Prévalence de l’hypomanie dans les dépressions majeures récurrentes ou résistantes : enquêtes Bipolact

Association between hypomania and self-harm behaviors in Chinese children and adolescents with depressive symptoms

Bipolar disorder (BD) is associated with a higher risk of self-harm (SH) when compared with depression. Therefore, it is reasonable to suspect that the state of mania or hypomania may independently contribute to increased SH risk. However, for hypomania, its association with SH remains less known. We intend to investigate this hypothesis in a large sample of Chinese children and adolescents with depressive symptoms. Based on a two-stage simple random cluster sampling method with probability proportionate to sample size (PPS) design, a total of 4,858 children and adolescents aged between 10 and 17 years were surveyed in southwestern China, Yunnan Province, by using self-administered questionnaires. Among them, 1,577 respondents with depressive symptoms were screened out and included in the final analysis. Descriptive statistics were calculated to illustrate the major characteristics of the study subjects. Multivariate logistic regression models were fitted to evaluate the adjusted association between hypomanic symptoms and SH. The prevalence of SH in children and adolescents with depressive symptoms was 63.92% (95% CI: 58.70-69.00%). The two hypomanic factors, which measure "active/elated" (factor I) and "risk-taking/irritable" (factor II), were significantly and discordantly associated with SH: after adjustment, every one-point increase in factor I and factor II scores was associated with 0.94-fold (95% CI: 0.91-0.97) and 1.25-fold (95% CI: 1.15-1.36) of odds ratio (OR) in SH prevalence. Further analyses based on quartiles of the two factors revealed a more prominent dose-response relationship between factor II and SH prevalence, SH repetition, and SH severity. The results of this study may suggest that, for hypomanic children and adolescents, individuals with elevated factor II score are probably of greater urgency for SH intervention. Major limitations of this study include inability of causal inference, risk of information bias, and limited results extrapolation.

DSM-IV diagnosis in depressed primary care patients with previous psychiatric ICD-10 bipolar disorder

BACKGROUND

In the past 20 years, much evidence has accumulated against the overly restrictive diagnostic concepts of hypomania in DSM-IV and DSM-IV-TR. We tested DSM-IV-TR and a broader modified version (DSM-IV-TRm) for their ability to detect bipolarity in patients who had been treated for bipolar disorders (BD) in psychiatric settings, and who now consulted general practitioners (GPs) for new major depressive episodes (MDE).

METHODS

Bipolact II was an observational, single-visit survey involving 390 adult patients attending primary care for MDE (DSM-IV-TR criteria) in 201 GP offices in France. The participating GPs (53.3 ± 6.5 years old, 80.1% male) were trained by the Bipolact Educational Program, and were familiar with the medical care of depressive patients.

RESULTS

Of the 390 patients with MDE, 129 (33.1%) were previously known as bipolar patients (ICD-10 criteria). Most of the latter bipolar patients (89.7%) had previously been treated with antidepressants. Only 9.3% of them met DMS-IV-TR criteria for BD. Conversely, 79.1% of the 129 bipolar patients met DMS-IV-TRm criteria for BD and showed strong associations with impulse control disorders and manic/hypomanic switches during antidepressant treatment.

LIMITATIONS

Limited training of participating GPs, recall bias of patients, and the study not being representative for untreated bipolar patients.

CONCLUSIONS

Very few ICD-10 bipolar patients consulting French GPs for MDE met DSM-IV-TR criteria for bipolar diagnosis, which suggests that DSM-IV-TR criteria are insufficient and too restrictive for the diagnosis of BD. DSM-IV-TRm was more sensitive, but 20% of bipolar patients were undetected.

Impact of an educational program on the management of bipolar disorder in primary care

OBJECTIVE

Government agencies and industry have recently undertaken educational programs for the management of bipolar disorder in primary care, but their medical impact is not well known. Therefore, we conducted a survey among general practitioners to evaluate the impact of the Bipolact Educational Program on the diagnosis and treatment of bipolar disorder.

METHODS

A total of 45 general practitioners attending the Bipolact Educational Program (trained group) were compared with a control group of 50 untrained general practitioners on their ability to: (i) diagnose bipolar I and II disorders and (ii) treat bipolar disorder patients appropriately.

RESULTS

Trained physicians, but not untrained physicians, showed a significant improvement (p < 0.0001, chi-square test) in the ability to identify patients as having bipolar I (from 10.4% to 28.8%) and bipolar II disorder (from 20.1% to 45.8%). This trend resulted in a strong decrease in nonidentified bipolar disorder patients (from 64.6% to 19.5%). Trained physicians, but not the untrained group, greatly increased the number of prescriptions for mood stabilizers for bipolar disorder patients, from 25.6% to 43.2% (p = 0.0013, chi-square test). Finally, trained physicians reduced the number of antidepressant prescriptions for bipolar disorder patients (the control group also reduced the number of antidepressant prescriptions, suggesting some bias in the survey).

CONCLUSION

A well-designed education package on diagnosis and management of bipolar disorder greatly increased the likelihood of physicians correctly assigning a subtype, namely bipolar I or bipolar II disorder, to patients already perceived as having some form of bipolar illness, and to prescribing mood stabilizers instead of antidepressants to these patients.

Screening for bipolar disorder in patients consulting general practitioners in France

BACKGROUND

Recently, an unexpected 3-fold higher screen positive rate for bipolar disorder was found among low-income American patients who were seeking primary care at an urban general medicine clinic as compared with the general population of the United States. The social health system in France is characterized by its open access, where most bipolar patients ask for care and where the major problem is diagnosis by the general practitioner (GP). Therefore, we investigated the prevalence of bipolar disorder among patients attending GP offices in France.

METHODS

This observational, single visit survey was performed among 10,265 patients (47.2±18.0 years old, 40% males) attending primary care in 95 GP offices in France. The participating GP made available an MDQ-French version questionnaire to all patients aged 15 years and over, going to his office during a full week, independently of the reason for medical consulting. In addition to the MDQ-French version questionnaire, patients answered items concerning sex, age, professional situation and marital state.

RESULTS

One thousand twenty-five (1025) patients did not complete the questionnaire and were excluded from the analysis. Of the 9240 analyzed questionnaires, 8.3% were classified as MDQ positives (MDQ+). MDQ+ patients were significantly younger (41.6 years versus 46.6 years for MDQ- patients, p<0.0001), more frequently divorced or separated (19.2% versus 8.6%, p<0.0001) and more frequently unemployed (15.2% versus 6.4%, p<0.0001). The gender distribution was not significantly different between the two groups.

CONCLUSIONS

The prevalence of receiving positive screening results for bipolar disease in 9240 patients consulting 95 randomly selected french general practitioners was 8.3%, as assessed by the MDQ questionnaire. This is a similar and unexpected high value as that reported for low-income american patients (9.8%). Besides low socioeconomic status, other factors should explain the high screen positive rate for bipolar disorder in patients attending primary care.