title: Risk of bipolar disorder and psychotic features in patients initially hospitalised with severe depression.
abstract: OBJECTIVE
  Severe depression may be a risk factor for diagnostic conversion into bipolar disorder (BD), and psychotic depression (PD) has been consistently associated with BD. The aims of the present study were to investigate the stability of the diagnosis of severe depression and the differences between PD and non-psychotic severe depression (non-PD), as well as to assess the effectiveness of electroconvulsive therapy (ECT).
  
  
  METHODS
  Patients who were hospitalised for severe depression (diagnosed according to ICD-10) both with and without psychotic symptoms (n=89; mean age=55.6 years, SD=13.9) from 2001 to 2010 were retrospectively assessed.
  
  
  RESULTS
  By the 75th month of follow-up assessments, 11(12.4%) patients had developed BD. Among these 11 converters, nine had developed BD within 1 year after admission. Only sub-threshold hypomanic symptoms were significantly related to developing BD. The number of depressive episodes and history of physical diseases were significantly increased in non-PD compared with PD patients, whereas ECT was significantly increased in PD compared with non-PD patients. There was a significant association between length of stay at the hospital and the number of days between admission and ECT.
  
  
  CONCLUSIONS
  Sub-threshold hypomanic symptoms may represent a prodrome of BD or an indicator of an already manifest phenotype, especially in older patients, which suggests cautious use of antidepressants. In severe depression, non-PD may often occur secondary to physical diseases and patients may experience increased recurrences compared with PD patients, which may be a more 'primary' disorder and often requires ECT treatments. ECT is effective for severe depression regardless of the presence of any psychotic feature; the earlier ECT is introduced, the better the expected treatment outcome.
authors.affiliation: Department of Psychiatry,Course of Integrated Brain Sciences,University of Tokushima School of Medicine,TokushimaJapan.
authors.forename: Kimiya
authors.initials: K
authors.lastname: Nakamura
authors.affiliation: Department of Psychiatry,Course of Integrated Brain Sciences,University of Tokushima School of Medicine,TokushimaJapan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Iga
authors.affiliation: Department of Psychiatry,Course of Integrated Brain Sciences,University of Tokushima School of Medicine,TokushimaJapan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Matsumoto
authors.affiliation: Department of Psychiatry,Course of Integrated Brain Sciences,University of Tokushima School of Medicine,TokushimaJapan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Ohmori
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D003937:Diagnosis, Differential; D004565:Electroconvulsive Therapy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006760:Hospitalization; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000928:Antidepressive Agents
keywords: psychosis