Role of Personality and Stress in the Genesis of Bipolar Disorder - Mixed States: "Could it be a solution to the Diagnostic confusion prevailing in this disorder? (Part II)" .
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Date
2011-04
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Abstract
Role of temperamental predisposition in the development of Mixed States is a relevant factor.
Mania seems to arise from a hyperthymic background and Mixed States seems to arise from a
depressive disposition. Aims: To compare the personality pathology and distribution of stress
of patients of mixed states distributed according to the number of standardized criteria fulfilled
and with the pure manic group. Materials and methods: Out of 214 bipolar disorder- current
episode manic patients diagnosed as per DSM IV TR ,admitted in psychiatry ward of P.B.M.
Hospital, Bikaner from 1st Jan 2007 to 31st Dec 2007,64 patients were randomly selected. Young’s
Mania Rating Scale and Montgomery Asberg Depression Rating Scale were applied to these
patients and 32 patients were assigned to mixed states on displaying one or more depressive
symptom on MADRS, excluding decreased sleep. Rest 32 patient were assigned to pure manic
group displaying no depressive symptoms. Presumptive Stressful Life Event Scale was applied
to find out any stress in the lifestyle of the sample and International Personality Disorder
Examination was applied on the third follow up visit. Results: Patients with personality
psychopathology and stress met 3 or more criteria as compared to those with personality
psychopathology without stress (p<0.01). Disorder level personality psychopathology, especially
anxious disorder level personality, was significantly higher in mixed group patients as compared
to pure manic patients(p<0.02).Meeting more criteria for mixed mania also meant higher scores
on MADRS(p<0.01) Also patients meeting more than 3 criteria for mixed states had a
significantly higher duration of hospital stay than those meeting less than 3 criteria(p<0.02)
Conclusion: Mixed states is a dimensional diagnosis, higher the vulnerability in terms of disorder
level personality psychopathology higher is the MADRS scores and greater episode duration.
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Keywords
Personality, Stress, Bipolor disorder-mixed states
Citation
Gupta Prerana, Gupta L N, Singhal A K, Verma K K, Prasad Shiv, Gupta Prachi. Role of Personality and Stress in the Genesis of Bipolar Disorder - Mixed States: "Could it be a solution to the Diagnostic confusion prevailing in this disorder? (Part II)". Delhi Psychiatry journal. 2011 Apr; 14 (1): 63-69.