Atypical features common in bipolar disorder subtypes, associated with therapy

By Shreeya Nanda, Senior medwireNews Reporter

Atypical features are prevalent in all subtypes of bipolar disorder, a Chinese survey published in Neuroscience Bulletin, shows, and are associated with the use of antidepressant medication in patients with mixed stage and remission subtypes.

Of the 3906 bipolar disorder patients recruited from the National Bipolar Mania Pathway Survey, 9.1% exhibited atypical features as per the DSM-IV criteria of mood reactivity together with at least two of the following so-called atypical feature B symptoms: hyperphagia, hypersomnia or weight gain, interpersonal rejection sensitivity and leaden paralysis.

Researcher Yiru Fang (Shanghai Jiao Tong University School of Medicine) and colleagues report that the point prevalence of atypical features increased to 11.8% when just the presence of two or more atypical feature B symptoms was used as the defining criteria.

Although all subtypes showed atypical features, patients with mixed state disease had the highest prevalence, with DSM-IV and atypical features B criteria met by 28.1% and 33.2%, respectively.

Mixed state patients meeting the atypical features B criteria were also significantly more likely to be taking antidepressants than those who did not, at 33.8% and 17.9%, respectively. A similar significant association was also observed in remission patients, with antidepressant use in 36.4% and 14.1% of patients who did and did not meet the criteria, respectively.

The researchers comment that their results are suggestive of broader issues regarding bipolar disorder treatment in China, such as the high prescription rate of antidepressants despite the lack of consensus regarding their effects in bipolar disorder patients.

They conclude: “In particular, the findings highlight the need to strengthen the education of physicians on [atypical features] in [bipolar disorder], to help clinicians recognize different aspects of [bipolar disorder] and depressive symptoms, and accordingly provide appropriate treatments.”

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