considerable clinical value, given the frequency with which these patients are encountered in such practice and the extent to which their misdiagnosis as unipolar MDD could lead to antidepressant monotherapy, thereby aggravating it in the absence of more appropriate treatment with mood stabilizers and/or atypical antipsychotics.

Athanasios Koukopoulos - One of the best experts on this subject based on the ideXlab platform.

  • melancholia agitata and mixed Depression
    Acta Psychiatrica Scandinavica, 2007
    Co-Authors: Athanasios Koukopoulos, Gabriele Sani, Giovanni Manfredi, Isabella Pacchiarotti, Paolo Girardi
    Abstract:

    Objective: The diagnostic entity of major depressive episode includes both simple and Agitated or mixed Depression. Mixed Depression is characterized by a full depressive episode with several symptoms of excitatory nature. Mixed Depressions worsen if treated with antidepressants. Method: We have reviewed the clinical charts of the 2141 patients treated at the Centro Lucio Bini of Rome from January 1999 to June 2006. These patients were diagnosed according to DSM-IV criteria. Research diagnostic criteria were applied for Agitated Depression with motor agitation and Author's diagnostic criteria for Agitated Depression without motor agitation. Results: One thousand and twenty-six patients had a depressive episode as index episode. Three hundred and forty six (33%) were mixed depressive states. One hundred and thirty eight (44%) of them were spontaneous; in 173 cases, the onset of the mixed Depression was associated with antidepressants. Conclusion: Psychic and motor agitation are considered equally important for the definition of Agitated Depression. Treating Agitated Depression with antidepressants worsens the clinical picture. The use of Electroconvulsive Therapy (ECT), neuroleptics and anticonvulsants are recommended. The term Melancholia Agitata is proposed for Agitated (mixed) Depression.

  • toward a validation of a new definition of Agitated Depression as a bipolar mixed state mixed Depression
    European Psychiatry, 2004
    Co-Authors: Franco Benazzi, Athanasios Koukopoulos, Hagop S Akiskal
    Abstract:

    Abstract Purpose. – As psychotic Agitated Depression is now a well-described form of mixed state during the course of bipolar I disorder, we sought to investigate the diagnostic validity of a new definition for Agitated (mixed) Depression in bipolar II (BP-II) and major depressive disorder (MDD). Materials and methods. – Three hundred and thirty six consecutive outpatients presenting with major depressive episodes (MDE) but without history of mania were evaluated with the Structured Clinical Interview for DSM-IV when presenting for the treatment of MDE. On the basis of history of hypomania they were assigned to BP-II ( n  = 206) vs. MDD ( n  = 130). All patients were also examined for hypomania during the current MDE. Mixed Depression was operationally defined by the coexistence of a MDE and at least two of the following excitatory signs and symptoms as described by Koukopoulos and Koukopoulos (Koukopoulos A, Koukopoulos A. Agitated Depression as a mixed state and the problem of melancholia. In: Akiskal HS, editor. Bipolarity: beyond classic mania. Psychiatr Clin North Am 1999;22:547–64): inner psychic tension (irritability), psychomotor agitation, and racing/crowded thoughts. The validity of mixed Depression was investigated by documenting its association with BP-II disorder and with external variables distinguishing it from unipolar MDD (i.e., younger age at onset, greater recurrence, and family history of bipolar disorders). We analyzed the data with multivariate regression (STATA 7). Results. – MDE plus psychic tension (irritability) and agitation accounted for 15.4%, and MDE plus agitation and crowded thoughts for 15.1%. The highest rate of mixed Depression (38.6%) was achieved with a definition combining MDE with psychic tension (irritability) and crowded thoughts: 23.0% of these belonged to MDD and 76.9% to BP-II. Moreover, any of these permutations of signs and symptoms defining mixed Depression was significantly and strongly associated with external validators for bipolarity. The mixed irritable-Agitated syndrome Depression with racing-crowded thoughts was further characterized by distractibility (74–82%) and increased talkativeness (25–42%); of expansive behaviors from the criteria B list for hypomania, only risk taking occurred with some frequency (15–17%). Conclusions. – These findings support the inclusion of outpatient-Agitated Depressions within the bipolar spectrum. Agitated Depression is validated herein as a dysphorically excited form of melancholia, which should tip clinicians to think of such a patient belonging to or arising from a bipolar substrate. Our data support the Kraepelinian position on this matter, but regrettably this is contrary to current ICD-10 and DSM-IV conventions. Cross-sectional symptomatologic hints to bipolarity in this mixed/Agitated depressive syndrome are virtually absent in that such patients do not appear to display the typical euphoric/expansive characteristics of hypomania—even though history of such behavior may be elicited by skillful interviewing for BP-II. We submit that the application of this diagnostic entity in outpatient practice would be of considerable clinical value, given the frequency with which these patients are encountered in such practice and the extent to which their misdiagnosis as unipolar MDD could lead to antidepressant monotherapy, thereby aggravating it in the absence of more appropriate treatment with mood stabilizers and/or atypical antipsychotics.

