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Bipolar I and II versus unipolar depression: Clinical differences and impulsivity/aggression traits

Published online by Cambridge University Press:  15 April 2020

K. Dervic ,
M. Garcia-Amador ,
K. Sudol ,
P. Freed ,
D.A. Brent ,
J.J. Mann ,
J.M. Harkavy-Friedman  and
M.A. Oquendo
K. Dervic
Affiliation:
Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Columbia University, 1051, Riverside Drive, NY10032, New YorkUSA Department of Psychiatry and Behavioral Science, College of Medicine, United Arab Emirates University, Al Ain, United Arab Emirates
M. Garcia-Amador
Affiliation:
Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
K. Sudol
Affiliation:
Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Columbia University, 1051, Riverside Drive, NY10032, New YorkUSA
P. Freed
Affiliation:
286, Madison Ave, New York, NY10016, USA
D.A. Brent
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
J.J. Mann
Affiliation:
Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Columbia University, 1051, Riverside Drive, NY10032, New YorkUSA
J.M. Harkavy-Friedman
Affiliation:
American Foundation for Suicide Prevention, USA
M.A. Oquendo*
Affiliation:
Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Columbia University, 1051, Riverside Drive, NY10032, New YorkUSA
*
* Corresponding author. E-mail address:[email protected] (M.A. Oquendo).
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Abstract

Objective:

To investigate distinguishing features between bipolar I, II and unipolar depression, and impulsivity/aggression traits in particular.

Methods:

Six hundred and eighty-five (n = 685) patients in a major depressive episode with lifetime Unipolar (UP) depression (n = 455), Bipolar I (BP-I) disorder (n = 151), and Bipolar II (BP-II) (n = 79) disorder were compared in terms of their socio-demographic and clinical characteristics.

Results:

Compared to unipolar patients, BP-I and BP-II depressed patients were significantly younger at onset of their first depressive episode, and were more likely to experience their first depressive episode before/at age of 15. They also had more previous affective episodes, more first- and second-degree relatives with history of mania, more current psychotic and subsyndromal manic symptoms, and received psychopharmacological and psychotherapy treatment at an earlier age. Furthermore, BP-I and BP-II depressed patients had higher lifetime impulsivity, aggression, and hostility scores. With regard to bipolar subtypes, BP-I patients had more trait-impulsivity and lifetime aggression than BP-II patients whereas the latter had more hostility than BP-I patients. As for co-morbid disorders, Cluster A and B Personality Disorders, alcohol and substance abuse/dependence and anxiety disorders were more prevalent in BP-I and BP-II than in unipolar patients. Whereas the three groups did not differ on other socio-demographic variables, BP-I patients were significantly more often unemployed that UP patients.

Conclusion:

Our findings comport with major previous findings on differences between bipolar and unipolar depression. As for trait characteristics, bipolar I and II depressed patients had more life-time impulsivity and aggression/hostility than unipolar patients. In addition, bipolar I and II patients also differed on these trait characteristics.

Keywords

MoodAggressionImpulsivityPersonality disorderSubstance abuse
Type
Original article
Information
European Psychiatry , Volume 30 , Issue 1 , January 2015 , pp. 106 - 113
Copyright
Copyright © European Psychiatric Association 2020

