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Comorbidity of Depression and Anxiety
Published in Siegfried Kasper, Johan A. den Boer, J. M. Ad Sitsen, Handbook of Depression and Anxiety, 2003
Giovanni B. Cassano, Nicolò B. Rossi, Stefano Pini
Detection of subtle, long-lasting, underlying psychopathology is more difficult when it is concomitant with an axis I disorder. Description of a clinical reality that includes a complex array of symptoms belonging to different disorders and their proper treatment led us to speak in terms of subclinical and atypical spectrum comorbidity. Early recognition of spectrum comorbidity (observed over a lifetime) leads to a significant improvement in diagnostic accuracy, choice of a more appropriate treatment strategy, management of treatment, control over the potential for substance abuse, and prediction of outcome [35]. Moreover, clinical experience shows that the adoption of a proper treatment strategy covering both the axis I disorder and the lifetime occurrence of spectrum symptoms often produces dramatic changes in the lifestyle of the patient, who feels free from psychopatho-logical features that the clinician and even the patient believed were stable personality traits. Unrecognized spectrum symptoms occurring at one time in the patient’s life may impact his or her personality and the presentation of any psychopathology at some future time. An example might be of a young man who, at the age of 20, experiences one or two mild panic attacks. He seeks no treatment, but the attacks change his life in certain ways. Prior to the mild panic attacks, he was described as energetic, open to new experiences , and socially outgoing with a hyperthymic temperament. Following the onset of panic symptoms, he becomes increasingly pavid, dependent, socially avoidant, and worried about his health. These features become stable and traitlike. When this patient is seen by a clinician at age 40 for a depressive episode, his panic symptoms have long been forgotten, and he presents as a fearful person, somewhat hypochondriacal, and dependent on others to such an extent that he tends to avoid remaining alone. Now the recognition of distinct symptoms of the panic spectrum and the consequent adoption of a well-targeted treatment strategy become fundamental. If the clinician attempts to treat only the depressive episode, he or she will miss the main reason for the patient’s 20 years of fearfulness, dependency, avoidness, and hypochondriasis, which were initiated and maintained by a partial expression of panic disorder.
Bipolar Disorders: Bipolar 1, Bipolar 2, and Cyclothymic Disorder
Published in Thomas L. Schwartz, Practical Psychopharmacology, 2017
People with B1D and B2D typically show patterns of sustained mood elevation (excessive happiness, expansiveness, euphoria, etc.) and mood depressions (sadness, loss of enjoyment, etc.). Major depressive episodes (MDE) will be thoroughly discussed in the major depressive disorder (MDD) chapter, but in brief are considered to occur when at least two weeks of pervasive low mood, low self-worth, low interest, low energy, poor concentration, alterations in appetite, psychomotor functioning change, and suicidal thinking occur. Prior to defining DSM-5 bipolar disorder, hypomanic and manic episodes must be precisely defined. (See below.) Finally, patients in mania are felt to be in a state of psychotic denial. As with other psychotic illnesses (schizophrenia) there is a frank loss of memory for present or past manic events. Unfortunately, patients do not remember their past manic transgressions. In less severe manic events (hypomania), some patients do remember events, and these less severe episodes are looked upon as positive. These patients feel really good. They are mood elevated, happy, energetic, with increased self-esteem. They do not need sleep and are overly productive. These hypomanic episodes are felt to be less impairing (may actually benefit the patient) but are a clear change in their usual functioning, and people in their environment take notice. Mild mannered patients appear to change to a hyperthymic temperament and become goal driven and more the life of the party in their actions. They feel like they are on extra caffeine or even cocaine, but without actually having used those substances. Hypomania is a natural high with fewer consequences than a full-blown manic event. Unfortunately, some patients will deceive their prescribers and state they are not hypomanic, have not suffered such events, as they purposefully want these experiences and do not want them removed by medication management. Therefore, despite excellent interviewing and/or rating scale use, a sizeable minority of BD patients will forget manic episodes or will deny the existence of hypomania, making a retrospective diagnosis difficult if they present in a euthymic or depressed state. Given this, a secondary interview with a significant other or family member, or obtaining past psychiatric records, robustly increases the accuracy of diagnosis.
Prodynorphin (PDYN) gene polymorphisms in Turkish patients with methamphetamine use disorder, changes in PDYN serum levels in withdrawal and the relationship between PDYN, temperament and depression
Published in Journal of Ethnicity in Substance Abuse, 2022
Güliz Şenormancı, Çetin Turan, Sevim Karakaş Çelik, Aycan Çelik, Tuba Gökdoğan Edgünlü, Dilek Akbaş, Ayşe Semra Demir Akca, Ömer Şenormancı
Hyperthymic temperament is one of the temperament characteristics being associated with MD (Yehya et al., 2019). Hyperthymic temperament is strongly influenced by the dopaminergic system in contrast to other characteristics (Rihmer et al., 2010). People with hyperthymic temperament have features such as difficulty in suppression, vulnerability to stimuli, impulsivity, and hyperthymic temperament is negatively associated with depressive symptoms. (Rovai et al., 2013). As all features reviewed together, it can be said that he high levels of PDYN in methamphetamine withdrawal may be related to the hyperthymic temperament and low levels of depression. To the best of our knowledge, no studies investigating PDYN level in the withdrawal period and of this relationship with temperament and depression level exist in the literature. New studies on this subject may be beneficial in terms of developing more effective strategies in the methamphetamine withdrawal.
Challenging predictions between affective temperaments, depression and anxiety in a Kosovo student community sample
Published in International Journal of Psychiatry in Clinical Practice, 2018
Mimoza Shahini, Merita Shala, Pajtim Xhylani, Shkumbin Gashi, Islam Borinca, Andreas Erfurth
Also results of Lazary, Gonda, Benko, Gacser, and Bagdy (2009), suggest that depressive, cyclothymic and anxious temperaments play an important role in depression. Similar findings were also reported by Karam et al. (2010), that anxious temperament was a powerful predictor of anxiety disorder and depression and hyperthymic temperament had preventive effects in most of the mental disorders. Hyperthymic temperament was not found also in correlation with depression in different studies (Asik et al., 2015; Gundogar, Kesebir, Demirkan, & Yaylaci, 2014; Kesebir et al., 2013; Perugi et al., 2012; Walsh, Royal, Barrantes-Vidal, & Kwapil, 2012). These findings and our current study suggest that hyperthymic temperament may play important role on serving as a defence mechanism against depression.
Affective temperaments during pregnancy and postpartum period: a click to hyperthymic temperament
Published in Gynecological Endocrinology, 2018
Esra Yazici, Hilal Uslu Yuvaci, Ahmet Bulent Yazici, Arif Serhan Cevrioglu, Atila Erol
The absence of the elevation in other scores apart from the hyperthymic characteristics may be considered as calmness and mood elevation as stated above, but, on the other hand, it is known that the hyperthymic temperament is a risk for bipolar disorder [22,23]. In the study carried out by Vigura and colleagues, it was detected that bipolar women had a higher risk of having manic and mixed episodes during pregnancy and depressive episode frequency is reduced during pregnancy [23]. This also corresponds to the hyperthymic temperament characteristics. The results we obtained with respect to the affective temperament characteristics are like those adapted to the affective temperament scores of this study. Even though pregnancy period is not defined in studies as a serious risk period for bipolar disorder, it is still emphasized that these periods should be carefully monitored especially in terms of relapses and recurrences [23].