E. Bemi, E. Pizza, L. Lattanzi, G. Perugi - Vol. 5/1
Testo Immagini Bibliografia Summary Riassunto Indice
Depressione atipica, spettro bipolare
e disturbo borderline di personalità;
Atypical depression, bipolar spectrum and Borderline Personality Disorder
Objective: atypical depression has still to find its place among mood disorders, because most studies to date have focused on target symptoms, neglecting comorbidity, outcome, clinical course and family data. The aim of this study was to explore relationships among atypical depression, bipolar spectrum disorders and borderline personality disorder.
Methods: to this end we investigated 91 DSM-IV depressive patients with atypical features and with one more mood reactivity criterion added, at the Outpatient facility or the Day-Hospital of the University of Pisa. Epidemiological and clinical characteristics were taken into account, as well as comorbidity with other mental disorders. Patients with psychotic or melancholic features were excluded. Patients were interviewed through the Pisa-Memphis Semistructured Interview for Mood Disorders (SIMD), the Structured Clinical Interview for DSM-III-R (SCID), and the Atypical Depression Interview (ADI), an interview developed for the purposes of the present study, and assessed by means of the Columbia Atypical Depression Diagnostic Scale (ADDS), the 90-item version of the Hopkins Symptoms Checklist (HSCL-90), and the Hamilton Rating Scale for Depression (HAM-D).
Results: of the total sample, 12 were men and 79 women; age ranged 15-55 years (mean 31.5, SD 8.8). Mean age at onset was 22.8, SD 8, and mean duration of disease was 8.7 years, SD 7, life stressors were present in 61.7% of patients during the 6 months preceding onset of present episode, 29.7% of patients had committed suicide attempts, 80.5% had no complete inter-episode remission. Lifetime comorbidity was 34.1% for panic disorder, 50.5% for agoraphobia, 27.5% for social phobia, 19.8% for obsessive-compulsive disorder, 7.7% for generalized anxiety disorder, 48.3% for body dysmorphic disorder, and 17.6% for eating disorders. Axis II disorders were present at high rates; borderline personality disorder was present in 46.2% of cases, dependent personality disorder in 48.4%, histrionic in 25.6%, avoidant in 62.2%, narcissistic in 20%, and obsessive-compulsive in 64.4%. The major finding was the presence of high rates of bipolar disorder II and soft bipolarity (76.9%); these patients presented high rates of comorbidity with anxiety disorders, impulse dyscontrol and eating disorders; they tended to subdivide into clinically/epidemiologically distinct syndromes. Presence of comorbidity in our sample appeared to influence the high rate of borderline personality disorder (N = 42, 46.2%). ;
Conclusions: in this perspective, atypical depression may be considered as a paradigm for the study of relationships between DSM-IV axis I mood disorders and axis II personality disorders.;