Validating Angst's "ups & downs" personality trait as a new marker of bipolar II disorder

Franco Benazzi
European Archives of Psychiatry and Clinical Neuroscience 2004, 254 (1): 48-54

BACKGROUND: Angst has recently found an association between the bipolar spectrum and a personality trait called "ups & downs", defined by the question "would you say you were one of those people who have frequent ups and downs?". Study aim was to find the frequency of "ups & downs" in a large sample of bipolar II (BPII) and major depressive disorder (MDD),and to test its association with BPII.

METHODS: Consecutive 89 MDD and 89 BPII outpatients were interviewed, during a major depressive episode (MDE),with the Structured Clinical Interview for DSM-IV, as modified by Benazzi and Akiskal (2003). Hypomanic symptoms during MDE were systematically assessed. The association between "ups & downs" (defined by Angst's question) and BPII was tested versus bipolar validators (young onset, many recurrences, atypical depression, depressive mixed state [MDE plus 3 or more concurrent hypomanic symptoms, following Akiskal and Benazzi's definition (2003)], and bipolar family history. Associations were tested by univariate and multivariate logistic regression (STATA 7).

RESULTS: "ups & downs" was present in 62.9% of BPII and in 33.7% of MDD (ratio = 1.86, p = 0.0001). All bipolar validators were significantly more common in BPII versus MDD. Sensitivity and specificity of bipolar validators for predicting BPII, including "ups & downs", showed that "ups & downs" had a balanced combination of sensitivity (62.9 %) and specificity (66.2 %) (i. e., sensitivity not too low compared to specificity and vice versa) for predicting BPII, and that it was strongly associated with BPII (odds ratio = 3.3, 95% CI 1.8-6.1). Multivariate analyses found that "ups & downs" independently and significantly predicted BPII among the other bipolar validators. Patients did not confuse "ups & downs" with many past MDEs, as the association with BPII did not change when controlled for recurrences.

CONCLUSIONS: Findings suggest that Angst's "ups and downs" might be a new marker of BPII. Its simple question might be useful to clinicians to better detect the highly underdiagnosed BPII during assessment of depression.

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