Validating Angst's "ups & downs" personality trait as a new marker of bipolar II disorder.
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.
Via Pozzetto 17, 48010 Castiglione di Cervia RA, Italy. f.benazzi@fo.nettuno.it
Franco
F
Benazzi
D000328:Adult; D017668:Age of Onset; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000523:psychology*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007406:Interview, Psychological / Q000379:methods; D016015:Logistic Models; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D015588:Observer Variation; D010045:Outpatients; D010551:Personality; D010552:Personality Assessment; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index