Results from an Egyptian study show that a substantial proportion of patients being treated for a major depressive episode (MDE) may have underlying bipolarity.
In a study of 306 patients, aged 18 to 76 years, undergoing treatment for an MDE at 19 psychiatric centers in Egypt, almost a third met criteria for bipolarity according to the Hypomania Checklist-32 second revision (HCL-32 R2).
By contrast, just 13.7% of MDE patients met criteria for bipolar disorder according to DSM-IV criteria.
"Evaluating bipolarity strictly on DSM-IV criteria alone may result in a failure to diagnose many patients who have symptoms of bipolarity, especially those with hypomanic symptoms," comment Tarek Okasha (Ain Shams University, Cairo) and team.
Overall, 188 (62.2%) of 302 MDE patients tested positive for manic/hypomanic symptoms, with a score of more than 14 on the HCL-32 R2.
However, just 80 (26.6%) of 306 patients had been previously diagnosed with bipolar I or II disorder.
Factors significantly associated with bipolarity among the patients included atypical depression (hypersomnia, hyperphagia, and/or leaden paralysis), a mixed state (racing thoughts, being more talkative, and/or distractibility), psychomotor agitation, irritability, mood reactivity, and an increased number of depressive symptoms.
The team also found that borderline personality disorder was significantly more common in patients with bipolarity than in those without, at around 10% versus 4%.
"The ability to differentiate between bipolar and depressive mood disorders is of critical importance in the field of psychiatry, as available treatments for these two conditions are quite different," comment Okasha et al in the Journal of Affective Disorders.
They conclude: "Physicians treating patients with major depression need to give special consideration to conducting an in-depth screening for BPD [bipolar disorder] that utilizes multiple assessment tools. Additionally, a number of key factors within a patient's psychiatric history and their clinical manifestations of depression may signal an increased likelihood of BPD."
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