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References

Aguiar Ferreira, Ad, Vasconcelos, A.G., Neves, F.S., Laks, J., Correa, H.. Affective temperaments: familiality and clinical use in mood disorders. J Affect Disord 2013; 148: 53–56. http://dx.doi.org/10.1016/j.jad.2012.11.047. [Epub 2012 Dec 11].CrossRefGoogle Scholar
Akiskal, H.S., Benazzi, F.. Continuous distribution of atypical depressive symptoms between major depressive and bipolar II disorders: dose-response relationship with bipolar family history. Psychopathology 2008; 41: 39–42 [Epub 2007 Oct 18].CrossRefGoogle ScholarPubMed
Akiskal, H.S., Walker, P., Puzantian, V.R., King, D., Rosenthal, T.L., Dranon, M.. Bipolar outcome in the course of depressive illness. Phenomenologic, familial, and pharmacologic predictors. J Affect Disord 1983; 5: 115–128.CrossRefGoogle ScholarPubMed
American Psychiatric Association, Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: VA: American Psychiatric Publishing; 2013.CrossRefGoogle Scholar
Angst, J., Marneros, A.. Bipolarity from ancient to modern times: conception, birth and rebirth. J Affect Disord 2001;67:3–19.CrossRefGoogle ScholarPubMed
Angst, J., Gamma, A., Endrass, J., Hantouche, E., Goodwin, R., Ajdacic, V., et al.Obsessive-compulsive syndromes and disorders: significance of comorbidity with bipolar and anxiety syndromes. Eur Arch Psychiatry Clin Neurosci 2005;255:65–71.CrossRefGoogle ScholarPubMed
Angst, J., Azorin, J.M., Bowden, C.L., Perugi, G., Vieta, E., Gamma, A., et al.Prevalence and characteristics of undiagnosed bipolar disorders in patients with a major depressive episode: the BRIDGE study. Arch Gen Psychiatry 2011;68:791–798.CrossRefGoogle ScholarPubMed
Ballester, J., Goldstein, T., Goldstein, B., Obreja, M., Axelson, D., Monk, K., et al.Is bipolar disorder specifically associated with aggression?. Bipolar Disord 2012;14:283–290.CrossRefGoogle ScholarPubMed
Ballester, J., Goldstein, B., Goldstein, T.R., Yu, H., Axelson, D., Monk, K., et al.Prospective longitudinal course of aggression among adults with bipolar disorder. Bipolar Disord 2013. http://dx.doi.org/10.1111/bdi.12168 [Epub ahead of print].CrossRefGoogle Scholar
Barratt, E.S.. Factor analysis of some psychometric measures of impulsiveness and anxiety. Psychol Rep 1965;16:547–554.CrossRefGoogle ScholarPubMed
Bassett, D.. Borderline personality disorder and bipolar affective disorder. Spectra or spectre? A review. Aust N Z J Psychiatry 2012;46:327–339.CrossRefGoogle ScholarPubMed
Beck, A.T., Ward, C.H., Mendelson, M., Mock, J., Erbaugh, J.. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–571.CrossRefGoogle ScholarPubMed
Beck, A.T., Weissman, A., Lester, D., Trexler, L.. The measurement of pessimism: the hopelessness scale. J Consult Clin Psychol 1974;42:861–865.CrossRefGoogle ScholarPubMed
Beck, A.T., Kovacs, M., Weissman, A.. Assessment of suicidal intention: the scale for suicide ideation. J Consult Clin Psychol 1979;47:343–352.CrossRefGoogle ScholarPubMed
Benazzi, F.. The relationship of major depressive disorder to bipolar disorder: continuous or discontinuous?. Curr Psychiatry Rep 2005;7:462–470.CrossRefGoogle ScholarPubMed
Benazzi, F.. The continuum/spectrum concept of mood disorders: is mixed depression the basic link?. Eur Arch Psychiatry Clin Neurosci 2006;256:512–515.CrossRefGoogle ScholarPubMed
Benazzi, F., Akiskal, H.S.. How best to identify a bipolar-related subtype among major depressive patients without spontaneous hypomania: superiority of age at onset criterion over recurrence and polarity?. J Affect Disord 2008;107:77–88 [Epub 2007 Sep 12].CrossRefGoogle ScholarPubMed
