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Does temperamental instability support a continuity between bipolar II disorder and major depressive disorder?

Published online by Cambridge University Press:  16 April 2020

F. Benazzi
F. Benazzi*
Affiliation:
Hecker Psychiatry Research Center, Forli, Italy University of California at San Diego, San Diego, CA, USA Collaborating Center, USA Department of Psychiatry, University of Szeged, Szeged, Hungary Department of Psychiatry, National Health Service of Forli, Via Pozzetto 17, 48015Castiglione di Cervia RA, Italy
*
*Corresponding author. Tel.: +39 335 6191 852; fax: +39 054 330 069. E-mail address: [email protected] (F. Benazzi).
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Abstract

Background

The current categorical split of mood disorders in bipolar disorders and depressive disorders has recently been questioned. Two highly unstable personality features, i.e. the cyclothymic temperament (CT) and borderline personality disorder (BPD), have been found to be more common in bipolar II (BP-II) disorder than in major depressive disorder (MDD). According to Kraepelin, temperamental instability was the ‘foundation’ of his unitary view of mood disorders.

Study aim

The aim was to assess the distributions of the number of CT and borderline personality items between BP-II and MDD. Finding no bi-modal distribution (a ‘zone of rarity’) of these items would support a continuity between the two disorders.

Methods

Study setting: an outpatient psychiatry private practice. Interviewer: A senior clinical and mood disorder research psychiatrist. Patient population: A consecutive sample of 138 BP-II and 71 MDD remitted outpatients. Assessment instruments: The structured clinical interview for DSM-IV Axis I Disorders-Clinician Version (SCID-CV), the SCID-II Personality Questionnaire for self-assessing borderline personality traits (BPT) by patients, the TEMPS-A for self-assessing CT by patients. Interview methods: Patients were interviewed with the SCID-CV to diagnose BP-II and MDD, and then patients self-assessed the questions of the Personality Questionnaire relative to borderline personality, and the questions of the TEMPS-A relative to CT. As clinically significant distress or impairment of functioning is not assessed by the SCID-II Personality Questionnaire, a diagnosis of BPD could not be made, but BPT could be assessed (i.e. all BPD items but not the impairment criterion). The distribution of the number of CT and BPT items was studied by Kernel density estimate.

Results

CT and BPT items were significantly more common in BP-II versus MDD. The Kernel density estimate distributions of the number of CT and BPT items in the entire sample had a normal-like shape (i.e. no bi-modality).

Conclusions

The expected finding, on the basis of previous studies and of the present sample features, was a clustering of CT and BPT items on the BP-II side of the curves. Instead, no bi-modality was present in the distributions of the number of CT and BPT items in the entire sample, showing a normal-like shape. By using the bi-modality approach, a continuity between BP-II and MDD seems supported, questioning the current categorical splitting of BP-II and MDD based on classic diagnostic validators.

Keywords

Bipolar II disorderMajor depressive disorderCyclothymic temperamentBorderline personalityContinuitySpectrumClassification
Type
Original articles
Information
European Psychiatry , Volume 21 , Issue 4 , June 2006 , pp. 274 - 279
Copyright
Copyright © European Psychiatric Association 2006

