Primary affective disorder: MMPI differences between unipolar and bipolar depressed subjects

Depression in inpatients: bipolar vs unipolar

162 depressed inpatients were divided into three diagnostic groups to compare patterns of sociodemographic characteristics, psychopathology, and psychosocial: 35 had a single episode of major depression, 96 had recurrent major depression, and 31 had a bipolar disorder. Psychopathology and psychosocial functioning were measured by clinician-rated scales, Montgomery-Asberg Depression Rating Scale, Hamilton Rating Scale for Depression, Clinical Global Impression, and self-rating scales, Symptom Checklist-90, Social Support Questionnaire, Social Adjustment Scale. The three groups were comparable on sociodemographic variables, with the exception of education. Univariate analyses showed a similar social impairment as measured by Social Support Questionnaire, Social Adjustment Scale, and no significant differences were recorded for the psychopathology when the total test scores (Montgomery-Asberg Depression Rating Scale, Hamilton Rating Scale for Depression, Clinical Global Index, Symptom Checklist-90) were evaluated. Some differences emerged for single items in the Montgomery-Asberg Depression Rating Scale and Symptom Checklist-90. These findings suggest a substantial similarity among the three groups. Results are discussed in terms of the clinical similarities between unipolar and bipolar patients during a depressive episode as well as the limitations of cross-sectional study implies.

Personality traits in subjects with bipolar I disorder in remission

This study compared the personality traits of subjects with bipolar I disorder in remission to the personality traits of subjects with no history of any mental illness. Subjects were assessed as part of a prospective, multicenter, naturalistic study of mood disorders. Diagnoses were rendered according to Research Diagnostic Criteria, through use of the Schedule for Affective Disorders and Schizophrenia - Lifetime Version. A total of 30 euthymic bipolar I subjects were compared to 974 never-ill subjects on 17 personality scales selected for their relevance to mood disorders. The subjects with bipolar I disorder in remission had more aberrant scores on 6 of the 17 personality measures, including Emotional Stability, Objectivity, Neuroticism, Ego Resiliency, Ego Control, and Hysterical Factor. These findings indicate that patients with bipolar I disorder in remission have personality traits that differ from those of normal controls.

The psychological assessment of depression: unipolars versus bipolars

Psychological test differences between unipolar (UD) and bipolar (BD) depressed inpatients were examined using the Minnesota Multiphasic Personality Inventory (MMPI, Hathaway and McKinley, 1943; MMPI-2, Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989), Millon Clinical Multiaxial Inventory (MCMI, Millon, 1983; MCMI-II, Millon 1987), and Symptom Checklist-90 (SCL-90-R, Derogatis, 1983). One hundred fifty-eight UD patients and 26 BD patients took these self-report tests at the beginning of their hospitalization. Results indicate that there were few consistent findings across the three tests (or versions of tests). Contrary to some previous studies, the BD patients did not exhibit a "social desirability" response set, nor did they produce "normal" test profiles. Although the tests were not able to identify depressed patients with past manic episodes, BD patients were more narcissistic, driven, and willing to engage in antisocial practices than were UD patients. These findings are discussed in terms of the clinical similarities between UD and BD patients during a depressive episode as well as the limitations of cross-sectional self-report measures to evaluate historical information regarding course of illness.

The use of the Rorschach to differentiate unipolar and bipolar disorders

We compared the Rorschach performance (using the Comprehensive System; Exner, 1986) of 29 unipolar depressed, 15 bipolar depressed, and 18 bipolar manic inpatient subjects (N = 62) classified on the basis of the Research Diagnostic Criteria (RDC; Spitzer, Endicott, & Robbins, 1985). The three main groups differed from one another on a variety of variables, especially those related to ideation and information processing. One finding of particular importance was that bipolar depressed subjects, like bipolar manic and unlike unipolar depressed subjects, showed a high level of cognitive slippage. These results suggest that the Rorschach possesses utility in the differential diagnosis of affective disorders.

Differentiating between schizophrenic and manic inpatients by means of the MMPI

Forty-five psychiatric inpatients with DSM-III diagnoses of schizophrenia and 31 inpatients with DSM-III diagnoses of bipolar disorder (and currently manic) were compared on the MMPI. Results indicated that although the schizophrenic patients achieved significantly higher scores on several of the MMPI scales (F, Pt, Sc, Si), these findings were of questionable clinical significance. On the other hand, the schizophrenic group did produce a significantly greater percentage of MMPI high-point pairs containing Scale 8(Sc): that is, 64.4% versus 35.5%.

