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H S Akiskal

Publications and source records attributed to H S Akiskal.

At least 19 recordsLinked to original sources
PubMed1992

The importance of measures of affective temperaments in genetic studies of mood disorders.

Collaboration between the University of Pisa, Italy, and the University of Tennessee, Memphis, U.S.A., on patients presenting with major depressive episodes (in the absence of nonaffective psychiatric illness) focused on the detection of depressive and hyperthymic temperaments. From our data on symptomatology, family history and course of 538 such patients, several findings emerge of cardinal relevance to genetic studies. Hyperthymic temperament, observed more commonly in men, appears as one pole of an attenuated form of manic-depressive illness. Thus, major depressives with this temperament have high rates of bipolar family history, even in the absence of hypomanic and manic episodes. The depressive temperament, more prevalent in women, is correlated with earlier onset and higher number of depressive episodes, greater severity of the Hamilton Rating Scale for Depression (HAM-D), as well as higher familial loading for mood disorders, compared with major depressives without this temperament. Building on Akiskal's latest model on the multifactorial origin of mood disorders, we submit that these temperamental dysregulations constitute the intermediate step between predisposing familial-genetic factors in affective illness and gender-related clinical expressions of mood disorders. The authors recommend that future high-risk prospective studies and genetic investigations should include measures of affective temperament.

Adult↗
PubMed1992

Proposed subtypes of bipolar II and related disorders: with hypomanic episodes (or cyclothymia) and with hyperthymic temperament.

In an attempt to improve the classification of Bipolar II disorders, we have examined a consecutive series of 687 primary major depressives: 5.1% gave a past history of mania (Bipolar I), 13.7% met our operational criteria for hypomania (Bipolar II), and the remaining 81.2% were provisionally categorized as 'unipolar.' Although Bipolar II was in some respects intermediate between Bipolar I and Unipolar, gender, familial bipolar history, age at onset and course characteristics generally supported its closer kinship to bipolar illness. Seventy one of the unipolars (10.3% of the total series) further met our operational criteria for hyperthymic temperament (U-HT), leaving behind a purer unipolar group of 487 major depressives. With respect to the proportion having male gender and bipolar family history, U-HT was similar to Bipolar I and II, and all three differed significantly from pure unipolar; as for age at onset, number of episodes and related indices of course, BI and BII were similar, and U-HT was closer to pure unipolar. These findings suggest that major depressive episodes arising from a hyperthymic temperament (constituting 12.4% of the 'unipolar' universe by conventional definition) are 'genotypically' closer to Bipolar II defined by hypomania, and course-wise similar to other unipolars.

Bipolar Disorder↗
PubMed1992

Immune cell imbalance in major depressive and panic disorders.

We investigated subsets of peripheral immunologic cells in 12 drug-free patients affected by major depression according to DSM-III-R criteria, and who had recent evidence of somatic diseases. They were compared with 10 drug-free depressives, with 10 patients with panic disorder, and with 12 healthy volunteers, all without somatic disease. The immune subsets were measured by flow cytometry. The results showed that both groups of depressives had the same abnormalities in immune cells compared with the healthy volunteers or the panic disorder patients; in particular they presented a lower number of CD3+, CD8+ and HLA-DR+. The patients with panic attacks did not differ from healthy controls, except for CD4+ cells which were significantly lowered, even in comparison with the depressive groups. These data, although preliminary and in a small sample, suggest that some immune parameters may be influenced by the presence of a major psychiatric disorder.

Adolescent↗
PubMed1992

Psychotic symptom patterns and the diagnosis of schizophrenia.

In comparing 101 psychotic patients subtyped by DSM-III criteria into paranoia, schizophrenia, schizoaffective, and affective disorders, we failed to distinguish them on the basis of delusional and hallucinatory experiences. These 'productive', 'positive' or 'irritative' symptoms--which the literature tends to link with temporolimbic dysfunction--did not appear specifically linked to schizophrenia. By contrast, 'negative' or 'deficit' symptoms--which the literature tends to relate to frontal lobe dysfunction--appeared more specific--especially for the disorganized subtype of schizophrenia. Although these data tend to support Bleulerian over Schneiderian conceptualization of schizophrenia, the heterogeneity of neuropsychological deficits implied in the negative symptom complexes limits the nosologic utility of the rubric of schizophrenia so defined.

Adolescent↗
PubMed1992

The clinical spectrum of so-called "minor" depressions.