Bowden, C.L.. A different depression: clinical distinctions between bipolar and unipolar depression. J Affect Disord 2005;84:117–125.CrossRefGoogle ScholarPubMed
Brodsky, B.S., Oquendo, M., Ellis, S.P., Haas, G.L., Malone, K.M., Mann, J.J.. The relationship of childhood abuse to impulsivity and suicidal behavior in adults with major depression. Am J Psychiatry 2001;158:1871–1877.CrossRefGoogle ScholarPubMed
Brown, G.L., Goodwin, F.K.. Human aggression and suicide. Suicide Life Threat Behav 1986;16:223–243.CrossRefGoogle ScholarPubMed
Buss, A.H., Durkee, A.. An inventory for assessing different kinds of hostility. J Consult Psychol 1957;21:343–349.CrossRefGoogle ScholarPubMed
Carlson, G.A., Meyer, S.E.. Phenomenology and diagnosis of bipolar disorder in children, adolescents, and adults: complexities and developmental issues. Dev Psychopathol 2006;18:939–969.CrossRefGoogle ScholarPubMed
Chamorro, J., Bernardi, S., Potenza, M.N., Grant, J.E., Marsh, R., Wang, S., et al.Impulsivity in the general population: a national study. J Psychiatr Res 2012 [Epub ahead of print].CrossRefGoogle ScholarPubMed
Corruble, E., Damy, C., Guelfi, J.D., Impulsivity:. a relevant dimension in depression regarding suicide attempts?. J Affect Disord 1999;53:211–215.CrossRefGoogle ScholarPubMed
Coryell, W., Endicott, J., Andreasen, N., Keller, M., Bipolar, I.. bipolar II, and non-bipolar major depression among the relatives of affectively ill probands. Am J Psychiatry 1985;142:817–821.Google Scholar
Danner, S., Fristad, M.A., Arnold, L.E., Youngstrom, E.A., Birmaher, B., Horwitz, S.M., et al.Early onset bipolar spectrum disorders: diagnostic issues. Clin Child Fam Psychol Rev 2009;12:271–293.CrossRefGoogle ScholarPubMed
de Aguiar Ferreira, A., Vasconcelos, A.G., Neves, F.S., Correa, H.. Affective temperaments and antidepressant response in the clinical management of mood disorders. J Affect Disord 2014;155:138–141. http://dx.doi.org/10.1016/j.jad.2013.10.038. [Epub 2013 Oct 28].CrossRefGoogle Scholar
Del Porto, J.A.. Bipolar disorder: evolution of the concept and current controversies. Rev Bras Psiquiatr 2004;49(suppl 3)630–636. [3,4,7,6].Google Scholar
DelBello, M.P., Carlson, G.A., Tohen, M., Bromet, E.J., Schwiers, M., Strakowski, S.M.. Rates and predictors of developing a manic or hypomanic episode 1 to 2 years following a first hospitalization for major depression with psychotic features. J Child Adolesc Psychopharmacol 2003;13:173–185.CrossRefGoogle ScholarPubMed
Di Nicola, M., Sala, L., Romo, L., Catalano, V., Even, C., Dubertret, C., et al.Adult attention-deficit/hyperactivity disorder in major depressed and bipolar subjects: role of personality traits and clinical implications. Eur Arch Psychiatry Clin Neurosci 2013 [Epub ahead of print].Google Scholar
Doerfler, L.A., Connor, D.F., Toscano, P.F. Jr.. Aggression, ADHD symptoms, and dysphoria in children and adolescents diagnosed with bipolar disorder and ADHD. J Affect Disord 2011;131:312–319.CrossRefGoogle ScholarPubMed
Duberstein, P.R., Heisel, M.J.. Personality traits and the reporting of affective disorder symptoms in depressed patients. J Affect Disord 2007;103:165–171. [Epub 2007 Feb 28].CrossRefGoogle ScholarPubMed
Dumlu, K., Orhon, Z., Ozerdem, A., Tural, U., Ulas, H., Tunca, Z.. Treatment-induced manic switch in the course of unipolar depression can predict bipolarity: cluster analysis based evidence. J Affect Disord 2011;134:91–101.CrossRefGoogle ScholarPubMed
