Mustaq Khan

Missed bipolarity and psychiatric comorbidity in women with postpartum depression

OBJECTIVE To investigate the diagnostic profile of women referred for postpartum depression. METHODS Fifty-six women seen consecutively with the referral diagnosis of postpartum depression were administered structured instruments to gather information about their DSM-IV Axis I diagnoses. RESULTS In terms of frequency of occurrence, the primary diagnoses in this sample were: major depressive disorder (46%), bipolar disorder not otherwise specified (29%), bipolar II disorder (23%), and bipolar I disorder (2%). A current comorbid disorder, with no lifetime comorbidity, occurred among 32% of the sample; by contrast, lifetime comorbidity alone (i.e., with no currently comorbid disorder) was found among 27%. Both a lifetime and a current comorbidity were found among 18% of the women, and 23% had no comorbid disorder. The most frequently occurring current comorbid disorder was an anxiety disorder (46%), with obsessive-compulsive disorder (62%) being the most common type of anxiety disorder. For lifetime comorbidity, substance use (20%) and anxiety disorders (12%) were the two most common. Over 80% of patients who scored positive on either the Highs Scale or the Mood Disorder Questionnaire met the diagnostic criteria for a bipolar disorder. CONCLUSION The results suggest that postpartum depression is a heterogeneous entity and that misdiagnosis of bipolar disorder in the postpartum period may be quite common. The findings have important clinical implications, which include the need for early detection of bipolarity through the use of reliable and valid assessment instruments, and implementation of appropriate prevention and treatment strategies.

Effects of concreteness and semantic relatedness on composite imagery ratings and cued recall

Day and Bellezza (1983) rejected a dual coding imagery explanation for the superior recall of concrete words because unrelated concrete pairs were rated lower in composite imagery but were still remembered better than related abstract pairs. We show that dual coding theory explains their results and our new findings using the same paradigm. In Experiment 1, 120 subjects rated imagery or relatedness for 108 pairs that varied in concreteness, pair relatedness, and associative strength. Incidental cued recall followed. Relatedness and strength affected imagery ratings, as did concreteness, and very low relatedness partly accounted for the low composite imagery ratings for unrelated concrete pairs. Concreteness and relatedness also affected recall, and suporior recall for unrelated concrete pairs occurred consistently under imagery but not under relatedness instructions. In Experiment 2, 40 subjects rated imagery value and recalled 24 pairs. Subsequent questioning indicated that composite images were retrieved better given stimuli from unrelated concrete than from related abstract pairs. These findings and Day and Bellezza’s original results are explained in terms of (1) imaginal and verbal associative processes, which jointly influence composite imagery ratings and recall, and (2) the critical role of stimulus concreteness during image retrieval and recall (i.e., the conceptual peg hypothesis).

Role of lamotrigine in the management of treatment-resistant bipolar II depression: A chart review

OBJECTIVES We report the results of a retrospective, naturalistic study of lamotrigine in the management of treatment-resistant bipolar II depression. METHODS Hospital charts of 31 patients treated at a mood disorders clinic, who had been on lamotrigine for at least six months after failing to show an adequate response to a combination of two mood stabilizers or a mood stabilizer and an antidepressant, were reviewed using the Clinical Global Impression-Improvement (CGI) rating scale. RESULTS Patients were seen for an average of 19.4 months following the introduction of lamotrigine. The lamotrigine daily dose ranged from 50-400 mg (mean dose 199.2 mg) as monotherapy or in combination with a mood stabilizer, an atypical antipsychotic, or a sedative/hypnotic drug. Very much improvement was seen in 52% of patients and 32% were considered much improved. CONCLUSIONS These naturalistic data suggest that lamotrigine alone or in combination with other psychotropic drugs was well tolerated and effective in the management treatment-resistant bipolar II depression. LIMITATIONS Retrospective design, small sample size, and lack of a control group.

Revisiting the association between endometriosis and bipolar disorder.

OBJECTIVE We sought to study the association between endometriosis and bipolar disorder. METHODS Using the Structured Clinical Interview for DSM-IV Axis I Disorders, the prevalence of bipolar disorder was compared in 27 patients with endometriosis and 12 women with pelvic pain not related to endometriosis who were seen at a specialty gynaecology clinic for women with chronic pelvic pain. RESULTS A significantly greater proportion of women in the endometriosis group were found to have bipolar disorder and a poorer quality of life than women with pelvic pain not related to endometriosis. CONCLUSION There may be an association between endometriosis and bipolar disorder. An optimal approach to managing endometriosis should include evaluation and treatment of psychiatric comorbidity, particularly bipolar disorder.

Post-partum depressive episodes and bipolar disorder.

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