Depresif Dönem İki Uçlu Bozukluk Tip I, Tip II ve Tek Uçlu Bozukluk'ta Farklı mıdır?

Amaç: Bu çalışmanın amacı, iki uçlu tip I (İUB-I), tip II(İUB-II) ve tek uçlu bozukluk (TUB) depresif dönemleriarasındaki farklılıkları incelemektir.Yöntem: Bu amaçla çalışmamızda yatarak ya da ayaktan tedavi gören, DSM-IVe göre İUB-I depresif dönemölçütlerini karşılayan 49, İUB-II depresif dönem ölçütlerinikarşılayan 47 ve majör depresif bozukluk (MDB) tanılı 46olgu ardışık olarak değerlendirilmiştir. Olgularda şimdikidepresif dönem için tedavi düzenlenmemiş olma şartıaranmıştır. Tanı görüşmeleri SCID-I ile yapılmış, hasta vehastalığa ilişkin bilgiler SKIP-TURK ile kaydedilmiştir. Herbir olguya, Hamilton Depresyon Ölçeği (HDDÖ), İntiharNiyeti Ölçeği (İNO), Barratt İmpusivite Ölçeği (BİS), Yemetutumu Envanteri (YTE), Pittsburgh Uyku Kalitesi İndeksi(PUKİ) ve Arizona Cinsel Yaşantılar Ölçeği (ASEX) uygulanmıştır.Bulgular: Melankolik belirtiler gösteren alt tip ve psikotikbulgu, İUB-I tanılı olgular arasında, atipik belirtiler gösterenalt tip ve özkıyım girişimi İUB-II tanılı olgular arasında dahasık bulunmuştur. Ani başlangıç ve mevsimsellik İUB-II tanılıolgular arasında en yüksek sıklıkta saptanmıştır. HDDÖmaddeleri tek tek karşılaştırıldığında 5., 6., 14. ve 17.madde (orta ve son uykusuzluk, genital belirtiler ve içgörü)dışındaki maddeler gruplar arasında farklılık göstermiştir.TUB tanılı olgularda HDDÖ ve BİS puanları arasında güçlü,İUB-I tanılı olgularda BİS ve PUKİ puanları arasında, İUB-IItanılı olgularda ise BİS ve YTE puanları arasında orta derecede bir ilişki vardır.Sonuç: Depresif dönem, duygudurum bozuklukları arasında bazı benzerlikler gösterse de, ayırıcı tanı ve tedaviyönünden yararlı olabilecek belirgin farklılıklar bulundurmaktadır.

Are Depressive Episodes Different in Bipolar Disorder type I, type II and Unipolar Depression?

Objective: The aim of this study to investigate thedifferences between depressive episodes of disorder typeI (BD-I), type II (BD-II) and unipolar depression (UD).Methods: For this purpose patients from outpatients orinpatients units have been included in the study. Fourtynine patients who were diagnosed with BD-I depressiveepisode, 47 patients who were diagnosed with BD-IIdepressive episode, and 46 patient who were diagnosedwith major depressive episode (UD) according to DSM-IVhave been evaluated consecutively. Exclusion criterionwas ordered treatment for current episode. Diagnosticinterviews were done with SCID-I and II, information aboutpatient and disease were recorded by using SKIP-TURK.Hamilton Depression Rating Scale (HDRS), Suicide IntentScale (SIS), Barratt Impulsivity Scale (BIS), The EatingAttitudes Test (EAT), Pittsburg Sleep Quality Index (PSQI)and Arizona Sexual Experience Scale (ASES) were used toevaluate each patient.Results: Melancholic features and psychotic symptomswere more frequent in BD-I, atypical features and suicidattempt were more frequent in BD-II. Sudden onsetand seasonality were mostly found in BD-II. However,item scores of HDRS, except items assessing middle andterminal insomnia, genital symptoms, and insight, weredifferent between the groups. There was a strong relationbetween HDRS and BIS scores in UD, a moderate relationbetween BIS and PSQI scores in BD-I, and a moderaterelation between BIS and EAT scores in BD-II patients.Conclusion: Although some similarities in the characteristicsof depressive episodes of mood disorders exist, there aresome remarkable differences between them that can beuseful in differential diagnosis and treatment.