Ekinci, O., Albayrak, Y., Ekinci, A.E., Caykoylu, A.. Relationship of trait impulsivity with clinical presentation in euthymic bipolar disorder patients. Psychiatry Res 2011;190:259–264.CrossRefGoogle ScholarPubMed
Fiedorowicz, J.G., Endicott, J., Leon, A.C., Solomon, D.A., Keller, M.B., Coryell, W.H.. Sub-threshold hypomanic symptoms in progression from unipolar major depression to bipolar disorder. Am J Psychiatry 2011;168:40–48.CrossRefGoogle Scholar
First, M.B., Spitzer, R.L., Gibbon, M., Williams, JBW. The structured clinical interview for DSM-III-R personality disorders (SCID-II, Version 2.0): part I: description. J Pers Disord 1995;9:83–91.CrossRefGoogle Scholar
Fletcher, K., Parker, G., Barrett, M., Synnott, H., McCraw, S.. Temperament and personality in bipolar II disorder. J Affect Disord 2012;136:304–309. [Epub 2011 Dec 10].CrossRefGoogle ScholarPubMed
Fornaro, M., Perugi, G., Gabrielli, F., Prestia, D., Mattei, C., Vinciguerra, V., et al.Lifetime comorbidity with different subtypes of eating disorders in 148 females with bipolar disorders. J Affect Disord 2010;121:147–151.CrossRefGoogle ScholarPubMed
Ghaemi, N., Sachs, G.S., Goodwin, F.K.. What is to be done? Controversies in the diagnosis and treatment of manic-depressive illness. World J Biol Psychiatry 2000;1:65–74. [Review].CrossRefGoogle ScholarPubMed
Gilman, S.E., Dupuy, J.M., Perlis, R.H.Risks for the transition from major depressive disorder to bipolar disorder in the National Epidemiologic Survey on alcohol and related conditions. J Clin Psychiatry 2012. [Epub ahead of print].Google ScholarPubMed
Goldberg, J.F., Garno, J.L.. Age at onset of bipolar disorder and risk for comorbid borderline personality disorder. Bipolar Disord 2009;11:205–208. http://dx.doi.org/10.1111/j.1399-5618.2008.00653.x.CrossRefGoogle Scholar
Goldberg, J.F., Harrow, M., Whiteside, J.E.. Risk for bipolar illness in patients initially hospitalized for unipolar depression. Am J Psychiatry 2001;158:1265–1270.CrossRefGoogle ScholarPubMed
Goldberg, J.F., Perlis, R.H., Bowden, C.L., Thase, M.E., Miklowitz, D.J., Marangell, L.B., et al.Manic symptoms during depressive episodes in 1,380 patients with bipolar disorder: findings from the STEP-BD. Am J Psychiatry 2009;166:173–181.CrossRefGoogle ScholarPubMed
Goldstein, B.I., Strober, M.A., Birmaher, B., Axelson, D.A., Esposito-Smythers, C., Goldstein, T.R., et al.Substance use disorders among adolescents with bipolar spectrum disorders. Bipolar Disord 2008;10:469–478.CrossRefGoogle ScholarPubMed
Hamilton, M.. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62.CrossRefGoogle ScholarPubMed
Hantouche, E.G., Akiskal, H.S.. Bipolar II vs. unipolar depression: psychopathologic differentiation by dimensional measures. J Affect Disord 2005;84:127–132.CrossRefGoogle ScholarPubMed
Hegerl, U., Bottner, A.C., Holtschmidt-Täschner, B., Born, C., Seemüller, F., Scheunemann, W., et al.Onset of depressive episodes is faster in patients with bipolar versus unipolar depressive disorder: evidence from a retrospective comparative study. J Clin Psychiatry 2008;69:1075–1080.CrossRefGoogle ScholarPubMed
Henin, A., Biederman, J., Mick, E., Sachs, G.S., Hirshfeld-Becker, D.R., Siegel, R.S., et al.Psychopathology in the offspring of parents with bipolar disorder: a controlled study. Biol Psychiatry 2005;58:554–561. [Epub 2005 Aug 22].CrossRefGoogle ScholarPubMed
Hillegers, M.H., Reichart, C.G., Wals, M., Verhulst, F.C., Ormel, J., Nolen, W.A.. Five-year prospective outcome of psychopathology in the adolescent offspring of bipolar parents. Bipolar Disord 2005;7:344–350.CrossRefGoogle ScholarPubMed
