Latent class analysis of manic and depressive symptoms in a population-based sample in São Paulo, Brazil.
BACKGROUND
Current diagnostic criteria cannot capture the full range of bipolar spectrum. This study aims to clarify the natural co-segregation of manic-depressive symptoms occurring in the general population.


METHODS
Using data from the Sao Paulo Catchment Area Study, latent class analysis (LCA) was applied to eleven manic and fourteen depressive symptoms assessed through CIDI 1.1 in 1464 subjects from a community-based study in Sao Paulo, Brazil. All manic symptoms were assessed, regardless of presence of euphoria or irritability, and demographics, services used, suicidality and CIDI/DSM-IIIR mood disorders used to external validate the classes.


RESULTS
The four obtained classes were labeled Euthymics (EU; 49.1%), Mild Affectives (MA; 31.1%), Bipolars (BIP; 10.7%), and Depressives (DEP; 9%). BIP and DEP classes represented bipolar and depressive spectra, respectively. Compared to DEP class, BIP exhibited more atypical depressive characteristics (hypersomnia and increase in appetite and/or weight gain), risk of suicide, and use of services. Depressives had rates of atypical symptoms and suicidality comparable to oligosymptomatic MA class subjects.


CONCLUSIONS
The use of lay interviewers and DSM-IIIR diagnostic criteria, which are more restrictive than the currently used DSM-IV TR.


CONCLUSIONS
Findings of high prevalence of bipolar spectrum and of atypical symptoms and suicidality as indicators of bipolarity are of great clinical importance, due to different treatment needs, and higher severity. Lifetime sub-affective and syndromic manic symptoms are clinically significant, arguing for the need of revising DSM bipolar spectrum categories.
Moreno
Doris Hupfeld
DH
Mood Disorders Unit (GRUDA), Department and Institute of Psychiatry, Clinical Hospital, School of Medicine, University of São Paulo, Brazil. dorismoreno@uol.com.br
Andrade
Laura Helena
LH
D000293:Adolescent; D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000145:classification* / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D001938:Brazil; D002391:Catchment Area, Health; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D003906:Developing Countries; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult