Search

Objective: To differentiate clinical and non‐clinical depression via a set of symptoms. Methods: A sample of 140 patients attending a clinical service for those with mood disorders together with 40 subjects denying ever experiencing a clinical episode of depression were compared, with participants completing a questionnaire capturing many symptoms of depression as well as illness correlates. Results: A latent class analysis of symptom data identified two classes and with class assignment corresponding strongly with initial clinical vs. non‐clinical assignment. Univariate analyses identified the extent to which individual symptoms contributed to differentiation. Study data suggested DSM criteria that would benefit from re‐writing or of reassignment. Two models for classifying clinical depression were generated. The first involved individuals feeling hopeless and also being suicidal or at risk of self‐harm. The second involved a symptom set corresponding to DSM‐5 criteria but with only five making significant independent contributions to diagnostic differentiation. Conclusion: The study is heuristic in offering a strategy for more precisely differentiating clinical and non‐clinical depression in more representative samples, so allowing resolution of key features, and determining whether a monothetic or polythetic diagnostic symptom criterion model is optimal. [ABSTRACT FROM AUTHOR]

Objective: A previous study identified categorically differing scores on the Sydney Burnout Measure (SBM) between individuals with self-identified burnout with ( n = 354) or without ( n = 188) a history of mental illness. The current study examined whether the SBM's validity held in both scenarios., Method: The factorial structure and scores on the SBM measure were compared between the two groups., Results: Similar underlying symptom constructs were identified. The group with a mental illness history had higher general factor scores, suggesting more severe burnout. The group without such a history (and thus a 'purer' burnout state) had higher scores on the empathy loss factor, suggesting its greater specificity to burnout than to other psychological states., Conclusions: Burnout appears to be experienced similarly by those with and without a mental illness history as measured by the SBM., Competing Interests: DisclosureThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: To determine if theta burst stimulation (TBS) is of preferential benefit to those with melancholic or non-melancholic depression as an adjunctive treatment for treatment resistant depression (TRD)., Methods: Fifty-two patients receiving TBS at a private psychiatric hospital participated in a naturalistic study. Four diagnostic strategies were used to assign melancholic versus non-melancholic depression subtype status. Depression symptoms were assessed at baseline, mid-treatment, and end of treatment using the Montgomery-Ǻsberg Depression Rating Scale - Self-Assessment (MADRS-S). Forty-one participants also completed the MADR-S at a six-week follow-up assessment., Results: We quantified poor correlations between the four study measures of melancholia; a finding suggesting that valid measurement of melancholia is likely to remain problematic. TBS led to significant reductions in depression symptoms from baseline to end of treatment, with this effect maintained at follow up. Response rates for the whole sample were 61.5 % at end of treatment and 53.7 % at follow-up, while remission rates were 34.6 % at end of treatment and 31.7 % at follow-up. Improvement rates as well as responder and remission rates were comparable for the melancholic and non-melancholic groups, irrespective of the diagnostic strategy used., Limitations: The study was naturalistic (i.e., there being no control group, and concomitant medication changes were allowed), depression severity was assessed only by use of self-report measures, and the sample size was relatively small., Conclusion: TBS appears to be non-specific, in that we failed to quantify any statistically significant differential benefit for those with melancholic compared to those with non-melancholic depression., Competing Interests: Declaration of competing interest The authors declare no potential conflicts of interest with respect to the research, authorship and/or publication of this article., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Debate is ongoing as to whether burnout can be differentiated from depression. This study evaluated whether burnout and depression could be distinguished using a new burnout measure and other variables., Methods: Scores on the Sydney Burnout Measure (SBM) were compared between participants with self-diagnosed burnout (BO-all group; n = 622) and clinically-diagnosed depression (DEP-all group; n = 90). The latter group was split into melancholic (DEP-mel; n = 56) and non-melancholic (DEP-nonmel; n = 34) depression subgroups for subsequent analyses. Differences in reporting of depressive symptoms and causal attributions were also evaluated., Results: While total SBM scores showed poor differentiation, the BO-all group had lower social withdrawal and higher empathy loss subscale scores than the depression groups. Odds ratios were significant for several of the depressive symptoms and causal attribution items when comparing the BO-all group to the DEP-all and DEP-mel groups, while only a few items were significant when comparing the BO-all and DEP-nonmel groups., Limitations: Participants in the depression group were assigned by clinician-based depression diagnoses, rather than by a standardised diagnostic interview, and the group had a relatively small sample size. Participants in the burnout group were self-diagnosed and not assessed for comorbid psychiatric diagnoses., Conclusions: There were some nuanced symptoms differences between burnout and depression, but many of the SBM symptoms were not specific to burnout. Results also suggested that burnout overlaps more with non-melancholic than melancholic depression, and that differentiation of burnout and depression may rely more on weighting causal factors over symptoms., Competing Interests: Declaration of competing interest None., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

