SİNEM GÖNENLİ TOKER, K. Oğuz KARAMUSTAFALIOĞLU

İlk atak majör depresyon tanısı konan hastalarda bipolariteyi öngörebilir miyiz? Bir pilot çalışma

Giriş: Bipolar bozukluk sık görülen bir psikiyatrik bozukluk olmasına rağmen tanısı çoğunlukla atlanabilmektedir. Özellikle depresif ve hipomanik ataklarda yanlış tanı sıktır. Bu çalışmada poliklinikte majör depresyon tanısı konulmuş hastalarda Hipomani Soru Listesi-32 (HSL-32) kullanılarak tanısı atlanmış olası bipolar hastaları saptamayı amaçladık. Bu çalışmada ayrıca HSL-32'nin bipolarite/unipolarite lehine ayırt edici belirli maddeleri olup olmadığını görmeyi amaçladık ve ileride yapılacak geniş ölçekli çok merkezli bir çalışmanın pilot çalışması olarak planladık. Yöntem: Çalışmaya psikiyatri polikliniğine ilk başvurusunda majör depresyon tanısı koyulan 100 hasta alındı ve HSL-32 uygulandı. HSL-32 kesme puanı 14 olarak kabul edilerek hastalar bipolar ve unipolar olmak üzere iki gruba ayrıldı. İki grup arasında 'evet' yanıtı verilen soruların dağılımı incelendi. Bulgular: HSL-32'den 52 hasta 14'ün üzerinde puan aldı ve bipolar grup olarak değerlendirildi. Bipolar ve unipolar grup arasında sosyodemografik değişkenler açısından anlamlı ilişki saptanmadı. İki grup ölçek sorularına verdikleri yanıtlara göre karşılaştırıldığında bipolar grupta özgüven artışı, enerji artışı, psikomotor aktivasyon, amaca yönelik aktivite artışı, konuşkanlık artışı, yaratıcılık ve duygudurum yüksekliğini içeren sorulara 'evet' yanıtı verme oranı unipolar gruba göre anlamlı olarak yüksek bulundu. Tartışma: Çalışmamıza katılan hastalarda bipolarite oranı %52 olarak hesaplandı. Literatürde daha düşük oranlar ve bizim bulduğumuz orana yakın yüksek oranlar vardır. Bu yüksek oranlara göre, HSL-32 bipolar bozukluk sıklığını belirlemede oldukça duyarlı olmakla birlikte, yeterince özgül olmayan bir tarama aracıdır. Özellikle bipolar I bozukluğu bipolar II bozukluk ve yineleyici majör depresif bozukluktan ayırt etmek gerektiğinde daha yüksek bir kesme puanına gerek duyulabileceği söylenebilir. Bipolar grupta HSL-32'nin özgüven artışı, enerji artışı, psikomotor aktivasyon, amaca yönelik aktivite artışı, konuşkanlık artışı, yaratıcılık ve duygudurum yüksekliğini içeren sorularına evet yanıtı verme oranı unipolar gruba göre anlamlı derecede yüksek bulundu. Bu sonuç klinik pratikte bipolarite şüphesi olan depresif hastaların muayenesinde özellikle bu alanlara odaklanılmasının faydalı olacağı bipolarite açısından ipucu olabileceği şeklinde yorumlanabilir. (Anadolu Psikiyatri Derg 2016; 17(1):12-17)

Can we predict bipolarity among patients diagnosed as major depression first episode? A pilot study