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References

Aalto-Setala, T, Haarasilta, L, Marttunen, M, Tuulio-Henrikson, A, Poikolainen, K, Aro, Het al.Major depressive episode among young adults: CIDI-SF versus SCAN consensus diagnoses. Psychol. Med. 2002;32:1309–1314.CrossRefGoogle ScholarPubMed
Akiskal, HS, Akiskal, KK, Haykal, RF, Manning, JS, Connor, PDTEMPS-A: progress towards validation of a self-rated clinical of the temperament evaluation of the Memphis, Pisa, Paris and San Diego autoquestionnaire. J. Affect. Disord. 2005;85:3–16.CrossRefGoogle ScholarPubMed
Akiskal, HS, Hantouche, EG, Allilaire, JFBipolar II with and without cyclothymic temperament: “dark” and “sunny” expressions of soft bipolarity. J. Affect. Disord. 2003;73:49–57.CrossRefGoogle ScholarPubMed
Akiskal, HSDemystifying borderline personality: critique of the concept and unorthodox reflections on its natural kinship with the bipolar spectrum. Acta Psychiatr. Scand. 2004;110:401–407.Google ScholarPubMed
Akiskal, HSValidating ‘hard and soft’ phenotypes within the bipolar spectrum: continuity or discontinuity?. J. Affect. Disord. 2003;73:1–5.CrossRefGoogle ScholarPubMed
Akiskal, HS, Benazzi, FOptimizing the detection of bipolar II disorder in outpatient private practice: toward a systematization of clinical diagnostic wisdom. J. Clin. Psychiatry 2005;66:914–921.10.4088/JCP.v66n0715CrossRefGoogle Scholar
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed.text revision (DSM-IV-TR). Washington, DC: American Psychiatric Association; 2000.Google Scholar
Angst, J, Gamma, A, Benazzi, F, Ajdacic, V, Eich, D, Rossler, WToward a re-definition of subthreshold bipolarity: epidemiology and proposed criteria for bipolar-II, minor bipolar disorders and hypomania. J. Affect. Disord. 2003;73:133–146.CrossRefGoogle Scholar
Angst, J, Gamma, A, Sellaro, R, Zhang, H, Merikangas, KToward validation of atypical depression in the community: results of the Zurich cohort study. J. Affect. Disord. 2002;72:125–138.CrossRefGoogle ScholarPubMed
Angst, J, Sellaro, R, Stassen, HH, Gamma, ADiagnostic conversion from depression to bipolar disorders: results of a long-term prospective study of hospital admissions. J Affect Disord 2005;84(1):49–157.CrossRefGoogle ScholarPubMed
Benazzi, FBipolar II disorder and major depressive disorder: continuity or discontinuity?. World J. Biol. Psychiatry 2003;4:166–171.CrossRefGoogle ScholarPubMed
Benazzi, FBorderline personality disorder and bipolar II disorder in private practice depressed outpatients. Compr. Psychiatry 2000;41:106–110.CrossRefGoogle ScholarPubMed
Benazzi, F, Akiskal, HSRefining the evaluation of bipolar II: beyond the strict SCID-CV guidelines for hypomania. J. Affect. Disord. 2003;73:33–38.CrossRefGoogle ScholarPubMed
Benazzi, FDepression with racing thoughts. Psychiatry Res. 2003;120:273–282.CrossRefGoogle ScholarPubMed
Benazzi, FFamily history validation of a definition of mixed depression. Compr. Psychiatry 2005;46:159–166.CrossRefGoogle ScholarPubMed
Cassano, GB, Rucci, P, Frank, E, Fagiolini, A, Dell’Osso, L, Shear, MKet al.The mood spectrum in unipolar and bipolar disorder: arguments for a unitary approach. Am. J. Psychiatry 2004;161:1264–1269.CrossRefGoogle ScholarPubMed
Coryell, WBipolar II disorder: the importance of hypomania. In: Goldber, JF, Harrow, M editors. Bipolar disorders. Clinical course and outcome. Washington, DC: American Psychiatric Press; 1999. p. 219–236.Google Scholar
Deltito, J, Martin, L, Riefkohl, J, Austria, B, Kissilenko, A, Corless, Cet al.Do patients with borderline personality disorder belong to the bipolar spectrum?. J. Affect. Disord. 2001;67:221–228.CrossRefGoogle ScholarPubMed
Dunner, DLClinical consequences of under-recognized bipolar spectrum disorder. Bipolar Disord. 2003;5:456–464.10.1046/j.1399-5618.2003.00073.xCrossRefGoogle ScholarPubMed