Howes, O.D., Lim, S., Theologos, G., Yung, A.R., Goodwin, G.M., McGuire, P.. A comprehensive review and model of putative prodromal features of bipolar affective disorder. Psychol Med 2011;41:1567–1577.CrossRefGoogle ScholarPubMed
Ibiloglu, A.O., Caykoylu, A.. Distinctive sociodemographic, clinical and temperament characteristics of bipolar I, bipolar II and major depressive disorder. Turk Psikiyatri Derg 2011;22:159–165.Google Scholar
Jiménez, E., Arias, B., Castellví, P., Goikolea, J.M., Rosa, A.R., Fañanás, L., et al.Impulsivity and functional impairment in bipolar disorder. J Affect Disord 2012;136:491–497.CrossRefGoogle ScholarPubMed
Joshi, G., Wozniak, J., Petty, C., Vivas, F., Yorks, D., Biederman, J., et al.Clinical characteristics of comorbid obsessive-compulsive disorder and bipolar disorder in children and adolescents. Bipolar Disord 2010;12:185–195.CrossRefGoogle ScholarPubMed
Judd, L.L., Schettler, P.J., Akiskal, H., Coryell, W., Fawcett, J., Fiedorowicz, J.G., et al.Prevalence and clinical significance of subsyndromal manic symptoms, including irritability and psychomotor agitation, during bipolar major depressive episodes. J Affect Disord 2012;138:440–448. [Epub 2012 Feb 6].CrossRefGoogle ScholarPubMed
Kim, J.H., Choi, S.S., Ha, K.. A closer look at depression in mothers who kill their children: is it unipolar or bipolar depression?. J Clin Psychiatry 2008;69:1625–1631.CrossRefGoogle ScholarPubMed
Kochman, F.J., Hantouche, E.G., Ferrari, P., Lancrenon, S., Bayart, D., Akiskal, H.S.. Cyclothymic temperament as a prospective predictor of bipolarity and suicidality in children and adolescents with major depressive disorder. J Affect Disord 2005;85:181–189.CrossRefGoogle ScholarPubMed
Li, C.T., Bai, Y.M., Huang, Y.L., Chen, Y.S., Chen, T.J., Cheng, J.Y., et al.Association between antidepressant resistance in unipolar depression and subsequent bipolar disorder: cohort study. Br J Psychiatry 2012;200:45–51.CrossRefGoogle ScholarPubMed
Luby, J.L., Belden, A.C.. Clinical characteristics of bipolar vs. unipolar depression in preschool children: an empirical investigation. J Clin Psychiatry 2008;69:1960–1969.CrossRefGoogle Scholar
Lunde, A.V., Fasmer, O.B., Akiskal, K.K., Akiskal, H.S., Oedegaard, K.J.. The relationship of bulimia and anorexia nervosa with bipolar disorder and its temperamental foundations. J Affect Disord 2009;115:309–314.CrossRefGoogle ScholarPubMed
Maina, G., Salvi, V., Rosso, G., Bogetto, F.. Cyclothymic temperament and major depressive disorder: a study on Italian patients. J Affect Disord 2010;121:199–203.CrossRefGoogle Scholar
Mechri, A., Kerkeni, N., Touati, I., Bacha, M., Gassab, L.. Association between cyclothymic temperament and clinical predictors of bipolarity in recurrent depressive patients. J Affect Disord 2011;132:285–288.CrossRefGoogle ScholarPubMed
Mitchell, P.B., Wilhelm, K., Parker, G., Austin, M.P., Rutgers, P., Malhi, G.S.. The clinical features of bipolar depression: a comparison with matched major depressive disorder patients. J Clin Psychiatry 2001;62:212–216. [quiz 217].CrossRefGoogle ScholarPubMed
Mitchell, P.B., Goodwin, G.M., Johnson, G.F., Hirschfeld, R.M.. Diagnostic guidelines for bipolar depression: a probabilistic approach. Bipolar Disord 2008;10:144–152.CrossRefGoogle ScholarPubMed
Mitchell, P.B., Frankland, A., Hadzi-Pavlovic, D., Roberts, G., Corry, J., Wright, A.. Comparison of depressive episodes in bipolar disorder and in major depressive disorder within bipolar disorder pedigrees. Br J Psychiatry 2011;199:303–309.CrossRefGoogle ScholarPubMed
