Evidence map›Paper›PMID 34782957›Full record

ArticleInternational journal of bipolar disorders2021

Mania and bipolar depression: complementing not opposing poles-a post-hoc analysis of mixed features in manic and hypomanic episodes.

Christoph Born, Heinz Grunze, Robert M Post, Lori L Altshuler, Ralph Kupka, Susan L McElroy, Mark A Frye, Trisha Suppes, Paul E Keck, Willem A Nolen and 1 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in International journal of bipolar disorders, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
0.5field-weighted citation impact, top 37% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it, 9 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 10 institutions in 4 countries.

Christoph BornParacelsus Medical University, Nuremberg, Germany.
Heinz GrunzeParacelsus Medical University, Nuremberg, Germany. heinz.grunze@icloud.com.ORCID http://orcid.org/0000-0003-4712-8979
Robert M PostBipolar Collaborative Network, Bethesda, MD, USA.
Lori L AltshulerDepartment of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Ralph KupkaDepartment of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.
Susan L McElroyLindner Center of HOPE, Mason, OH, USA.
Mark A FryeDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
Trisha SuppesDepartment of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA.
Paul E KeckLindner Center of HOPE, Mason, OH, USA.
Willem A NolenDepartment of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Lars SchaererDepartment of Psychiatry and Psychotherapy Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.
Lindner Center of HOPE · USAmsterdam University Medical Centers · NLGeorge Washington University · USMayo Clinic · USParacelsus Medizinische Privatuniversität · DESaab (Switzerland) · CHUniversity Medical Center Groningen · NLUniversity of California, Los Angeles · USUniversity of Freiburg · DEVA Palo Alto Health Care System · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDepending on the classification system used, 5-40% of manic subjects present with concomitant depressive symptoms. This post-hoc analysis evaluates the hypothesis that (hypo)manic subjects have a higher burden of depression than non-(hypo)manic subjects.

methodsData from 806 Bipolar I or II participants of the Stanley Foundation Bipolar Network (SFBN) were analyzed, comprising 17,937 visits. A split data approach was used to separate evaluation and verification in independent samples. For verification of our hypotheses, we compared mean IDS-C scores ratings of non-manic, hypomanic and manic patients. Data were stored on an SQL-server and extracted using standard SQL functions. Linear correlation coefficients and pivotal tables were used to characterize patient groups.

resultsMean age of participants was 40 ± 12 years (range 18-81). 460 patients (57.1%) were female and 624 were diagnosed as having bipolar I disorder (77.4%) and 182 with bipolar II (22.6%). Data of 17,937 visits were available for analyses, split into odd and even patient numbers and stratified into three groups by YMRS-scores: not manic < 12, hypomanic < 21, manic < 30. Average IDS-C sum scores in manic or hypomanic states were significantly higher (p < .001) than for non-manic states. (Hypo)manic female patients were likely to show more depressive symptoms than males (p < .001). Similar results were obtained when only the core items of the YMRS or only the number of depressive symptoms were considered. Analyzing the frequency of (hypo)manic mixed states applying a proxy of the DSM-5 mixed features specifier extracted from the IDS-C, we found that almost 50% of the (hypo)manic group visits fulfilled DSM-5 mixed features specifier criteria.

conclusionSubjects with a higher manic symptom load are also significantly more likely to experience a higher number of depressive symptoms. Mania and depression are not opposing poles of bipolarity but complement each other.

Indexed as

Bipolar disorderDepressionHypomaniaManiaMixed states

Identifiers

PMID34782957
PMCPMC8593087
OpenAlexW3213210993

What OpenQuestion holds

Textmetadata
LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.