PDF

___

1. Coryell W. Bipolar II Disorder: a progress report. J Affective Disord. 1996;41:159-62.
2. Coryell W, Endicott J, Maser JD. Longterm stability of polarity distinctions in the affective disorders. Am J Psychiatry. 1995;152:385-90.
3. Judd LL, Akiskal HS, Schettler PJ. The comparative clinical phenotype and long term longitudinal episode course of bipolar I and II: a clinical spectrum or distinct disorders? J Affect Disord. 2003;73:19-32.
4. Fieve RR, Dunner DL. Unipolar and bipolar affective states, in the nature and the treatment of depression. Ed. Flach FF, Draghi SS. 1975, New York, Wiley, pp. 145-60.
5. Perugi G, Akiskal HS. The soft bipolar spectrum redefined: focus on the cyclothymic, anxious-sensitive, impulse-dyscontrol, and binge-eating connection in bipolar II and related conditions. Psychiatr Clin North Am. 2002;25:713-37.
6. Mantere O, Suominen K, Valtonen HM. Differences in outcome of DSM-IV bipolar I and II disorders. Bipolar Disord. 2008;10:413-25.
7. Çorapçıoğlu A, Aydemir Ö, Yıldız M. DSM-IV Eksen I Bozuklukları (SCID-I) İçin Yapılandırılmış Klinik Görüşme, Klinik Versiyon. 1999, Ankara, Hekimler Yayın Birliği.
8. Özerdem A, Yazıcı O, Tunca Z, Mood Disorders Study Group, Psychiatric Association of Turkey and K Tırpan. Establishment of Computerized Registry Program for Bipolar Illnes in Turkey: SKİP- TÜRK. J Affect Disord. 2004;84:86.
9. Williams BW. A structured interview guide for Hamilton Depression Rating Scale. Arch Gen Psychiatr. 1978;45:742-7.
10. Akdemir A, Örsel S, Dağ İ. Hamilton depresyon derecelendirme ölçeğinin geçerliği, güvenilirliği ve klinikte kullanımı. Psikiyatri Psikoloji Psikofarmakoloji Dergisi. 1996;4:251-9.
11. Mieczkowski TA, Sweeney JA, Haas GL. Factor composition of the Suicide Intent Scale. Suicide Life Threat Behav. 1993;23:37-45.
12. Dilbaz N, Bitlis V, Bayam G. İntihar Niyeti Ölçeği geçerlilik ve Güvenilirlik Çalışması. XXXI Ulusal Psikiyatri Kongresi, 1995, Bildiri Özet Kitabı, s: 39.
13. Patton JH, Stanford MS, Barratt ES. Factor structure of the Barratt Impulsiveness Scale. J Clin Psychol. 1995;51:768-74.
14. Güleç H, Tamam L, Güleç MY. Barratt Dürtüsellik Ölçeği- 11in Türkçe uyarlamasının psikometrik özellikleri. Klinik Psikofarmakoloji Dergisi 2008;18:251-8.
15. Garner DM, Garfinkel PE. The Eating Attitudes Test: an index of the symptoms of AN. Psychol Med. 1979;9:273-9.
16. Erol N, Savaşır I. Yeme Tutumu Testi: Anoreksiya belirtiler indexi. Psikoloji Derg. 1989;7:19-25.
17. Buysse DJ, Reynolds CF 3rd, Monk TH. The Pittsburgh Sleep Quality İndex: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193-213.
18. Ağargün MY, Kara H, Anlar Ö. Pittsburgh Uyku Kalitesi İndexinin Geçerliği ve Güvenirliği. Türk Psikiyatri Dergisi. 1996;7:107-15.
19. McGahuey CA, Gelenberg AJ, Laukes CA. The Arizona Sexual Experience Scale: reliability and validity. J Sex Marital Ther. 2000;26:25-40.
20. Soykan A. The reliability and validity of Arizona sexual experiences scale in Turkish ESRD patients. Int J Impot Res. 2004;16:531-4.
21. Kessing LV. Gender differences in the phenomenology of bipolar disorder. Bipolar Disord. 2004;6:421-5.
22. Ellouze F, Ayedi S, Cherif W, Ben Abla T, Mrad MF. Spouses and bipolar disorder. Encephale. 2011;37:41-7.
