Systematic clinical methodology for validating bipolar-II disorder: data in mid-stream from a French national multi-site study (EPIDEP)

• Published in: Journal of affective disorders 1998-09, Vol.50 (2), p.163-173
• Main Authors: Hantouche, Elie G, Akiskal, Hagop S, Lancrenon, Sylvie, Allilaire, Jean-François, Sechter, Daniel, Azorin, Jean-Michel, Bourgeois, Marc, Fraud, Jean-Philippe, Châtenet-Duchêne, Liliane
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Bipolar Disorder - classification; Bipolar Disorder - diagnosis; Bipolar-II, affective temperaments; Cyclothymia; Depressive Disorder - classification; Depressive Disorder - diagnosis; Diagnosis, Differential; Feasibility Studies; Female; France; Humans; Hypomania; Major depression; Male; Medical sciences; Middle Aged; Psychiatry - standards; Psychology. Psychoanalysis. Psychiatry; Psychometrics. Diagnostic aid systems; Psychopathology. Psychiatry; Severity of Illness Index; Techniques and methods
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/S0165-0327(98)00112-8

Background: This paper presents the methodology and clinical data in mid-stream from a French multi-center study (EPIDEP) in progress on a national sample of patients with DSM-IV major depressive episode (MDE). The aim of EPIDEP is to show the feasibility of validating the spectrum of soft bipolar disorders by practising clinicians. In this report, we focus on bipolar II (BP-II). Method: EPIDEP involves training 48 French psychiatrists in 15 sites; construction of a common protocol based on the criteria of DSM-IV and Akiskal (Soft Bipolarity), as well as criteria modified from the work of Angst (Hypomania Checklist), the Ahearn-Carroll Bipolarity Scale, HAM-D and Rosenthal Atypical Depression Scale; Semi-Structured Interview for Evaluation of Affective Temperaments (based on Akiskal-Mallya), self-rated Cyclothymia Scale (Akiskal), family history (Research Diagnostic Criteria); and prospective follow-up. Results: Results are presented on 250 (of the 537) MDE patients studied thus far during the acute phase. The rate of BP-II disorder which was 22% at initial evaluation, nearly doubled (40%) by systematic evaluation. As expected from the selection of MDE by uniform criteria, inter-group comparison between BP-II vs unipolar showed no differences on the majority of socio-demographic parameters, clinical presentation and global intensity of depression. Despite such uniformity, key characteristics significantly differentiated BP-II from unipolar: younger age at onset of first depression, higher frequency of suicidal thoughts and hypersomnia during index episode, higher scores on Hypomania Checklist and cyclothymic and irritable temperaments, and higher switching rate under current treatment. Eighty-eight percent of cases assigned to cyclothymic temperament by clinicians (with a cut-off of 10/21 items on self-rated cyclothymia) were recognized as BP-II. Evaluation of this temperament by clinician and patient correlated at a highly significant level ( r=0.73; p