Comparison of self-reports and clinicians' ratings of unipolar major depression

Recent literature has unfavorably compared self-report measures of depression to clinician-administered measures such as the Hamilton Rating Scale. In the present study, the Beck Depression Inventory and the MMPI D scale were compared to the Hamilton Rating Scale to assess the effectiveness of each measure in discriminating unipolar depressed psychiatric inpatients ( n = 26) from inpatients without a major affective disorder ( n = 11). Scores on the Beck scale and the MMPI Depression scale but not the Hamilton Rating Scale were significantly related to the diagnosis of unipolar major depression.

The validity of animal models of depression

Eighteen animal models of depression are reviewed in relation to three sets of validating criteria. Of the 18 models, five could only be assessed for predictive validity, seven could be assessed for predictive and face validity, and six could potentially have predictive, face and construct validity. Some traditional models (reserpine reversal, amphetamine potentiation) are rejected as invalid; the models with the highest overall validity are the intracranial self-stimulation, chronic stress and learned helplessness models in rats, and the primate separation model.

Dopamine and depression: a review of recent evidence. I. Empirical studies

This paper reviews evidence from human, predominantly clinical, studies, relevant to the hypothesis that depression involves reduced levels of dopamine (DA) function. With the exception of Parkinson's disease, there is little evidence that treatments which decrease DA function are potent inducers of depression, but it is argued that such a relationship might not necessarily be expected. There is good evidence that the nigro-striatal DA system is underactive in retarded depressions, and some evidence that DA agonists are therapeutically effective in these cases. It remains unclear whether changes in DA function are primary or secondary.

MMPI state dependency during the course of bipolar psychosis

Minnesota Multiphasic Personality Inventory (MMPI) profiles completed during unambiguous manic, depressed, and euthymic periods were compared in a sample of 22 bipolar (manic-depressive) patients, 13 females and 9 males, drawn from an outpatient psychiatry clinic; each patient was "multiplex-selected" in that each had a first-degree relative with a severe psychiatric disorder. Both the manic and depressed phase MMPIs revealed significant and prototypical signs of psychopathology corresponding with the clinical picture. In contrast, the mean remission profile was entirely within normal limits. At least in some individuals, bipolar disorder seems to be associated with complete restitution of normality.

Intellectual function in primary affective disorder

The possible effects of clinical depression on intellectual function were investigated in unipolar and bipolar patients. Ninety-six hospitalized depressed patients completed the Wechsler Adult Intelligence Scale (WAIS) on admission and 34 were retested on remission. The high average full scale IQs found remained relatively stable throughout, consistent with earlier studies indicating a limited relationship between intellectual function and clinical severity of depression. No evidence was found for retarded psychomotor activity in bipolar groups or increased psychomotor activity in unipolar groups on three WAIS subtests of psychomotor function, but full scale IQ increased slightly in hypomania.

MMPI correlates of affective disorders

Compared 24 unipolar depressives with 24 chronic intermittent depressives on the MMPI. The mean profiles did not differ significantly. However, an MMPI clinician was able to sort the profiles, at an above-chance level, into two groups. The rules for such classification are stated. The results are contrasted with the findings of significant differences between unipolar and bipolar depressives. The hypothesis is offered that unipolar and chronic depressives may not differ on severity of symptomatology.

Gender differences in bipolar affective disorder

We report a study of gender differences in a sample of 111 manic patients. Female manics (N = 78) exhibited fewer manic and more depressive symptoms than males (N = 33). Although male manics had a more frequent history of delayed landmarks, the two groups did not differ in cortical function as measured by EEG and neuropsychological testing. There were no significant differences between male and female relatives of male and female probands for unipolar or bipolar affective disorder, alcoholism or sociopathy. Female relatives of both groups were at greater risk for total affective disorder and male relatives were at greater risk for alcoholism. Familial illness patterns indicated that male and female manics shared the same genetic liability for affective disorder and that X-linked transmission was unlikely.

Personality in unipolar and bipolar manic-malancholic patients

By use of standardized case-recording criteria (MULTI-CLAD) manic-melancholic patients were classified as unipolar (n = 13) and bipolar (n = 23). Personality patterns are evaluated when patients were in neutral mood (defined by low symptom rating scale scores). Results showed that the similarities in the personality patterns of unipolars and bipolars were much pronounced than the differences. In general, the score patterns of the various scales in both groups of patients were found to be within the normal score range. However, this was indirectly expressed by high Lie (or denial) score levels on the Eysenck scale. The dynamic explanations of this form of symptom-denial are discussed. Moreover, our findings are discussed in connection with lithium treatment which was the main therapy the patients had received.