Objective: Bipolar disorder is a common psychiatric disorder, although the diagnosis is often delayed until. Especially depressed and hypomanic episodes misdiagnosis are very frequent. We aimed in this study, patients with the major depression, detect possible diagnosis of bipolar disorder to using Hypomania Checklist-32 (HCL-32). This study we also aimed to see whether certain HCL-32 items in favor of distinguishing bipolar disorder, we planned this study as a pilot study for a future large-scale multicenter study. Methods: This study included 100 patients who diagnosed as major depressive disorder according the DSM-IV in first admission and patients were asked to complete the HSL-32. HSL-32 cut-off score of 14 was considered to be bipolar and unipolar patients were divided into two groups. Results: 52 patients took more than 14 on HCL-32 and these patients were evaluated as bipolar group. There were no differences about sociodemographic variables between groups. Answers of the two groups were compared according to the HCL-32; bipolar group had significantly higher rate of answering 'yes' to following question; the increase in self-esteem, increased energy, psychomotor activation, goal-oriented activity, increased talkativeness, creativity and elevated mood. Conclusions: We found 52% bipolarity rate of our study group. There are lower and similar rates are exist in the literature. By looking at these high rates, HCL-32 is quite sensitive in determining the incidence of bipolar disorder, but not specific enough to say that a screening tool. Especially bipolar I disorder, bipolar II disorder and recurrent major depressive disorder necessary to distinguish said to be needed at a higher cut-off points. Bipolar group had significantly higher rate of answering 'yes' to certain questions; so in depressed patients with suspected clinical practice examination bipolarity putting more focus on these areas would be beneficial, especially in terms of bipolarity can be interpreted as the tip. (Anatolian Journal of Psychiatry 2016; 17(1):12-17)

