Dissociative Experience in Unipolar and Bipolar Depression: Exploring the Great Divide
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Objective: Unipolar and bipolar depression (UD and BD) differ strikingly in respect to neurobiology, course and management, but their apparent clinical similarity often leads to misdiagnosis resulting in chronicity of course and treatment failure. In this study we have tried to assess whether UD and BD can be differentiated on the basis of their dissociative symptoms. Methods: Thrty-six UD patients and 35 BD patients in active episodes, without any psychiatric comorbidity were selected from outpatient department and compared for depressive and dissociative symptoms using Hamilton Depression Rating Scale and Dissociative Experience Scale-II (DES-II). Results: We found that thought the two groups didn’t differ in terms of the socio-demographic or clinical variables, BD group had significantly higher dissociative experience (U=343, p=0.001) than UD and the difference remained significant even after adjusting for the confounding factors. Conclusion: Our study shows that dissociative symptoms are significantly more prevalent in the depressive episodes of bipolar affective disorder as compared to the UD and can be an important tool in differentiating between the two disorders with very similar clinical profile. The difference can be measured using a simple self-report questionnaire like DES-II.
Abstract
Objective: Unipolar and bipolar depression (UD and BD) differ strikingly in respect to neurobiology, course and management, but their apparent clinical similarity often leads to misdiagnosis resulting in chronicity of course and treatment failure. In this study we have tried to assess whether UD and BD can be differentiated on the basis of their dissociative symptoms. Methods: Thrty-six UD patients and 35 BD patients in active episodes, without any psychiatric comorbidity were selected from outpatient department and compared for depressive and dissociative symptoms using Hamilton Depression Rating Scale and Dissociative Experience Scale-II (DES-II). Results: We found that thought the two groups didn’t differ in terms of the socio-demographic or clinical variables, BD group had significantly higher dissociative experience (U=343, p=0.001) than UD and the difference remained significant even after adjusting for the confounding factors. Conclusion: Our study shows that dissociative symptoms are significantly more prevalent in the depressive episodes of bipolar affective disorder as compared to the UD and can be an important tool in differentiating between the two disorders with very similar clinical profile. The difference can be measured using a simple self-report questionnaire like DES-II.
참고문헌 (24)
- Bowden CL, "Strategies to reduce misdiagnosis of bipolar depression", Psychiatr Serv, 52, pp.51~55 (2001)[DOI]
- Smith DJ, "Is underdiagnosis the main pitfall when diagnosing bipolar disorder? Yes", BMJ, 340, pp.c854~ (2010)[DOI]
- Angst J, "The bipolar spectrum", Br J Psychiatry, 190, pp.189~191 (2007)[DOI]
- Koukopoulos A, "DSM-5 criteria for depression with mixed features: a farewell to mixed depression", Acta Psychiatr Scand, 129, pp.4~16 (2014)[DOI]
- Spiegel D, "Dissociative disorders in DSM-5", Depress Anxiety, 28, pp.E17~E45 (2011)[DOI]
- van Ijzendoorn MH, "The measurement of dissociation in normal and clinical populations: Meta-analytic validation of the Dissociative Experiences Scale (DES)", Clin Psychol Rev, 16, pp.365~382 (1996)[DOI]
- Oedegaard KJ, "Dissociative experiences differentiate bipolar-II from unipolar depressed patients: the mediating role of cyclothymia and the Type A behaviour speed and impatience subscale", J Affect Disord, 108, pp.207~216 (2008)[DOI]
- Carlson EB, "An update on the dissociative experiences scale", Dissociation, 6, pp.16~27 (1993)
- Zimmerman M, "Severity classification on the Hamilton Depression Rating Scale", J Affect Disord, 150, pp.384~388 (2013)[DOI]
- Latalova K, "Cognitive dysfunction, dissociation and quality of life in bipolar affective disorders in remission", Psychiatr Danub, 22, pp.528~534 (2010)
- Ghosal MK, "Conversion (dissociative) symptoms as a presenting feature in early onset bipolar disorder: a case series", BMJ Case Rep, 2009, pp.bcr01~ (2009)
- Ociskova M, "Coping strategies, hope, and treatment efficacy in pharmacoresistant inpatients with neurotic spectrum disorders", Neuropsychiatr Dis Treat, 11, pp.1191~1201 (2015)
- Johnson SL, "Life events as predictors of mania and depression in bipolar I disorder", J Abnorm Psychol, 117, pp.268~277 (2008)[DOI]
- Olley A, "When euthymia is just not good enough: the neuropsychology of bipolar disorder", J Nerv Ment Dis, 193, pp.323~330 (2005)[DOI]
- Latalova K, "Bipolar affective disorder and dissociation--comparison with healthy controls", Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 155, pp.181~186 (2011)[DOI]
- Etkin A, "Resolving emotional conflict: a role for the rostral anterior cingulate cortex in modulating activity in the amygdala", Neuron, 51, pp.871~882 (2006)[DOI]
- Krawczyk DC, "Contributions of the prefrontal cortex to the neural basis of human decision making", Neurosci Biobehav Rev, 26, pp.631~664 (2002)[DOI]
- Critchley HD, "Neural systems supporting interoceptive awareness", Nat Neurosci, 7, pp.189~195 (2004)[DOI]
- Chatterjee SS, "I do not exist-Cotard syndrome in insular cortex atrophy", Biol Psychiatry, 77, pp.e52~e53 (2015)[DOI]
- McEwen BS, "Stress and hippocampal plasticity: implications for the pathophysiology of affective disorders", Hum Psychopharmacol, 16(S1), pp.S7~S19 (2001)[DOI]
- Ehling T, "Volume of discrete brain structures in complex dissociative disorders: preliminary findings", Prog Brain Res, 167, pp.307~310 (2008)
- Vermetten E, "Hippocampal and amygdalar volumes in dissociative identity disorder", Am J Psychiatry, 163, pp.630~636 (2006)[DOI]
- Sharma A, "Divergent relationship of depression severity to social reward responses among patients with bipolar versus unipolar depression", Psychiatry Res, 254, pp.18~25 (2016)[DOI]
- Ghaemi SN, "Cades disease and beyond: misdiagnosis antidepressant use and a proposed definition for bipolar spectrum disorder", Can J Psychiatry, 47, pp.125~134 (2002)[DOI]