This study aimed to examine the convergent validity of a new measure of burnout, the Sydney Burnout Measure (SBM) by comparison against the field standard measure - the Maslach Burnout Inventory (MBI). A second aim was to consider burnout's association with psychological distress. 1483 dental professionals completed the two burnout measures as well as two measures of psychological distress. The overall correlation between total scores on the two measures (and on shared constructs) was high, and thus the convergent validity of the SBM was supported. Further, the SBM and MBI total scores correlated highly with total scores on the two measures of distress. Exploratory structural equation modelling (ESEM) also identified substantial overlap between the measures, especially in relation to the exhaustion subscales of the burnout measures and their overlap with psychological distress items. While future research is required to determine which burnout measure and its associated burnout definition is most valid, our findings argue for further consideration of how burnout may best be conceptualized, as well as whether the syndrome is worthy of elevation to mental disorder status., Competing Interests: Declaration of Competing Interest None, (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objective: There is currently little consensus as to how burnout is best defined and measured, and whether the syndrome should be afforded clinical status. The latter issue would be advanced by determining whether burnout is a singular dimensional construct varying only by severity (and with some level of severity perhaps indicating clinical status), or whether a categorical model is superior, presumably reflecting differing 'sub-clinical' versus 'clinical' or 'burning out' vs 'burnt out' sub-groups. This study sought to determine whether self-diagnosed burnout was best modelled dimensionally or categorically., Methods: We recently developed a new measure of burnout which includes symptoms of exhaustion, cognitive impairment, social withdrawal, insularity, and other psychological symptoms. Mixture modelling was utilised to determine if scores from 622 participants on the measure were best modelled dimensionally or categorically., Results: A categorical model was supported, with the suggestion of a sub-syndromal class and, after excluding such putative members of that class, two other classes. Analyses indicated that the latter bimodal pattern was not likely related to current working status or differences in depression symptomatology between participants, but reflected subsets of participants with and without a previous diagnosis of a mental health condition., Conclusion: Findings indicated that sub-categories of self-identified burnout experienced by the lay population may exist. A previous diagnosis of a mental illness from a mental health professional, and therefore potentially a psychological vulnerability factor, was the most likely determinant of the bimodal data, a finding which has theoretical implications relating to how best to model burnout.

Objectives: Judging that the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria for defining mania/hypomania (and thus bipolar I/II disorders, respectively) would benefit from review, we formed an expert taskforce to derive modified criteria for consideration. The aim of this paper is to summarise the component stages and detail the final recommended criteria., Methods: We first sought taskforce members' views on the Diagnostic and Statistical Manual of Mental Disorders criteria and how they might be modified. Next, members recruited patients with a bipolar I or II disorder, and who were asked to judge new definitional options and complete a symptom checklist to determine the most differentiating items. The latter task was also completed by a small comparison group of unipolar depressed patients to determine the mood state items that best differentiate unipolar from bipolar subjects. Subsequent reports overviewed analyses arguing for bipolar I and II as being categorically distinct and generated empirically derived diagnostic criteria., Results: Alternatives to all the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria were generated. Modifications included recognising that impairment is not a necessary criterion, removing hospitalisation as automatically assigning bipolar I status, adding an irritable/angry symptom construct to the symptom list, deleting a mandatory duration period for manic/hypomanic episodes, and requiring a greater number of affirmed symptoms for a bipolar diagnosis to manage the risk of overdiagnosis. Granular symptom criteria were identified by analyses and constructed to assist clinician assessment. A potential bipolar screening measure was developed with analyses showing that it could clearly distinguish bipolar versus unipolar status, whether symptom items were assigned as having equal status or weighted by their quantified diagnostic contribution., Conclusion: While requiring further validation, we suggest that the revised criteria overcome several current Diagnostic and Statistical Manual of Mental Disorders (5th ed.) limitations to defining and differentiating the two bipolar sub-types, while still respecting and preserving the Diagnostic and Statistical Manual of Mental Disorders template. It will be necessary to determine whether the bipolar screening measure has superiority to currently accepted measures.

Whether burnout is synonymous with stress is a question of clinical importance when considering the nosological status and management of both states. The biological changes associated with both stress and burnout suggest considerable overlap. However, we argue that the widespread acceptance by the lay community of burnout as a distinct and relatable syndrome suggests it is worthy of independent designation.