Moreno, J.K., Fuhriman, A., Selby, M.J.. Measurement of hostility, anger, and depression in depressed and non-depressed subjects. Pers Assess 1993;61:511–523.CrossRefGoogle Scholar
Moreno, C., Hasin, D.S., Arango, C., Oquendo, M.A., Vieta, E., Liu, S., et al.Depression in bipolar disorder versus major depressive disorder: results from the National Epidemiologic Survey on alcohol and related conditions. Bipolar Disord 2012;14:271–282.CrossRefGoogle ScholarPubMed
Mueser, K.T., Gottlieb, J.D., Cather, C., Glynn, S.M., Zarate, R., Smith, L.F., et al.Antisocial personality disorder in people with co-occurring severe mental illness and substance use disorders: clinical, functional, and family relationship correlates. Psychosis 2012;4:52–62.CrossRefGoogle ScholarPubMed
Najt, P., Perez, J., Sanches, M., Peluso, M.A., Glahn, D., Soares, J.C.. Impulsivity and bipolar disorder. Eur Neuropsychopharmacol 2007;17:313–320.CrossRefGoogle ScholarPubMed
Nandagopal, J.J., Fleck, D.E., Adler, C.M., Mills, N.P., Strakowski, S.M., DelBello, M.P.. Impulsivity in adolescents with bipolar disorder and/or attention-deficit/hyperactivity disorder and healthy controls as measured by the Barratt Impulsiveness Scale. J Child Adolesc Psychopharmacol 2011;21:465–468.CrossRefGoogle ScholarPubMed
NIMH genetics initiative: family interview for genetic studies (FIGS) Rockville: National Institute of Mental Health; 1992.Google Scholar
Nurnberger, J.I. Jr., McInnis, M., Reich, W., et al.A high-risk study of bipolar disorder. Childhood clinical phenotypes as precursors of major mood disorders. Arch Gen Psychiatry 2011;68:1012–1020.CrossRefGoogle ScholarPubMed
Nusslock, R., Frank, E.. Sub-threshold bipolarity: diagnostic issues and challenges. Bipolar Disord 2011;13:587–603.CrossRefGoogle Scholar
Olfson, M., Das, A.K., Gameroff, M.J., Pilowsky, D., Feder, A., Gross, R., et al.Bipolar depression in a low-income primary care clinic. Am J Psychiatry 2005;162:2146–2151.CrossRefGoogle Scholar
Oquendo, M.A., Halberstam, B., Mann, J.J.Risk factors for suicidal behavior: utility and limitations of research instruments. In: First, M.B., editor. Standardized assessment for the clinician. Washington, D.C: APPI; 2003. 103–130.Google Scholar
Oquendo, M.A., Ellis, S.P., Chesin, M.S., Birmaher, B., Zelazny, J., Tin, A., et al.Familial transmission of parental mood disorders: unipolar and bipolar disorders in offspring. Bipolar Disord 2013;15:764–773.CrossRefGoogle ScholarPubMed
Overall, J.E., Gorham, D.R.. The brief psychiatric rating scale. Psychol Rep 1962;10:799–812.CrossRefGoogle Scholar
Parker, G.. Predicting onset of bipolar disorder from subsyndromal symptoms: a signal question?. Br J Psychiatry 2010;196:87–88.CrossRefGoogle ScholarPubMed
Parker, G., Fletcher, K.. Differentiating bipolar I and II disorders and the likely contribution of DSM-5 classification to their cleavage. J Affect Disord 2014;152–154:57–64.Google ScholarPubMed
Perlis, R.H., Brown, E., Baker, R.W., Nierenberg, A.A.. Clinical features of bipolar depression versus major depressive disorder in large multicenter trials. Am J Psychiatry 2006;163:225–231.CrossRefGoogle ScholarPubMed
Perris, C.. A study of bipolar (manic-depressive) and unipolar recurrent depressive psychoses IV. A multidimensional study of personality traits. Acta Psychiatr Scand Suppl 1966;194:68–82.CrossRefGoogle ScholarPubMed
Perroud, N., Baud, P., Mouthon, D., Courtet, P., Malafosse, A.. Impulsivity, aggression and suicidal behavior in unipolar and bipolar disorders. J Affect Disord 2011;134:112–118. http://dx.doi.org/10.1016/j.jad.2011.05.048. [Epub 2011 Jul 1].CrossRefGoogle Scholar
