BACKGROUND: Distinguishing bipolar disorder (BP) from major depressive disorder (MDD) has important relevance for prognosis and treatment. Prior studies have identified clinical features that differ between these two diseases but have been limited by heterogeneity and lack of replication. We sought to identify depression-related features that distinguish BP from MDD in large samples with replication. METHOD: Using a large, opportunistically ascertained collection of subjects with BP and MDD we selected 34 depression-related clinical features to test across the diagnostic categories in an initial discovery dataset consisting of 1228 subjects (386 BPI, 158 BPII and 684 MDD). Features significantly associated with BP were tested in an independent sample of 1000 BPI cases and 1000 MDD cases for classifying ability in receiver operating characteristic (ROC) analysis. RESULTS: Seven clinical features showed significant association with BPI compared with MDD: delusions, psychomotor retardation, incapacitation, greater number of mixed symptoms, greater number of episodes, shorter episode length, and a history of experiencing a high after depression treatment. ROC analyses of a model including these seven factors showed significant evidence for discrimination between BPI and MDD in an independent dataset (area under the curve = 0.83). Only two features (number of mixed symptoms, and feeling high after an antidepressant) showed an association with BPII versus MDD. CONCLUSIONS: Our study suggests that clinical features distinguishing depression in BPI versus MDD have important classification potential for clinical practice, and should also be incorporated as 'baseline' features in the evaluation of novel diagnostic biomarkers.
BACKGROUND: Distinguishing bipolar disorder (BP) from major depressive disorder (MDD) has important relevance for prognosis and treatment. Prior studies have identified clinical features that differ between these two diseases but have been limited by heterogeneity and lack of replication. We sought to identify depression-related features that distinguish BP from MDD in large samples with replication. METHOD: Using a large, opportunistically ascertained collection of subjects with BP and MDD we selected 34 depression-related clinical features to test across the diagnostic categories in an initial discovery dataset consisting of 1228 subjects (386 BPI, 158 BPII and 684 MDD). Features significantly associated with BP were tested in an independent sample of 1000 BPI cases and 1000 MDD cases for classifying ability in receiver operating characteristic (ROC) analysis. RESULTS: Seven clinical features showed significant association with BPI compared with MDD: delusions, psychomotor retardation, incapacitation, greater number of mixed symptoms, greater number of episodes, shorter episode length, and a history of experiencing a high after depression treatment. ROC analyses of a model including these seven factors showed significant evidence for discrimination between BPI and MDD in an independent dataset (area under the curve = 0.83). Only two features (number of mixed symptoms, and feeling high after an antidepressant) showed an association with BPII versus MDD. CONCLUSIONS: Our study suggests that clinical features distinguishing depression in BPI versus MDD have important classification potential for clinical practice, and should also be incorporated as 'baseline' features in the evaluation of novel diagnostic biomarkers.
Entities:
Keywords:
Bipolar disorder; diagnosis; major depressive disorder; mixed symptoms; psychosis
Authors: Amar K Das; Mark Olfson; Marc J Gameroff; Daniel J Pilowsky; Carlos Blanco; Adriana Feder; Raz Gross; Yuval Neria; Rafael Lantigua; Steven Shea; Myrna M Weissman Journal: JAMA Date: 2005-02-23 Impact factor: 56.272
Authors: Philip B Mitchell; Andrew Frankland; Dusan Hadzi-Pavlovic; Gloria Roberts; Justine Corry; Adam Wright; Colleen K Loo; Michael Breakspear Journal: Br J Psychiatry Date: 2011-04-20 Impact factor: 9.319
Authors: Fernando S Goes; Bradley Sadler; Jennifer Toolan; Rachel D Zamoiski; Francis M Mondimore; Dean F Mackinnon; Barbara Schweizer; J Raymond Depaulo; James B Potash Journal: Bipolar Disord Date: 2007-12 Impact factor: 6.744
Authors: Isabella Pacchiarotti; David J Bond; Ross J Baldessarini; Willem A Nolen; Heinz Grunze; Rasmus W Licht; Robert M Post; Michael Berk; Guy M Goodwin; Gary S Sachs; Leonardo Tondo; Robert L Findling; Eric A Youngstrom; Mauricio Tohen; Juan Undurraga; Ana González-Pinto; Joseph F Goldberg; Ayşegül Yildiz; Lori L Altshuler; Joseph R Calabrese; Philip B Mitchell; Michael E Thase; Athanasios Koukopoulos; Francesc Colom; Mark A Frye; Gin S Malhi; Konstantinos N Fountoulakis; Gustavo Vázquez; Roy H Perlis; Terence A Ketter; Frederick Cassidy; Hagop Akiskal; Jean-Michel Azorin; Marc Valentí; Diego Hidalgo Mazzei; Beny Lafer; Tadafumi Kato; Lorenzo Mazzarini; Anabel Martínez-Aran; Gordon Parker; Daniel Souery; Ayşegül Ozerdem; Susan L McElroy; Paolo Girardi; Michael Bauer; Lakshmi N Yatham; Carlos A Zarate; Andrew A Nierenberg; Boris Birmaher; Shigenobu Kanba; Rif S El-Mallakh; Alessandro Serretti; Zoltan Rihmer; Allan H Young; Georgios D Kotzalidis; Glenda M MacQueen; Charles L Bowden; S Nassir Ghaemi; Carlos Lopez-Jaramillo; Janusz Rybakowski; Kyooseob Ha; Giulio Perugi; Siegfried Kasper; Jay D Amsterdam; Robert M Hirschfeld; Flávio Kapczinski; Eduard Vieta Journal: Am J Psychiatry Date: 2013-11 Impact factor: 18.112
Authors: Rasim Somer Diler; Tina R Goldstein; Danella Hafeman; Brian Thomas Rooks; Dara Sakolsky; Benjamin I Goldstein; Kelly Monk; Mary Beth Hickey; David Axelson; Satish Iyengar; Boris Birmaher Journal: Bipolar Disord Date: 2017-06-14 Impact factor: 6.744
Authors: Rasim Somer Diler; Tina R Goldstein; Danella Hafeman; John Merranko; Fangzi Liao; Benjamin I Goldstein; Heather Hower; Mary Kay Gill; Jeffrey Hunt; Shirley Yen; Martin B Keller; David Axelson; Michael Strober; Satish Iyengar; Neal D Ryan; Boris Birmaher Journal: J Child Adolesc Psychopharmacol Date: 2017-02-28 Impact factor: 2.576
Authors: Tobias Bracht; Sarah Steinau; Andrea Federspiel; Christoph Schneider; Roland Wiest; Sebastian Walther Journal: Neuroimage Clin Date: 2018-10-01 Impact factor: 4.881