23. De Dios C, González-Pinto A, Montes JM, Goikolea JM, Saiz-Ruiz J, Prieto E, Vieta E. Predictors of recurrence in bipolar disorders in Spain (PREBIS study data). J Affect Disord. 2012;141:406-14.
24. Shippee ND, Shah ND, Williams MD, Moriarty JP, Frye MA, Ziegenfuss JY. 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;13: 90-9.
25. Mantere O, Suominen K, Leppamaki S. The clinical characteristics of DSM-IV bipolar I and II disorders: baseline findings from the Jorvi Bipolar Study (JoBS). Bipolar Disord. 2004;6:395-405.
26. Brugue E, Colom F, Sanchez-Moreno J. Depression subtypes in bipolar I and II disorders. Psychopathology. 2008;41:111-4.
27. Parker G, McCraw S, Hadzi-Pavlovic D, Hong M, Barrett M. Bipolar depression: Prototypically melancholic in its clinical features. J Affect Disord. 2012;146:35-9.
28. Mitchell PB, Wilhelm K, Parker G. The clinical features of bipolar depression: a comparison with matched major depressive disorder patients. J Clin Psychiatry. 2001;62:212-6.
29. Judd LL, Akiskal HS, Schettler PJ. A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Arch Gen Psychiatry. 2003; 60:261-9.
30. Kesebir S, Bayrak A, Ünübol B, Turan Ç, Ünal A, Çakır S. Are depressive episodes of bipolar disorder I and II different? Bipolar Disord. 2012;14:89.
31. Hegerl U, Bottner AC, Merql R. Speed of onset of depressive episodes: a clinical criterion helpful for seperating uni from bipolar disorders. Neuropsychiatr. 2008;22:92-9.
32. Parker G, Roy K, Wilhelm K. The nature of bipolar depression. J Affect Disord. 2000; 59:217-24.
33. Parker G, Hadzi-Pavlovic D, Tully L. Distinguishing bipolar and unipolar disorders: an isomer model. J Affect Disord. 2006;96:67- 73.
34. Vahip S, Kesebir S, Gönül AS, Akdeniz F. The difference in the symptom profile of the bipolar and unipolar depression. Bipolar Disord. 2002;4:36.
35. Perlis RH, Brown E, Baker RW, Nierenberg AA. Clinical features of bipolar depression versus major depressive disorder in large multicenter trials. Am J Psychiatry. 2006;163:225-31.
36. Duncan WC Jr, Pettigrew KD, Gillin JC. REM architecture changes in bipolar and unipolar depression. Am J Psychiatry. 1979;136:1424-7.
37. Baek JH, Park DY, Choi J. Differences between bipolar I and bipolar II disorders in clinical features, comorbidity, and family history. J Affect Disord. 2011;131:59-67.
38. Perlis RH, Ostacher MJ, Uher R. Stability of symptoms across major depressive episodes in bipolar disorder. Bipolar Disord. 2009; 11:867-75.
39. Valtonen HM, Suominen K, Haukka J. Differences in incidence of suicide attempts during phases of bipolar I and II disorders. Bipolar Disord. 2008;10:588-96.
40. Coryell W, Solomon DA, Fiedorowicz JG. Anxiety and outcome in bipolar disorder. Am J Psychiatry. 2009;166:1238-43.
41. Gurpequi M, Casanova J, Cervera S. Clinical and neuroendocrine profiles of endogenous unipolar and bipolar depression. Acta Psychiatr Scand. 1985;320:30-7.
42. Raja M, Azzoni A. Sexual behaviour and problems among patients with severe chronic psychosis. Eur Psychiatry. 2003;18:70-6.
43. Tondo L, Lepri B, Baldessarini RJ. Reproduction among 1975 Sardinian women and men diagnosed with major mood disorders. Acta Psychiatr Scand. 2011;123:283-9.