By Franco Benazzi and Hagop Souren Akiskal
ESI Special Topics,
September 2003
Citing URL - http://www.esi-topics.com/nhp/2003/september-03-Benazzi-Akiskal.html
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Franco Benazzi and Hagop Souren Akiskal
answer a few questions about this month's
new hot paper in the field of Psychiatry/Psychology.
From
•>>September 2003
Field:
Psychiatry/Psychology
Article Title: "Delineating bipolar II mixed states in the Ravenna-San Diego collaborative study: the relative prevalence and diagnostic significance of hypomanic features during major depressive episodes"
Authors: Benazzi,
F;Akiskal, HS
Journal: J AFFECT DISORDERS
Volume: 67
Page: 115-122
Year: DEC 2001
* Via Pozzetto 17, I-48015 Castiglione Di Cervia, RA, Italy.
* Natl Hlth Serv, Dept Psychiat, Forli, Italy.
* Univ Calif San Diego, Int Mood Ctr, San Diego, CA 92103 USA.
* VA Psychiat Serv, San Diego, CA USA.
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 Why
do you think your paper is highly cited?
It is a new finding about a disorder (depressive mixed state)
which is very common but also very much underdiagnosed. It is really
the first data-based and compelling description of an entity which
was described more than 100 years ago and, despite its high
prevalence, is basically ignored in the official DSM-IV
classification; this means it is ignored in  the
research literature, and there is virtually nothing in the
controlled pharmacological literature.
Does
it describe a new discovery or a new methodology that's useful to
others?
Depressive mixed state will require a more complex
pharmacological treatment of depression. Using only antidepressants
in this state could worsen depression, while the excitement (hypomanic)
symptoms present during this depression should be first treated with
mood stabilizers and/or antipsychotics. Detection of depressive
mixed states requires systematic assessment, during depression, of
hypomanic symptoms, which is not possible by following current
guidelines and structured interviews for depression.
Could
you summarize the significance of your paper in layman's terms?
It describes how common depression with concurrent excitement (hypomanic)
symptoms is in outpatients. Many have Bipolar-II disorder
(depression and hypomania episodes alternating), but it is not
uncommon in Major Depressive Disorder (no history of
mania/hypomania), best shown by the related studies we have carried
out up to now; search: "Benazzi F" or "Akiskal
H" on Medline. First classified by Kraepelin in 1913,
depressive mixed states are common, and have an important impact on
the treatment of depression—which can get worse with the use of
antidepressants alone. The reason of the current high underdiagnosis
rate is that, usually, during depression assessment there is no
assessment of the DSM-IV hypomanic symptoms, which need to be probed
to be found. The most common ones in these states are irritability,
racing thoughts, psychomotor agitation (not severe), increased
talkativeness, and distractibility (related to the crowding of the
mind by too many thoughts, not to the thought inhibition of the
non-mixed depression).
How
did you become involved in this research?
It was a natural outcome of our studies on Bipolar-II
disorder.
Franco Benazzi, M.D.
Senior Staff Psychiatrist
University of California at San Diego
San Diego, CA, USA
Collaborating Psychiatry Center, Ravenna (Italy)
and Department of Psychiatry
National Health Service
Forli, Italy
Hagop Souren Akiskal, M.D.
Professor of Psychiatry and Director of International Mood Center
University of California at San Diego
San Diego Veterans Administration Medical Center
San Diego, CA, USA
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ESI Special
Topics, September 2003
Citing URL - http://www.esi-topics.com/nhp/2003/september-03-Benazzi-Akiskal.html
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