A Brief Screening Chart for Distinguishing Unipolar from Bipolar Depression during First Depressive Episode

Abstract

The study focused on the search for differences between depression within bipolar disorder (BD) and unipolar depression (UPD), based on the cited findings in the scientific literature and the results from the studied clinical samples. The ultimate goal of the study was to develop a screening chart for bipolar depression (BPD) during first depressive episode.

One hundred and forty consecutively hospitalized patients, 23 men and 37 women with UPD and 23 men and 57 women with BPD diagnosed with M.I.N.I. РWC 5.0.0 Bulgarian Version (DSM--IV) and Hamilton Depression Rating Scale (HDRS-17) were examined with a specially designed screening chart for bipolar depression (SCBPD). The chart encompasses 69 parameters covering demographic data, somatic and psychiatric comorbidities, personal development, onset, course, clinical markers, cognitive deficits, and disease outcome all aimed at detecting differences between UPD and BPD.

Fifteen significant parameters such as clinical symptoms, comorbidities (alcohol abuse), behavioural and temperamental characteristics were isolated on the basis of the applied screening chart. These grouped factors were called an abbreviated screening chart for bipolar depression (ASCBPD). The receiver-operating characteristic (ROC) curve showed that ASCBPD correctly classified 76 of 80 cases (95.00%) as BPD (sensitivity) and correctly classified 58 out of 60 cases (96.67%) as UPD (specificity). The ASCBPD has shown high reliability, validity, and accuracy in discriminating BPD from UPD during index depressive episode.

Clinical symptoms such as mood reactivity and mood swings, impulsivity, irritability, affective alternation, increased motor drive and logorrhoea along with comorbidity such as alcohol abuse, behavioural and temperamental traits can serve reliably for differentiating BPD from UPD.