  • Agitated Depression as a mixed state and the problem of melancholia
    Psychiatric Clinics of North America, 1999
    Co-Authors: Athanasios Koukopoulos
    Abstract:

    The extensive use of antidepressant drugs in the treatment of all forms of Depression makes the question of the real nature of Agitated Depression a crucial issue because many patients have adverse outcomes, including increased agitation, increased insomnia, increased risk of suicide, and sometimes the onset of psychotic symptoms. Agitated Depression is no longer considered a mixed state in the DSM system. After a review of the literature on melancholia agitata as a mixed state and on the introduction of the concept of mixed states, this article has examined the psychopathology of Agitated Depression. The main symptoms are depressive mood with marked anxiety, restlessness, and often delusions. In other cases, psychic agitation and racing or crowded thoughts prevail alongside anxiety and depressed mood. The mixed nature of these symptoms has been discussed and new diagnostic criteria proposed, including those syndromes without marked restlessness but with evident psychic agitation and racing or crowded thoughts. It is suggested that all the varieties of Agitated Depression be called mixed Depression, with the following diagnostic criteria: A. Major depressive episode B. At least two of the following symptoms: 1. Motor agitation 2. Psychic agitation or intense inner tension 3. Racing or crowded thoughts.

Luca Bartoli - One of the best experts on this subject based on the ideXlab platform.

  • Agitated unipolar major Depression prevalence phenomenology and outcome
    The Journal of Clinical Psychiatry, 2006
    Co-Authors: Mario Maj, Raffaele Pirozzi, Lorenza Magliano, Andrea Fiorillo, Luca Bartoli
    Abstract:

    OBJECTIVE: This study aimed to explore how prevalent Agitated "unipolar" major Depression is, whether it belongs to the bipolar spectrum, and whether it differs from nonAgitated "unipolar" major Depression with respect to course and outcome. METHOD: The study was conducted from January 1, 1978, to December 31, 1996. From 361 patients with major depressive disorder, the authors selected those fulfilling Research Diagnostic Criteria for Agitated Depression. These 94 patients were compared to 94 randomly recruited patients with nonAgitated major depressive disorder regarding demographic and historical features, the clinical characteristics of the index episode, the percentage of time spent in an affective episode during a prospective observation period, and the 5-year outcome. Patients with Agitated major depressive disorder who had at least 2 manic/hypomanic symptoms in their index episode were compared to the other patients with Agitated major depressive disorder with respect to the same variables. RESULTS: Patients with Agitated major depressive disorder were more likely to receive antipsychotics during their index episode and spent a higher proportion of time in an affective episode during the observation period compared with patients with nonAgitated major depressive disorder. The presence of at least 2 manic/hypomanic symptoms in the index episode was associated with a higher rate of family history of bipolar I disorder, a higher score for suicidal thoughts during the episode, a longer duration of the episode, and a higher affective morbidity during the observation period. CONCLUSION: The diagnosis of Agitated major depressive disorder is not uncommon and has significant therapeutic and prognostic implications. The subgroup of patients with at least 2 manic/hypomanic symptoms may suffer from a mixed state and/or belong to the bipolar spectrum. Language: en