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Bourgeois M. Importance of DSM IV (APA) and ICD-10 (WHO) in diagnosis and treatment of mood disorders. Encephale 1995; 21:47-52.
Merikangas KR, Jin R, He JP, Kessler RC, Lee S, Sampson NA, et al. Prevalence and corraletes of bipolar spectrume disorder in the world mental health survey initiative. Arch Gen Psychiatry 2011; 68:241-251.
APA. Practice Guideline for the Treatment of Patients with Bipolar Disorder (revision). Am J Psychiatry 2001; 159:1-50.
Hirschfeld RM, Vornik LA. Recognition and diag- nosis of bipolar disorder. J Clin Psychiatry 2004; 65(Suppl.15):5-9.
Ghaemi SN, Boiman EE, Goodwin FK. Diag- nosing bipolar disorder and the effect of antide- pressants: a naturalistic study. J Clin Psychiatry 2000; 61:804-808.
Ghaemi SN, Ko JY, Goodwin FK. 'Cade's disease' and beyond: misdiagnosis, antidepressant use and proposed definition for bipolar spectrum disor- der. Can J Psychiatry 2002: 47; 125-134.
Hantouche EG, Akiskal HS, Lancrenon S, Allilaire JF, Sechter D, Azorin JM, et al. Systematic clinical methodology fpr validating bipolar-II disorder: data in mid-stream from French national multi-site stud- y (EPIDEP). J Affect Disord 1998; 50:163-173.
Angst J, Azorin JM, Bowden CI, Perugi G, Vieta E, Gamma A, et al. Prevalance ang characteristics of undiagnosed bipolar disorders in patients with major depressive episode: the BRIDGE Study. Arch Gen Psychiatry 2011; 68:791-798.
Brieger P. Bipolar affective disorders. Part I: diag- nosis, epidemiology and course. Fortschr Neurol Psychiatr 2007; 75:673-682.
Slama F. Epidemiology of bipolar disorders. Rev Prat 2005; 55(Suppl.5):481-485.
Solomon DA, Leon AC, Maser JD, Truman CJ, Coryell W, Endicott J, et al. Distinguishing bipolar major depression from unipolar major depression with the screening assessment of depression- polarity (SAD-P). J Clin Psychiatry 2006; 67(Suppl.3):434-442.
Baethge C, Smolka MN, Gruschka P, Berghofer A, Schlattmann P, Bauer M, et al. Does pro- phylaxis-delay in bipolar disorder influence out- come? Results from a long-term study of 147 pa- tients. Acta Psychiatr Scand 2003; 107:260-267.
Baethge C, Tondo L, Bratti IM, Bschor T, Bauer M, Viguera AC, et al. Prophylaxis latency and outcome in bipolar disorders. Can J Psychiatry 2003; 48;449-457.
Berk M, Dodd S, Callaly P, Berk L, Fitzgerald P, de Castella AR, et al. History of illness prior to a diagnosis of bipolar disorder or schizoaffective disorder. J Affect Disord 2007; 103(Suppl.1- 3):181-186.
Akiskal HS, Benazzi F. Atypical depression: a varient of bipolar II or a bridge between unipolar and bipolar II? J Affect Disord 2005; 84:209-217.
Akiskal HS, Benazzi F. Continuous distribution of atypical depressive symptoms between major depressive and bipolar II disorders: dose-re- sponse relationship with bipolar family history. Psychopathol 2008; 41(Suppl.1):39-42.
Thase ME. Bipolar depression: diagnostic and treatment considerations. Dev Psychopathol 2006; 18(Suppl.4):1213-1230.
Benazzi F, Akiskal H. Irritable-hostile depression: further validation as a bipolar depressive mixed state. J Affect Disord 2005; 84(Suppl.2-3):197- 207. 19. Rybakowski
JK, Suwalska A, Lojko D, Rymaszewska J, Kiejna A. Types of depression more frequent in bipolar than in unipolar affective illness: results of the Polish DEP-BI study. Psychopathol 2007; 40(3):153-158.
Judd LL, Akiskal HS. The prevalence and disa- bility of bipolar spectrum disorders in the US popu- lation: re-analysis of the ECA database taking into account subthreshold cases. J Affect Disord 2003; 73(Suppl.1-2):123-131.
Suppes T, Leverich GS, Keck PE, Nolen WA, Denicoff KD, Altshuler LL, et al. The Stanly foun- dation Bipolar Treatment outcome Network II. Demographics and illness characteristic of the first 261 patients. J Affect Disord 2001; 67:45-49.
Angst J, Adolfsson R, Benazzi F, Gamma A, Hantouche E, Meyer TD, et al. The HCL-32: towards a self-assessment tool for hypomanic symptoms in outpatients. J Affect Disord 2005; 88:217-233.
Forty L, Smith D, Jones I, Caesar S, Fraser C, Gordon-Smith K, et al. Identifying hypomanic fea- tures in major depressive disorder using the Hypo- mania Checklist (HCL-32). J Affect Disord 2009; 114:68-73.
Wu YS, Angst J, Ou CS, Chen HC, Lu RB. Vali- dation of the Chinese version of the Hipomania Checklist (HCL-32) as an instrument for detecting hypo(mania) in patients with mood disorders. J Affect Disord 2008; 106:133-143.
Vieta E, Sanches-Moreno J, Bulbena A, Cha- morro L, Ramos JL, Artal J, et al. Cross validation with the mood disorder questionaire (MDQ) of an instrument for detection of hipomania in Spanish: The 32 item Hipomania Symptom Check list (HCL-32). J Affect Disord 2007; 101:43-55.
Carta MG, Hardoy MC, Cadeddu M, Murru A, Campus A, Morosini PL, et al. The accurancy of the italian version of the Hipomania Checklist (HCL-32) for the screening of bipolar disorders and comparison with the Mood Disorder Question- naire (MDQ) in clinical sample. Clin Pract Epidemiol Ment Health 2006; 8:2.
Soares OT, Hupfeld Moreno D, De Moura EC, Angst J, Moreno RA. Reliabilty and validity of a Brazilian version of the Hypomania Checklist (HCL-32) compared to the Mood Disorder Ques- tionnaire (MDQ). Rev Bras Psychiarty 2010; 32:416-423.
Yang HC, Yuan CM, Liu TB, Li LJ, Peng HJ, Liao CP, et al. Validity of the 32 item Hipomania Check- list (HCL-32) in clinical sample with mood disor- ders in China. BMC Psychiatry 2011; 11:84-89.
Aydemir Ö, Akkaya C, Altınbaş K, Kora K, Dikici DS, Akdeniz F, ve ark. Hipomani Soru Listesi-32- Yenilenmiş Türkçe sürümünün güvenilirlik ve geçerlilik çalışması. 47.Ulusal Psikiyatri Kongresi Kongre Bildiri Kitapçığı s.71, 2011, Antalya, Türkiye.
Vieta E, Angst J, Reed C, Bertsch J, Haro JM. Predictors of switching from mania to depression in a large observational study across Europe (EMBLEM). Affect Disord 2009; 118:1-3.
Rybakowski JK, Dudek D, Pawlowski T, Lojko D, Siwek M, Kiejna A. Use of the hypomania checklist-32 and the mood disorder questionnaire for detecting bipolarity in 1051 patients with major depressive disorder. Eur Psychiatry 2012; 27(Suppl.8):577-581.