Reassessing the bipolar-unipolar dichotomy

This paper is a critical review of the literature on the dichotomous classification of affective disorders into unipolar and bipolar types. The majority of genetic studies show significant overlap in the liability to develop two forms of illness, and the majority of lithium studies show a similar clinical responsiveness of both groups to both acute and maintenance treatment. Biological studies comparing the two groups are difficult to interpret as most have compared manics to depressives without controlling for motor activity, excitement, and other state-dependent clinical variables. Viewed in light of our research findings in a recent genetic study of affective states, we believe these data suggest that the separation of affective disorders by polarity may have been premature, and that the search for heterogeneity should now be carried out using alternative strategies.

Denial and somatization as characteristics of bipolar depressed groups

A group of 104 depressed patients (54 bipolar and 50 unipolar) completed the booklet form of the MMPI. In addition to the usual validity and clinical scales of the MMPI, 55 special scales, selected for relevancy to the affective disorders, also were included in the study. Inspection of the 11 of 68 MMPI scales on which the biopolar group had significantly higher mean scores than the unipolar group disclosed a patterning of scales suggestive of the use of denial and somatization. These results, coupled with those of other recent studies, suggest that socially desirable response sets and the use of denial and somatization on the MMPI are adaptive defenses in bipolar depressed groups.

Adaptability in bipolar depressed groups

Evidence that bipolar depressed groups appear to be normal and report less psychopathology than their unipolar counterparts is discussed in the context of denial of and adaptability to the stress of depression.

Primary affective disorder: anxiety in unipolar and bipolar depressed groups

A group of 50 patients (29 bipolar and 21 unipolar) hospitalized for depression were compared on the IPAT Anxiety Scale. The bipolar depressed group reported significantly less anxiety than the unipolar group. This finding supports the results of other studies that reported relatively less psychopathology in bipolar groups during the acute depressive state. It is suggested that test-taking defensiveness, especially denial, might account for relatively lower anxiety and MMPI scores in bipolar groups.

Biogenic amine-related enzymes and personality variations in normals

Altered activities of biogenic amine-related enzymes have been reported in some studies of patients with affective disorders and chronic schizophrenia. To evaluate whether any relationship between personality variations, including non-diagnosed psychopathology, and these enzymes might occur in non-psychiatric patients, 95 young adult volunteers were studied. Higher MMPI and Zuckerman sensation--seeking scale scores were found in male, but not female, volunteers with lower platelet and plasma amine oxidase activities. Males generally exhibited negative correlations, while females had positive correlations between the psychological test scores and amine oxidase activities. In contrast to the amine oxidase results, no associations were observed between plasma dopamine beta-hydroxylase activities and the personality variables.

Classification of the MMPI profiles of two alcoholic groups

Ninety-two per cent of the MMPI CODES OF 60 ALCOHOLICS IN THE Link Society and institutional groups of the present study were classified according to a mixed typological-dimensional model. The study applied reciprocal two-digit high-point codes and also five different spiked codes and two different codes which include more than two scales in predominant position. Related codes suggesting different diagnostic descriptions were, however, separated from each other. The present study also used new interpretations of some MMPI scales, detailed descriptions of the other scales and applied some critically examined measurements of certain authors. Of special interest is a detailed interpretation of codes opathic deviate) scale as a measurement of hysterical personality. The above methods gave a more exact identification of the MMPI codes than a previous study of the present author and suggest that it is possible to give a more refined description of different personality disorders in particular but also of other psycho-pathological and behavioural characteristics of the alcoholic patients in the Link Society and institutional groups. The different typal dimensions measured by the MMPI high-point codes seem to be of theoretical value but also seem to be useful for a more differentiated and adequate treatment of alcoholics. In further corroborative studies there is a need for more case history descriptions in order to correct for local departures. It is also possible that these descriptions may aid in giving a clearer identification of the codes, including scale 5, not classified in the present study.

Primary affective disorder: Bender-Gestalt sequence of placement as an indicator of impulse control

The Bender-Gestalt protocols of 37 bipolar (depression plus mania) and 30 unipolar (depression alone) Ss hospitalized for depression were compared for sequential patterns of placement on the test paper. Of 11 Ss with an itregular sequence and 11 Ss with an overly methodical sequence, 9 were subsequently identified as bipolar and 10 as unipolar, respectively. When these two groups with contrasting sequences were compared on the Ma and Pt scales of the MMPI, the bipolar group had significantly higher scores than the unipolar group on the Ma scale and significantly lower scores on the Pt scale. These results suggest that irregular sequence of placement and lack of impulse control are more characteristic of bipolar depression and overly methodical sequence and impulse control are more characteristic of unipolar depression.