  • Agitated Depression in bipolar i disorder prevalence phenomenology and outcome
    American Journal of Psychiatry, 2003
    Co-Authors: Mario Maj, Raffaele Pirozzi, Lorenza Magliano, Luca Bartoli
    Abstract:

    OBJECTIVE: The study aimed to explore how prevalent Agitated Depression is in bipolar I disorder, whether it represents a mixed state, and whether it differs from nonAgitated Depression with respect to course and outcome. METHOD: From 313 bipolar I patients with an index episode of major Depression, the authors selected those fulfilling Research Diagnostic Criteria for Agitated Depression. These 61 patients were compared to 61 randomly recruited bipolar I patients with an index episode of nonAgitated Depression and 61 randomly recruited bipolar I patients with an index episode of mania regarding demographic, historical, and clinical features. The two depressive groups were also compared regarding time to recovery from the index episode, treatment received for that episode, percentage of time spent in an affective episode during a prospective observation period, and 5-year outcome. RESULTS: Patients with Agitated Depression were consistently not elated or grandiose, but one-fourth had the cluster of sympto...

Hans Mørch Jensen - One of the best experts on this subject based on the ideXlab platform.

  • Case Report Persistent Genital Arousal Disorder: Confluent Patient History of Agitated Depression, Paroxetine Cessation, and a Tarlov Cyst
    2016
    Co-Authors: Simone Eibye, Hans Mørch Jensen
    Abstract:

    License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We report a case of a woman suffering from persistent genital arousal disorder (PGAD) after paroxetine cessation. She was admitted to a psychiatric department and diagnosed with Agitated Depression. Physical investigation showed no gynaecological or neurological explanation; however, a pelvic MRI scan revealed a Tarlov cyst. Size and placement of the cyst could not explain the patient’s symptoms; thus neurosurgical approach would not be helpful. Her Depression was treated with antidepressant with little effect. Electroconvulsive therapy improved the patient’s symptoms though they did not fully resolve. More awareness of PGAD and thorough interdisciplinary conferences are necessary to insure an unequivocal treatment strategy. 1. Background Persistent genital arousal disorder (PGAD) is a rare disease. Only a few case reports have been published [1–4] and no prevalence has been reported yet. It is often women who suffer from the symptoms of PGAD; however, the diagnosis is not gender-specific.The symptoms of PGAD are as follows [5]

  • Persistent genital arousal disorder: confluent patient history of Agitated Depression, paroxetine cessation, and a tarlov cyst.
    Case reports in psychiatry, 2014
    Co-Authors: Simone Eibye, Hans Mørch Jensen
    Abstract:

    We report a case of a woman suffering from persistent genital arousal disorder (PGAD) after paroxetine cessation. She was admitted to a psychiatric department and diagnosed with Agitated Depression. Physical investigation showed no gynaecological or neurological explanation; however, a pelvic MRI scan revealed a Tarlov cyst. Size and placement of the cyst could not explain the patient's symptoms; thus neurosurgical approach would not be helpful. Her Depression was treated with antidepressant with little effect. Electroconvulsive therapy improved the patient's symptoms though they did not fully resolve. More awareness of PGAD and thorough interdisciplinary conferences are necessary to insure an unequivocal treatment strategy.

Andrew Moskowitz - One of the best experts on this subject based on the ideXlab platform.

  • scared stiff catatonia as an evolutionary based fear response
    Psychological Review, 2004
    Co-Authors: Andrew Moskowitz
    Abstract:

    Catatonia, long viewed as a motor disorder, may be better understood as a fear response, akin to the animal defense strategy tonic immobility (after G. G. Gallup & J. D. Maser, 1977). This proposal, consistent with K. L. Kahlbaum's (1874/1973) original conception, is based on similarities between catatonia and tonic immobility ("death feint") as well as evidence that catatonia is associated with anxiety and Agitated Depression and responds dramatically to benzodiazepines. It is argued that catatonia originally derived from ancestral encounters with carnivores whose predatory instincts were triggered by movement but is now inappropriately expressed in very different modern threat situations. Found in a wide range of psychiatric and serious medical conditions, catatonia may represent a common "end state" response to feelings of imminent doom and can serve as a template to understand other psychiatric disorders.