The DOI matches its Crossref record; 35 of the 35 references it cites were found in a registry or an index.
Frequency of manic symptoms during a depressive episode and unipolar ‘depressive mixed state’ as bipolar spectrum
Abstract
Objective: To report the frequency of intra‐episode manic symptoms in depressive episodes, and to evaluate unipolar depressive mixed state (DMS) as bipolar spectrum. Method: A total of 958 (863 unipolar, 25 bipolar II, and 70 bipolar I) depressive in‐patients were assessed in terms of manic symptoms at admission, and several clinical variables using standardized methods. Results: The frequency of manic symptoms (flight of idea, logorrhea, aggression, excessive social contact, increased drive, irritability, racing thoughts, and distractibility) was significantly higher in bipolar depressives than in unipolar depressives. Unipolar depressives with DMS – defined as having two or more manic symptoms – had more similarities to bipolar depressives than to other unipolar depressives in clinical variables such as onset age, family history of bipolar disorder, and possibly suicidality. Conclusion: Depressive mixed state is frequent, particular in bipolar depressives. Unipolar depressives with DMS may be better classified into bipolar spectrum.
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“However, the fact that several people with recurrent depression experience some episodes which are melancholic and some others which are not 58 seems to argue in favour of the latter option.”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [58]
In the citing paper
“The DSM/ICD approach, considering melancholic and psychotic features as 'specifiers' or 'qualifiers' to the diagnosis of depression, rather than assuming that melancholia and psychotic depression are distinct diagnostic entities, is also supported by the evidence that, in many people with recurrent depression, some episodes are either psychotic or melancholic and some others are not. 58,86”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [58]
Citations
Cites
Multiple Comparisons Using Rank Sums
Dunn, O. J. (1964) · Technometrics · doi:10.1080/00401706.1964.10490181 · Cited by 5,168
The Family History Method Using Diagnostic Criteria
Andreasen, N. C. (1977) · Archives of General Psychiatry · doi:10.1001/archpsyc.1977.01770220111013 · Cited by 1,903
Manic Depressive Insanity and Paranoia
Kraepelin, E. (1921) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-192104000-00057 · Cited by 1,319
A Family Study of Schizoaffective, Bipolar I, Bipolar II, Unipolar, and Normal Control Probands
Gershon, E. S. (1982) · Archives of General Psychiatry · doi:10.1001/archpsyc.1982.04290100031006 · Cited by 987
Akiskal, H. S., & Pinto, O. (1999) · Psychiatric Clinics of North America · doi:10.1016/s0193-953x(05)70093-9 · Cited by 686
Switching From 'Unipolar' to Bipolar II
Akiskal, H. S. (1995) · Archives of General Psychiatry · doi:10.1001/archpsyc.1995.03950140032004 · Cited by 677
The Prevalent Clinical Spectrum of Bipolar Disorders: Beyond DSM-IV
Akiskal, H. S. (1996) · Journal of Clinical Psychopharmacology · doi:10.1097/00004714-199604001-00002 · Cited by 535
Hantouche, E. G., Akiskal, H. S., Lancrenon, S., Allilaire, J., Sechter, D., Azorin, J., Bourgeois, M. L., Fraud, J.-P., & Châtenet-Duchêne, L. (1998) · Journal of Affective Disorders · doi:10.1016/s0165-0327(98)00112-8 · Cited by 435
Swann, A. C. (1997) · Archives of General Psychiatry · doi:10.1001/archpsyc.1997.01830130041008 · Cited by 379
Raskin, A., Schulterbrandt, J. G., Reatig, N., & McKeon, J. J. (1969) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-196901000-00010 · Cited by 372
Research works printed but not linked: 6
- SatoT BottlenderR KleindienstN MöllerH‐J.Irritable psychomotor elation in depressed inpatients: a factor validation of mixed depression.J Affect Disord2002(in press).
- World Health Organization., 1992, The ICD‐10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines.
- Renfordt E, 1983, AMDP‐system in pharmacopsychiatry., 125
- Baumann U, 1983, AMDP‐System in Pharmacopsychiatry, 74
- Pietzcker A, 1983, AMDP‐system in pharmacopsychiatry., 88
- SPSS., 1995, SPSS
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Rachid, F., Golaz, J., Bondolfi, G., & Bertschy, G. (2006) · The World Journal of Biological Psychiatry · doi:10.1080/15622970600671002 · Cited by 14
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Mineo, L., Rodolico, A., Spedicato, G. A., Aguglia, A., Bolognesi, S., Concerto, C., Cuomo, A., Goracci, A., Maina, G., Fagiolini, A. M., et al. (2022) · European Psychiatry · doi:10.1192/j.eurpsy.2022.20 · Cited by 13
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Shim, I. H., Bae, D. S., & Bahk, W. (2016) · Annals of Clinical Psychiatry · doi:10.1177/104012371602800311 · Cited by 11
Benarous, X., Guedj, M.-J., Braitman, A., Gallois, É., & Lana, P. (2014) · L Encéphale · doi:10.1016/j.encep.2014.06.003 · Cited by 9
Zaninotto, L., Souery, D., Calati, R., Scudellari, P., Janiri, L., Montgomery, S., Kasper, S. F., Zohar, J., Mendlewicz, J., & Serretti, A. (2014) · Annals of Clinical Psychiatry · doi:10.1177/104012371402600402 · Cited by 8
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Metadata
- Authors
- Sato, T., Bottlender, R., Schröter, A., & Möller, H. ‐.
- Affiliations
- Ludwig-Maximilians-Universität München (DE)
- Corresponding author
- Sato, T.
- ORCID
- Möller, H.‐J.
- Venue
- Acta Psychiatrica Scandinavica
- Publisher
- Wiley
- Published
- 2003-03-27
- Volume
- 107
- Issue
- 4
- Pages
- 268-274
- ISSN
- 0001-690X (ISSN-L)
- 1600-0447
- OpenAlex
- W2114010171
- Cited by
- 170
- References
- 35
- Citations by year
- 2026: 1 · 2025: 3 · 2023: 2 · 2022: 2 · 2021: 1 · 2020: 5 · 2019: 7 · 2018: 3 · 2017: 3 · 2016: 5 · 2015: 18 · 2014: 8 · 2013: 8 · 2012: 6
- FWCI
- 13.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Acta Psychiatrica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- depressive mixed state, manic symptoms, bipolar spectrum, bipolar disorder, major depressive disorder, depressive episodes, bipolar II disorder, bipolar I disorder, irritability, suicidality, family history of bipolar disorder, age of onset
- MeSH terms
- Adult, Affect, Bipolar Disorder, Depression, Female, Humans, Male, Middle Aged, Periodicity, Severity of Illness Index, Disease Progression
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