Perugi, G., Del Carlo, A., Benvenuti, M., Fornaro, M., Toni, C., Akiskal, K., et al.Impulsivity in anxiety disorder patients: is it related to comorbid cyclothymia?. J Affect Disord 2011;133:600–606.CrossRefGoogle ScholarPubMed
Quilty, L.C., Pelletier, M., Deyoung, C.G., Michael Bagby, R.. Hierarchical personality traits and the distinction between unipolar and bipolar disorders. J Affect Disord 2013;147:247–254.CrossRefGoogle ScholarPubMed
Rybakowski, J.K.. Bipolarity and inadequate response to antidepressant drugs: clinical and psychopharmacological perspective. J Affect Disord 2012;136:e13–e19. [Epub 2011 May 31].CrossRefGoogle ScholarPubMed
Sala, R., Axelson, D.A., Castro-Fornieles, J., Goldstein, T.R., Goldstein, B.I., Ha, W., et al.Factors associated with the persistence and onset of new anxiety disorders in youth with bipolar spectrum disorders. J Clin Psychiatry 2012;73:87–94.CrossRefGoogle ScholarPubMed
Saunders, E.F., Fitzgerald, K.D., Zhang, P., McInnis, M.G.. Clinical features of bipolar disorder comorbid with anxiety disorders differ between men and women. Depress Anxiety 2012;29:739–746.CrossRefGoogle ScholarPubMed
Serretti, A., Mandelli, L., Lattuada, E., Cusin, C., Smeraldi, E.. Clinical and demographic features of mood disorder subtypes. Psychiatry Res 2002;112:195–210.CrossRefGoogle ScholarPubMed
Shippee, N.D., Shah, N.D., Williams, M.D., Moriarty, J.P., Frye, M.A., Ziegenfuss, J.Y.. Differences in demographic composition and in work, social, and functional limitations among the populations with unipolar depression and bipolar disorder: results from a nationally representative sample. Health Qual Life Outcomes 2011;9:90.CrossRefGoogle ScholarPubMed
Skjelstad, D.V., Malt, U.F., Holte, A.. Symptoms and behaviors prior to the first major affective episode of bipolar II disorder. An exploratory study. J Affect Disord 2011;132:333–343.CrossRefGoogle ScholarPubMed
Smith, D.J., Craddock, N.. Unipolar and bipolar depression: different of the same?. Br J Psychiatry 2011;199:272–274.CrossRefGoogle ScholarPubMed
Souery, D., Zaninotto, L., Calati, R., Linotte, S., Mendlewicz, J., Sentissi, O., et al.Depression across mood disorders: review and analysis in a clinical sample. Compr Psychiatry 2012;53:24–38.CrossRefGoogle Scholar
Spitzer, R.L., Williams, JBW, Gibbon, M., First, M.B.Structured Clinical Interview for DSM-III-R. Patient edition (SCID-P). Washington, D.C: American Psychiatric Press; 1990.Google Scholar
Sublette, E.M., Carballo, J.J., Moreno, C., Brent, D.A., Birmaher, B., Mann, J.J., et al.Substance use disorders and suicide attempts in bipolar subtypes. J Psychiatr Res 2009;43:230–238.CrossRefGoogle Scholar
Swann, A.C.The strong relationship between bipolar and substance use disorder. Ann N Y Acad Sci 2010;1187:276–293.CrossRefGoogle ScholarPubMed
Ucok, A., Karaveli, D., Kundakci, T., Yazici, O.Comorbidity of personality disorders with bipolar mood disorders. Compr Psychiatry 1998;39:72–74.CrossRefGoogle ScholarPubMed
Winokur, G., Coryell, W., Endicott, J., Akiskal, H.Further distinctions between manic-depressive illness (bipolar disorder) and primary depressive disorder (unipolar depression). Am J Psychiatry 1993;150:1176–1181.Google Scholar
Winokur, G., Coryell, W., Keller, M., Endicott, J., Akiskal, H.A prospective follow-up of patients with bipolar and primary unipolar affective disorder. Arch Gen Psychiatry 1993;50:457–465.CrossRefGoogle ScholarPubMed
Young, R.C., Biggs, J.T., Ziegler, V.E., Meyer, D.A.A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 1978;133:429–435.CrossRefGoogle ScholarPubMed
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