Do depressive and manic symptoms differentially impact on functioning in acute depression? Results from a large, cross-sectional study

被引:9
作者
Anmella, Gerard [1 ]
Gil-Badenes, Joaquin [1 ]
Pacchiarotti, Isabella [1 ]
Verdolini, Norma [1 ,2 ]
Aedo, Alberto [1 ,3 ]
Angst, Jules [4 ]
Azorin, Jean-Michel [5 ]
Bowden, Charles L. [6 ]
Mosolov, Sergey [7 ]
Samalin, Ludovic [8 ]
Popovic, Dina [9 ]
Young, Allan H. [10 ]
Perugi, Giulio [10 ]
Vieta, Eduard [1 ]
Murru, Andrea [1 ]
机构
[1] Univ Barcelona, IDIBAPS, CIBERSAM, Bipolar & Depress Disorders Unit,Inst Neurosci,Ho, 170 Villarroel St 12-0, Barcelona 08036, Catalonia, Spain
[2] Univ Perugia, Santa Maria Misericordia Hosp, Dept Med, Div Psychiat Clin Psychol & Rehabil, Ellisse Bldg,8th Floor, I-06132 Perugia, Italy
[3] Pontificia Univ Catolica Chile, Sch Med, Dept Psychiat, Bipolar Disorders Unit, Santiago, Chile
[4] AP HM, Psychiat Pole, Marseille, France
[5] Univ Texas Hlth Sci Ctr San Antonio, Dept Psychiat, San Antonio, TX 78229 USA
[6] Moscow Res Inst Psychiat, Dept Therapy Mental Disorders, Moscow, Russia
[7] Univ Clermont Auvergne, EA 7280, Dept Psychiat, CHU Clermont Ferrand, 58 Rue Montalembert, F-63000 Clermont Ferrand, France
[8] Psychiat B Chaim Sheba Med Ctr, Ramat Gan, Israel
[9] Kings Coll London, Inst Psychiat Psychol & Neurosci, Dept Psychol Med, Ctr Affect Disorders, London, England
[10] Univ Pisa, Sect Psychiat, Dept Expt & Clin Med, Via Roma 67, I-56100 Pisa, Italy
关键词
Symptoms; Functioning; Major depressive episode; Bipolar depression; BRIDGE-II-Mix; BIPOLAR DISORDER; LARGE COHORT; ANTIDEPRESSANTS; HETEROGENEITY; METAANALYSIS; AGGRESSION;
D O I
10.1016/j.jad.2019.09.070
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: Diagnostic criteria for a major depressive episode capture heterogeneous presentations across unipolar (UD) and bipolar (BD) and first-onset (FDE) depression. We evaluated the contribution of each depressive and (hypo)manic symptom to worse functioning in UD/BD/FDE subgroups. Methods: A post-hoc analysis of the BRIDGE-II-Mix study. Acutely depressed patients were stratified into UD, BD and FDE. Each (hypo)manic or depressive symptom was included in a diagnosis-specific logistic regression model with functioning as dependent variable. Better/worse functioning was set with median diagnosis-specific GAF scores cutoffs. All p values were two-tailed. Statistical significance was set at p < 0.05. Results: A total of 2768/2811 depressed individuals were enrolled. In BD (N= 716), "recurrent thoughts of death" (OR 2.48, p < 0.0001) and "feelings of worthlessness" (OR 2.28, p < 0.0001) among depressive symptoms, "aggressiveness" (OR 1.67, p= 0.022) as the unique (hypo)manic symptom, significantly contributed to worse functioning. In UD (N= 1357), "depressed mood" (OR 5.6, p= 0.031) and "diminished interest or pleasure" (OR 4.77, p < 0.0001) among depressive, "grandiosity" (OR 3.5, p= 0.014) among (hypo)manic symptoms, most significantly contributed to worse functioning. In FDE (N= 677) "recurrent thoughts of death" (OR 1.99, p < 0.0001) and "insomnia/hypersomnia" (OR 1.88, p= 0.039) among depressive, "grandiosity" (OR 5.98, p= 0.038) as (hypo)manic symptoms significantly contributed to worse functioning. Limitations: The post-hoc and cross-sectional design do not allow for prognostic or causal inferences. Conclusions: Key depressive and (hypo)manic symptoms distinctively associate with worse functional outcome in acute depression, with differential diagnostic-specific magnitude of effect. Core depressive symptoms are associated with worse functioning in unipolar depression, but not in bipolar or first-episode depression.
引用
收藏
页码:30 / 39
页数:10
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