Reviewing the recent literature on the overlapping spectrum of neurotic depressive and dysthymic conditions--unofficially referred to as "minor," "atypical" or "characterologic" depressives--the authors conclude that significant symptomatologic admixtures with anxiety disorders do not represent the prototypical features of these disorders as defined in DSM-III-R. It is long-standing anhedonia on an intermittent or chronic basis which appears to characterize the trait illness of dysthymia. The emerging data on dysthymia suggest that it begins early in life, is often complicated by major depressions, and pursues a chronic--often pernicious--course. The development of hypomanic switches during the prospective course of some of these patients further suggests some kinship to bipolar disorder. Although traditionally conceived as being largely "psychogenic," familial data and selected biologic indices--especially in the area of sleep--and thymoleptic responsiveness impart some credibility to the role of biologic factors in the origin of these disorders. Given the high prevalence of dysthymic conditions in clinical practice, new research strategies on their causes are needed as a precondition for more rational treatment approaches.

Depressive Disorder↗
PubMed1992

[The depressive patient before depression].

This paper describes five prototypes of depression which develop from different temperamental substrates: timid-inhibited, dysthymic, hyperthymic, cyclothymic and irritable. They correspond, respectively, to anxious depressions, double depressions, anergic depressions, rapid-cycling depressions, and hostile depressions. The author argues that, despite a certain degree of overlap in pharmacologic response, each prototype has a relatively unique profile, including benzodiazepines, MAOIs, SSRIs, TCAs, lithium, low dose neuroleptics and anti-epileptic agents.

Anxiety Disorders↗
PubMed1992

Major depressive episode: unipolar and bipolar II.

Major Depressive Episod (MDE) delimits a wide range of heterogeneous disorders. Nowadays, both for research and for therapeutic aims, precise characteristization of MDE subtypes are needed, different subtypes of MDE requiring individualized short, long-term and preventive treatments. As patients mainly seek for physician help during the full-blown depressive phase, we focused our study on patients presenting a major depression as the index episode. In order to attempt to isolate subtypes of the disorder relatively to the mood spectrum disease and to obtain a better clinical characterization of each, we have considered the role of soft indicators of bipolarity or of milder mood disregulations in distinguishing among subtypes of MDE; special attention was devoted to detect spontaneous or drug-induced hypomania, as well as to assess the hyperthymic or cyclothymic temperament, and family history for mood disorders. Data on prior course, characteristics of index episode, and familial aggregation of patients with Bipolar II Disorder support the autonomy of this condition. Differently from our previous analyses we considered Bipolar II with hypomanic episodes separately from U-HT unipolar with only hyperthymic temperament. The comparison between these two subgroups showed a higher percentage of males in the hyperthymics, longer duration of illness and a greater number of depressive episodes and hospitalizations in bipolar II with hypomania. Data from our analyses are exposed and discussed.

Adult↗
PubMed1991

The manic-depressive mixed state: familial, temperamental and psychopathologic characteristics in 108 female inpatients.

Data on 108 hospitalized bipolar I women were analyzed to characterize those whose course was marked with at least one mixed episode (i.e. an episode with concomitant manic and depressed features) on the basis of various anamnestic and cross-sectional clinical features in comparison with those without mixed episodes. Our data revealed a later age of appearance of the first mixed episode in the course of bipolar illness with a tendency to recur true to type; greater prevalence of mood incongruent psychotic features; lower frequency of hyperthymic temperament; and familial depressive, rather than bipolar, disorders. These characteristics tend to identify the mixed state as a distinct longitudinal pattern of manic-depressive illness.

Adult↗
PubMed1991

Chronic depression.

Recent research has enabled clinicians to reclassify many patients who formerly were diagnosed as having personality disorders as instead suffering from chronic depression. The American Psychiatric Association now recognizes two subtypes of such depression: (1) residual (partly remitted) major depression and (2) dysthymia. As a result of these developments, an increasing number of psychiatrists now treat selected chronically depressed patients with full trials of a broad range of thymoleptic agents, thus alleviating the suffering of many patients who had previously been deemed refractory. The author summarizes his research efforts to establish the clinical legitimacy of chronic depression and suggests that supportive psychotherapeutic and psychoeducational approaches can enhance the therapeutic gains achieved through pharmacotherapy.

Antidepressive Agents↗
PubMed1990

Gender-mediated clinical features of depressive illness. The importance of temperamental differences.

In a consecutive clinical series of 538 subjects with primary mood disorders the male:female differences were most skewed (1:4) in recurrent unipolars, 1:2 in single episode and bipolar I subtypes, and about even (1:1) in bipolar II. The sexes did not differ in age at onset of depression, stressors preceding index episodes, endogenous features, psychotic symptoms, suicide attempts, and rates of chronicity. Females had lower mean number of hypomanic, and higher mean number of depressive, episodes. Females also exhibited more anxiety and somatisation, and were more likely to endorse psychopathological items on self-report instruments, which were not reflected in objective measures. Finally, they were more likely to have been admitted to hospital. These gender differences could in part be explained by the higher prevalence of the depressive temperament in women, and of the hyperthymic temperament in men.

