title: Evaluating response to mood stabilizers in patients with mixed depression: A study of agreement between three different mania rating scales and a depression rating scale.
abstract: BACKGROUND
  The aim of the present study was to evaluate agreement between three pairs formed by one of three mania scales (Young Mania Rating Scale [YMRS], Bech-Rafaelsen Mania Scale [BRMS], or the Clinician-Administered Rating Scale for Mania [CARS-M]) and a single depression scale (21-item Hamilton Depression Rating Scale [21-HAM-D]) for evaluation of response to mood stabilizers in patients with mixed bipolar disorder.
  
  
  METHODS
  Between 2010 and 2014, 68 consecutive bipolar type I and II outpatients with mixed depression as per DSM-IV-TR and Cincinnati criteria were included in this 8-week open-label trial to randomly receive carbamazepine, lithium carbonate, or valproic acid as monotherapy.
  
  
  RESULTS
  Patterns of response (defined as a reduction of at least 50% in one of the mania scales and on the 21-HAM-D) were strikingly similar: 21-HAM-D+YMRS=22.1%, 21-HAM-D+BRMS=20.6%, and 21-HAM-D+CARS-M=23.5% (p<0.368). Assessment of agreement revealed very high kappa coefficients: 21-HAM-D+YMRS vs. 21-HAM-D+CARS-M, kappa=0.87; 21-HAM-D+YMRS vs. 21-HAM-D+BRMS, kappa=0.78; 21-HAM-D+CARS-M vs. 21-HAM-D+BRMS, kappa=0.91 (p<0.001).
  
  
  CONCLUSIONS
  The decision to combine a depression rating scale with any one mania rating scale to assess treatment response in patients with mixed depression is questionable.
  
  
  CONCLUSIONS
  The present study suggests that any one of the three tested mania rating scales (YMRS, BRMS, and CARS-M) can be combined with the 21-HAM-D to assess treatment response in patients with mixed bipolar disorder. This should give clinicians an added measure of confidence in using this strategy until valid, and specific instruments are developed for assessment of mixed states.
authors.affiliation: Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), School of Medicine, Porto Alegre, RS, Brazil; Teaching and Research Program in Mood Disorders (PROPESTH), Hospital Psiquiátrico São Pedro, Porto Alegre, RS, Brazil. Electronic address: fmshansis@gmail.com.
authors.forename: Flávio Milman
authors.initials: FM
authors.lastname: Shansis
authors.affiliation: Teaching and Research Program in Mood Disorders (PROPESTH), Hospital Psiquiátrico São Pedro, Porto Alegre, RS, Brazil; Postgraduate Program in Obstetrics and Gynecology, UFRGS, School of Medicine, Porto Alegre, RS, Brazil.
authors.forename: Mateus
authors.initials: M
authors.lastname: Reche
authors.affiliation: Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), School of Medicine, Porto Alegre, RS, Brazil; Postgraduate Program in Obstetrics and Gynecology, UFRGS, School of Medicine, Porto Alegre, RS, Brazil; Service of Obstetrics and Gynecology, Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Department of Obstetrics and Gynecology, UFRGS, School of Medicine, Porto Alegre, RS, Brazil; Department of Gynecological Endocrinology and Reproductive Medicine, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.
authors.forename: Edison
authors.initials: E
authors.lastname: Capp
mesh_terms: D000328:Adult; D018692:Antimanic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000209:etiology; D002220:Carbamazepine / Q000627:therapeutic use; D003866:Depressive Disorder / Q000150:complications / Q000188:drug therapy* / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D016651:Lithium Carbonate / Q000627:therapeutic use; D008297:Male; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use
chemical_list: D018692:Antimanic Agents; D016651:Lithium Carbonate; D002220:Carbamazepine; D014635:Valproic Acid
keywords: Agreement study; Bipolar disorder; Depression rating scale; Mania rating scales; Mixed symptoms; Mood stabilizers