Discuss Bipolar
Blog to discuss being Bipolar
US researchers have found that the phenomenon of “mixed hypomania” occurs frequently in pediatric bipolar II patients and tends to go unrecognized in early daytime assessments.
The DSM-IV recognizes mania and mixed phases but not the state of mixed hypomania where mixed features involve hypomania rather than mania.
“Our preliminary observations suggest that the phenomenon described by us is quite common among bipolar children and adolescents presenting in an outpatient setting and should therefore command public health attention and efforts directed at replication,” say Steven Dilsaver (Comprehensive Doctors Medical Group Inc., Arcadia, California) and Hagop Akiskal (University of California, San Diego).
The authors evaluated 47 bipolar patients aged 7??”17 years presenting to an outpatient clinic using a structured instrument designed to detect the presence of major depressive episodes (MDE), hypomania, psychotic disorders, and behavioral disorders. Mixed hypomania was defined as MDE and hypomania occurring over at least a 2-week period.
Overall, 85.2% of patients were classified as either bipolar I mixed or bipolar II mixed (38.3%). Focusing the study on the 18 mixed bipolar II patients, the researchers found that this group tended to experience morning depression and some combination of nocturnal rising or elated mood often presented with spikes of euphoria and increased goal-directed activity between the hours of 1900 and 0300. Furthermore, 27.8% of patients showed an inversion of the sleep??”wake cycle.
The researchers found that when patients were seen in the morning, they appeared depressed and showed no signs for a concurrence of depressive and hypomanic symptoms apart from irritability. Conversely, when seen in the mid-to-late afternoon they exhibited irritability, distractibility, and the emergence of psychomotor activation relative to earlier on in the day.
“It is our impression that patients, when seen in the mid-to-late afternoon, sometimes exhibited a transitional state between depressive and hypomanic syndromes,” write Dilsaver and Akiskal in the Journal of Affective Disorders.
They point out that for diagnosing mixed hypomania the clinician must attune to the behavior and experience of a patient over a 24-hour cycle. Additionally, the misleading lack of features of hypomania other than irritability during early assessments “can mislead clinicians into concluding that a patient has major depressive disorder and that treatment with an antidepressant is indicated,” say the authors.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009
