Kathryn Fletcher

Treating depression with the evidence-based psychotherapies: a critique of the evidence

Objective:  While Cognitive Behaviour Therapy (CBT) and Interpersonal Therapy (IPT) have been positioned as first‐line evidence‐based treatments for depression, we suggest that limitations to the ‘evidence’ deserve wider appreciation.

Inching toward Bethlehem: Mapping melancholia

BACKGROUND As melancholia has resisted symptom-based definition, this report considers possible explanations and options for moving forward. Clinician-assigned melancholic and non-melancholic groups were initially compared to refine a candidate set of differentiating symptoms alone for examination against a set of non-clinical validators. Analyses then examined the capacity of both the refined symptom and validator sets to discriminate the assigned melancholic and non-melancholic subjects. METHODS Subjects completed measures assessing symptoms and correlates (putative validators) of diagnostic sub-type, and were assessed independently by two psychiatrists. RESULTS Analyses identified 14 severity-based symptoms as discriminating clinically-diagnosed groups - with melancholic subjects differing significantly from non-melancholic subjects across a number of validators. Such symptom-based discrimination was superior to DSM-IV and Newcastle Index assignment in a study sub-set. While the refined symptom set had an overall accurate classificatory rate of 68%, use of the combined sets of refined symptoms and validators improved classification to 80%. CONCLUSIONS Melancholia definition is improved by the use of correlates in addition to depressive symptoms, suggesting that melancholia may be mapped more precisely by use of multiple co-ordinates or data sources.

Clinical differentiation of bipolar II disorder from borderline personality disorder.

Purpose of review Differentiating bipolar II disorder (BP II) from borderline personality disorder (BPD) is a common diagnostic dilemma. The purpose of this review is to focus on recent studies that have considered clinical differences between the conditions including family history, phenomenology, longitudinal course, comorbidity and treatment response, and which might advance their clinical distinction. Recent findings Findings suggest key differentiating parameters to include family history, onset pattern, clinical course, phenomenological profile of depressive and elevated mood states, and symptoms of emotional dysregulation. Less specific differentiation is provided by childhood trauma history, deliberate self-harm, comorbidity rates, neurocognitive features, treatment response and impulsivity parameters. Summary This review refines candidate variables for differentiating BP II from BPD, and should assist the design of studies seeking to advance their phenomenological and clinical distinction.

Costs of the principal mood disorders: A study of comparative direct and indirect costs incurred by those with bipolar I, bipolar II and unipolar disorders

BACKGROUND While there have been many studies comparing direct and indirect costs engendered individually and nationally by those with unipolar (UP) and bipolar (BP) disorders, there has been no previous study comparing costs across the bipolar I (BP I) and bipolar II (BP II) disorders. METHODS We examine direct and indirect costs attributable to a mood disorder in a sample of 44 BP I, 102 BP II and 279 UP patients attending a tertiary referral clinic, and with comparable illness durations of some 20 years and comparable treatment durations. We calculated direct and indirect costs incurred for their lifetime of illness based on relevant cost structures, in Australian dollars. RESULTS The mean lifetime indirect costs for BP I patients was

Emotion regulation strategies in bipolar II disorder and borderline personality disorder: Differences and relationships with perceived parental style

134,318, as against

Gender differences in depression severity and symptoms across depressive sub-types

76,821 for BP II and

Further examination of the utility and comparative properties of the MSQ and MDQ bipolar screening measures

68,347 for UP patients, joining with respective health care costs of

Coping profiles in bipolar disorder

26,353,

Differentiating the bipolar disorders from borderline personality disorder.

17,580 and

Anhedonia in melancholic and non-melancholic depressive disorders

27, 237, to generate total costs of