Bipolar Disorder↗
PubMed1990

Bupropion as a promising approach to rapid cycling bipolar II patients.

Bupropion was added to lithium and/or levothyroxine in four female and two male bipolar II patients who had established baselines of at least 2 years of rapid cycling that had not responded to several of the most commonly used anticycling interventions. Although all six patients improved significantly, the response was dramatic in four (three female, one male) and is still sustained after an average of 2 years of continued treatment. Furthermore, unlike what happened in their prior course with more conventional antidepressants, none developed hypomania nor was rapid cycling observed during the course of continued pharmacotherapy. These findings, based on open but systematic clinical observation, suggest that bupropion may have special merit for rapid cycling, predominantly depressed bipolar patients and that, under close clinical vigilance, combining bupropion with appropriate doses of lithium is both efficacious and safe.

Adult↗
PubMed1989

Lack of specificity of reduced platelet imipramine binding in different psychiatric conditions.

We compared 3H-imipramine binding in 10 major depressives with that in 29 healthy volunteers, 13 patients with panic disorder, 9 patients with bulimia, 9 suicide attempters, and 6 schizophrenic patients. None of the comparison groups had histories of major mood disorders, except the suicide attempters. We found a significant reduction of the maximum binding capacity (Bmax) in all groups of patients as compared with healthy controls. These data cast doubt upon the specificity of the decrease of platelet 3H-imipramine binding in major depression, but suggest a possible pharmacological common denominator involving the serotonin system.

Adolescent↗
PubMed1989

Predictors of compliance with lithium and carbamazepine regimens in the long-term treatment of recurrent mood and related psychotic disorders.

This study examined compliance with lithium and carbamazepine regimens from the perspective of the illness and its characteristics. Patients were more likely to stay in treatment when prophylaxis was begun following a depressive episode and in the presence of congruent psychotic experiences. The reverse was true for grandiose and manic patients and those with somatic preoccupations.

Aged↗
PubMed1989

Psychopathology, temperament, and past course in primary major depressions. 1. Review of evidence for a bipolar spectrum.

In reviewing recent findings on affective conditions in the interface of unipolar and bipolar disorders, we find evidence favoring a partial return to Kraepelin's broad concept of manic-depressive illness, which included many recurrent depressives and temperamental variants. This review addresses methodologic, clinical, and familial considerations in the definition and characterization of a proposed spectrum of bipolar disorders which subsumes episodic and chronic forms. Episodic bipolar disorders are subclassified into bipolar schizoaffective, and bipolar I and II, and bipolar III or pseudo-unipolar forms. Chronic bipolar disorders could be either intermittent or persistent, and are subclassified into chronic mania, protracted mixed states, and rapid-cycling forms, as well as the classical temperaments (cyclothymic, hyperthymic, irritable and dysthymic).

Bipolar Disorder↗
PubMed1989

Psychopathology, temperament, and past course in primary major depressions. 2. Toward a redefinition of bipolarity with a new semistructured interview for depression.

We report on the utility of a new instrument to identify subtypes of major depressive episodes with special reference to pseudo-unipolar conditions. By incorporating reliable measures of depressive and hyperthymic temperamental characteristics in subtype definitions, we achieve the sharpest possible demarcation between unipolar and bipolar disorders. The new procedures also reveal that 1 out of 3 primary depressives in a consecutive series of 405 patients belong to the bipolar spectrum. Furthermore, among bipolars, bipolar II disorder (redefined as major depressions with hypomania or hyperthymic temperament) represents the most common variant. We discuss the nosologic, therapeutic, methodologic and theoretical implications of these considerations on the unipolar-bipolar dichotomy. Given that major depression emerges as the final common clinical expression of a heterogeneous group of disorders, it underscores the importance of focusing on temperament and course of illness in subclassification efforts such as attempted here.

Adult↗
PubMed1989

Depression before and after age 65. A re-examination.

Systematic and detailed psychopathological examination of 400 consecutive primary major depressives failed to confirm common clinical stereotypes which ascribe greater somatisation, hypochondriasis, agitation, psychotic tendencies, and chronicity to old age. Those above 65 were more likely to suffer from single episodes of depression that were often precipitated, whereas subjects whose illness began earlier were more likely to express depression as part of a recurrent unipolar or bipolar disorder, with higher rates of affective temperamental pathology and familial affective illness. The acute clinical picture was relatively uniform in older and younger depressives and, taken together with the other findings, tends to favour a spectrum model of primary mood disorders.

Adult↗