0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Letter to the Editor   |    
Dr. Maj and Colleagues Reply
MARIO MAJ, M.D., Ph.D.; RAFFAELE PIROZZI, M.D.; LORENZA MAGLIANO, M.D., Ph.D.; LUCA BARTOLI, M.D.
Am J Psychiatry 2005;162:194-194. doi:10.1176/appi.ajp.162.1.194

To the Editor: We are grateful to Dr. Sato et al. for their letter, which confirms the current revival of interest in agitated bipolar depression as a possible mixed state. Dr. Sato et al. state that in our article we did not report on anxiety symptoms in our bipolar I patients with an index episode of agitated depression. This is not correct. In Table 3 of our article, we did report the mean score on the item "inner tension" of the Comprehensive Psychopathological Rating Scale (defined in the scale as "mental tension mounting to panic, dread, and anguish"). This score was significantly higher in patients with agitated depression (mean=1.40, SD=0.49) than in those with nonagitated depression (mean=0.95, SD=0.56) (F=21.5, df=1, 120, p<0.001) and in those with mania (mean=0.46, SD=0.50) (F=107.6, df=1, 120, p<0.0001). Of the eight patients with agitated depression who showed both three symptoms of factor 2 and all of the symptoms of factor 5 of Cassidy et al. (1) for mania, six (75%) had a score of at least 1 on the "inner tension" item. In line with these findings, Koukopoulos et al. (2) used the expression "anxious-excited depression" to identify the mixed depressive state and listed "intense inner tension" as one of the symptoms characterizing the condition, whereas Akiskal and Mallya (3) mentioned "refractory anxiety" among the symptoms of mixed depression. Perhaps the current characterization of the "new" psychopathology of mania (reflected in our current assessment instruments) is not sophisticated enough to allow a clear demarcation between "anxiety" and "nonclassic manic" symptoms.

We agree with Dr. Sato et al. that the issue of agitated depression as a possible mixed state is also relevant to bipolar II and unipolar depression, and we are currently studying two cohorts of bipolar II and unipolar patients with an index episode of agitated depression, along with appropriate comparison groups.

Cassidy F, Forest K, Murry E, Carroll BJ: A factor analysis of the signs and symptoms of mania. Arch Gen Psychiatry  1998; 55:27–32
[PubMed]
[CrossRef]
 
Koukopoulos A, Pani L, Serra G, Minnai G, Reginaldi D: La dépression anxieuse excitée: un syndrome affectif mixte. Encephale 1995; 21(special number 6):33–36
 
Akiskal HS, Mallya G: Criteria for the "soft" bipolar spectrum: treatment implications. Psychopharmacol Bull  1987; 23:68–73
[PubMed]
 
+

References

Cassidy F, Forest K, Murry E, Carroll BJ: A factor analysis of the signs and symptoms of mania. Arch Gen Psychiatry  1998; 55:27–32
[PubMed]
[CrossRef]
 
Koukopoulos A, Pani L, Serra G, Minnai G, Reginaldi D: La dépression anxieuse excitée: un syndrome affectif mixte. Encephale 1995; 21(special number 6):33–36
 
Akiskal HS, Mallya G: Criteria for the "soft" bipolar spectrum: treatment implications. Psychopharmacol Bull  1987; 23:68–73
[PubMed]
 
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Books
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 2.  >
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 11.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 1.  >
DSM-5™ Clinical Cases > Chapter 4.  >
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 9.  >
Topic Collections
Psychiatric News
APA Guidelines
PubMed Articles