Abstract: Burnout is a topic of high public and research interest, but debate remains as to how the syndrome should best be defined, measured, and diagnosed. In this article, we overview how issues relating to burnout's definition and measurement as well as the debate surrounding its overlap with depression have led to ambiguity surrounding its diagnostic status. We argue for a broader conceptualization of burnout and detail why we position it as distinct from depression, before providing recommendations for clinicians when considering a burnout diagnosis. We highlight that all measures of burnout risk "false-positive" diagnoses and that they should more be viewed as screening strategies with a definitive diagnosis (of "burning out" or "being burnt out") requiring close clinical assessment and exclusion of alternate psychological and physical conditions., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: While there are several accepted screening measures for identifying those with a bipolar disorder, variations in overall classification rates argue for the pursuit of a more discriminating measure. Extant measures, as well as the DSM-5, rate each diagnostic criterion as having equivalent weighting values; an approach which may compromise diagnostic assignment if symptoms vary considerably in their diagnostic sensitivity. We therefore sought to develop a new measure and examine whether a weighted rating scale was superior to one assigning equivalent weightings to each item., Methods: An international sample of 165 bipolar patients and a comparison sample of 29 unipolar patients completed a measure assessing 96 putative manic/hypomanic symptoms. A previous machine learning analysis had identified the twenty most discriminating items. In this study, analysis was undertaken involving only the ten most discriminating items., Results: Whether items were scored as each having equivalent value or as weighted by their machine learning-generated values, classificatory accuracy was extremely high (in the order of 96%). Analyses also identified optimal cut-off scores. High classificatory accuracy was also obtained when scores for separate bipolar I and bipolar II groups were compared with scores from the unipolar group., Limitations: The sample consisted of comparatively few unipolar patients., Conclusions: The ten-item set allows a new measure for researchers to evaluate, while the items should assist clinician assessment as to whether a patient has a bipolar or unipolar mood disorder., (Copyright © 2021. Published by Elsevier B.V.)

Objective: As burnout has been neglected in medical and psychiatric education, we seek to provide a summary overview., Methods: We extract salient findings from the published literature and offer some challenges., Results: We critique the current principal model of burnout, argue for broadening the symptom constructs and for a diathesis-stress model where a perfectionistic personality style is a key predisposing factor, and observe that burnout is not limited by those in formal work. We argue that burnout is not synonymous with depression, overview biological underpinnings, and summarise a three-fold management model., Conclusion: As many burnout patients are referred to psychiatrists, awareness of its symptom pattern and management nuances is of key importance.

Objective: To demonstrate that there can be distinctive differences in information generated by standard interval measures as against using daily monitoring for evaluating progress in those with a bipolar disorder., Method: We undertook a 20-week study of individuals with a bipolar II disorder randomly assigned to receive either lamotrigine or lithium. Patients were rated on standard measures of depression and hypomania at monthly intervals, and they also completed a daily rating measure of their mood swings. We sought to demonstrate the potential for differing interpretations that emerge from these measurement strategies., Results: We graphed data for one subject who showed distinct improvement but demonstrated distinctly differing trajectories provided by monthly and daily data. In a second analysis, we considered sets of those who were judged as improving distinctly with lithium or lamotrigine to determine whether the drugs differed in speed of action, and again observed differing patterns between monthly and daily rating measures., Conclusions: A daily rating strategy appeared to provide additional and differing data compared to standard monthly measures. We therefore argue for the inclusion of daily mood ratings in clinical trials evaluating mood stabilisers and their use by clinicians in managing those with a bipolar II disorder.

Objectives: Burnout is a state of exhaustion resulting from prolonged and excessive workplace stress. We sought to examine biological underpinnings of burnout, focussing on mechanisms and physical consequences., Methods: We searched the literature on burnout and evaluated studies examining biological parameters in patient populations (i.e. 'clinical' burnout) as well as in individuals from the general population judged as having some degree of burnout evaluated using a dimensional approach., Results: Findings suggest that burnout is associated with sustained activation of the autonomic nervous system and dysfunction of the sympathetic adrenal medullary axis, with alterations in cortisol levels. Limited studies have also shown altered immune function and changes in other endocrine systems. Consequences of burnout include increased allostatic load, structural and functional brain changes, excito-toxicity, systemic inflammation, immunosuppression, metabolic syndrome, cardiovascular disease and premature death. Limitations of studies include variability in study populations, low specificity of burnout measures, and mostly cross-sectional studies precluding examination of changes across the course of burnout., Conclusions: Further examination of biological mechanisms of burnout would benefit from more homogeneous clinical samples, challenge tests and prospective studies. This would assist in differentiation from conditions such as depression and aid with development of specific treatment targets for burnout.