Dunner, DL, Tay, KLDiagnostic reliability of the history of hypomania in bipolar II patients and patients with major depression. Compr. Psychiatry 1993;34:303–307.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, J.B.W.Structured clinical interview for DSM-IV axis I disorders-clinician version (SCID-CV). Washington, DC: American Psychiatric Press; 1997.Google Scholar
First, MB, Gibbon, M, Spitzer, RL, Williams, J.B.W., Benjamin, LSSCID-II personality questionnaire. Washington, DC: American Psychiatric Press; 1997.Google Scholar
Goldberg, JF, Harrow, M, Whiteside, JERisk for bipolar illness in patients initially hospitalized for unipolar depression. Am. J. Psychiatry 2001;158:1265–1270.CrossRefGoogle ScholarPubMed
Hantouche, E, Meyer, TD, Skeppar, P, Vieta, E, Scott, JThe HCL-32: towards a self assessment tool for hypomanic symptoms in outpatients. J. Affect. Disord. 2005;88:217–233.Google Scholar
Hantouche, EG, Akiskal, HS, Lencrenon, S, Allilaire, J.-F., Sechter, D, Azorin, J.-M.et al.Systematic clinical methodology for validating bipolar-II disorder: data in mid-stream from a French national multi-site study (EPIDEP). J. Affect. Disord. 1998;50:163–173.CrossRefGoogle Scholar
Joyce, PR, Luty, SE, McKenzie, JM, Mulder, RT, McIntosh, VV, Carter, FAet al.Bipolar II disorder: personality and outcome in two clinical samples. Aust. N. Z. J. Psychiatry 2004;38:433–438.CrossRefGoogle ScholarPubMed
Kendler, KSToward a scientific psychiatric nosology. Strengths and limitations. Arch. Gen. Psychiatry 1990;47:969–973.CrossRefGoogle Scholar
Kendell, R, Jablensky, ADistinguishing between the validity and utility of psychiatric diagnoses. Am. J. Psychiatry 2003;160:4–12.CrossRefGoogle ScholarPubMed
Koenigsberg, HW, Harvey, PD, Mitropoulou, V, Schmeidler, J, New, AS, Goodman, Met al.Characterizing affective instability in borderline personality disorder. Am. J. Psychiatry 2002;159:784–788.CrossRefGoogle ScholarPubMed
Kraepelin, EManic-depressive insanity and paranoia. Edinburgh: E. & S. Livingstone; 1921.CrossRefGoogle Scholar
Levitt, AJ, Joffe, RT, Ennis, J, MacDonald, C, Kutcher, SPThe prevalence of cyclothymia in borderline personality disorder. J. Clin. Psychiatry 1990;51:335–339.Google ScholarPubMed
Links, PS, Heslegrave, RJProspective studies of outcome. Understanding mechanisms of change in patients with borderline personality disorder. Psychiatr. Clin. North Am. 2000;23:137–150.CrossRefGoogle ScholarPubMed
McMahon, FJ, Stine, OC, Chase, GA, Meyers, DA, Simpson, SG, DePaulo, JR Jr.Influence of clinical subtype, sex, and lineality on age at onset of major affective disorder in a family sample. Am. J. Psychiatry 1994;151:210–215.Google Scholar
Mitchell, PB, Malhi, GSBipolar depression: phenomenological overview and clinical characteristics. Bipolar Disord. 2004;6:530–539.CrossRefGoogle ScholarPubMed
Perugi, G, Toni, C, Travierso, MC, Akiskal, HSThe role of cyclothymia in atypical depression: toward a data-based reconceptualization of the borderline-bipolar II connection. J. Affect. Disord. 2003;73:87–98.CrossRefGoogle Scholar
Preston, GA, Marchant, BK, Reimherr, FW, Strong, RE, Hedges, DWBorderline personality disorder in patients with bipolar disorder and response to lamotrigine. J. Affect. Disord. 2004;79:297–303.CrossRefGoogle ScholarPubMed
Salgado-Ugarte, IH, Shimizu, M, Taniuchi, TExploring the shape of univariate data using Kernel density estimators. STATA Technical Bulletin 1994;16:8–19.Google Scholar
Simpson, SG, McMahon, FJ, McInnis, MG, MacKinnon, DF, Edwin, D, Folstein, SEet al.2002. Diagnostic reliability of bipolar II diagnosis. Arch. Gen. Psychiatry 2002;59:736–740.CrossRefGoogle Scholar
World Health Organization. The ICD-10 classification of mental and behavioural disorders. Geneva: World Health Organization; 1992.Google Scholar
Zimmerman, M, Mattia, JIAxis I diagnostic comorbidity and borderline personality disorder. Compr. Psychiatry 1999;40:245–252.CrossRefGoogle ScholarPubMed
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