Burnout is currently operationalised as comprising of exhaustion, depersonalization and reduced personal accomplishment. However, questions have been raised as to whether this three-factor model accurately characterises the syndrome. We therefore sought to re-examine burnout's key symptoms and to develop a new model of the syndrome. 622 participants who self-identified as experiencing burnout completed a questionnaire covering a large item set of candidate burnout symptoms. Bifactor modelling identified a 34-item general factor that was dominated by items capturing exhaustion and cognitive dysfunction, but which also included items indicative of decreased work performance, insularity and a depressed mood. Five specific factors capturing additional data variance were identified and were interpreted as representing cognitive impairment, empathy loss, exhaustion, compromised work performance, and social withdrawal. Reliability indices indicated that the general factor alone accounted for most of the variance in observed scale scores for each specific factor, except for the loss of empathy specific factor. We concluded that burnout may therefore potentially be modelled as a unidimensional construct comprising exhaustion, cognitive impairment, compromised work performance, empathy loss and social withdrawal. Further, while those with burnout are likely to experience depressive symptoms, their presence is not of necessity indicative of clinical depression., (Copyright © 2021. Published by Elsevier B.V.)

Purpose/background: No study to date has compared lithium and lamotrigine as maintenance mood stabilizers for bipolar II disorder. The aim of this study was to evaluate and compare these two medications in terms of their maintenance efficacy and side effect profile, thus evaluating their comparative cost/benefit profile., Methods/procedures: Forty-four subjects with a newly diagnosed bipolar II disorder were randomly assigned to receive either lithium or lamotrigine treatment in a 20-week single-blinded study. Subjects received either slow-release lithium progressively up-titrated to achieve a serum level of 0.8 mEq/L, or lamotrigine increased progressively to a maintenance dose of 200 mg/d. Our primary outcome measure examined daily data on hypomanic and depressive symptoms. Secondary measures evaluated hypomanic and depressive symptom severity, global functioning, and global improvement in hypomanic and depressive symptoms., Findings/results: We terminated the trial principally because of severe ongoing side effects experienced by many of those receiving lithium, and with additional concerns about initial severe side effects (including psychosis) experienced by several assigned to lamotrigine. Analyses of study completer data for 28 participants suggested comparable efficacy of both medications; however, lamotrigine had a distinctly lower rate of severe side effects across the study. We calculated that if study trends on outcome measures were valid, then an extremely large sample would be required to demonstrate superiority of either drug, thus making it unlikely that any such adequately powered study will be mounted in the future., Implications/conclusions: The small sample size limits any definitive conclusions, but our data suggest that lithium and lamotrigine are likely to have equal efficacy as mood stabilizers for those with a bipolar II condition but that, as maintenance treatments, lithium has more distinctive side effects., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

There has been a longstanding debate as to whether the bipolar disorders differ categorically or dimensionally, with some dimensional or spectrum models including unipolar depressive disorders within a bipolar spectrum model. We analysed manic/hypomanic symptom data in samples of clinically diagnosed bipolar I, bipolar II and unipolar patients, employing latent class analyses to determine if separate classes could be identified. Mixture analyses were also undertaken to determine if a unimodal, bimodal or a trimodal pattern was present. For both a refined 15-item set and an extended 30-item set of manic/hypomanic symptoms, our latent class analyses favoured three-class solutions, while mixture analyses identified trimodal distributions of scores. Findings argue for a categorical distinction between unipolar and bipolar disorders, as well as between bipolar I and bipolar II disorders. Future research should aim to consolidate these results in larger samples, particularly given that the size of the unipolar group in this study was a salient limitation., (Copyright © 2021. Published by Elsevier B.V.)

Background: This study aimed to improve the accuracy of bipolar disorder diagnoses by identifying symptoms that help to distinguish mania/hypomania in bipolar disorders from general 'happiness' in those with unipolar depression., Methods: An international sample of 165 bipolar and 29 unipolar depression patients (as diagnosed by their clinician) were recruited. All participants were required to rate a set of 96 symptoms with regards to whether they typified their experiences of manic/hypomanic states (for bipolar patients) or when they were 'happy' (unipolar patients). A machine learning paradigm (prediction rule ensembles; PREs) was used to derive rule ensembles that identified which of the 94 non-psychotic symptoms and their combinations best predicted clinically-allocated diagnoses., Results: The PREs were highly accurate at predicting clinician bipolar and unipolar diagnoses (92% and 91% respectively). A total of 20 items were identified from the analyses, which were all highly discriminating across the two conditions. When compared to a classificatory approach insensitive to the weightings of the items, the ensembles were of comparable accuracy in their discriminatory capacity despite the unbalanced sample. This illustrates the potential for PREs to supersede traditional classificatory approaches., Limitations: There were considerably less unipolar than bipolar patients in the sample, which limited the overall accuracy of the PREs., Conclusions: The consideration of symptoms outlined in this study should assist clinicians in distinguishing between bipolar and unipolar disorders. Future research will seek to further refine and validate these symptoms in a larger and more balanced sample., (Copyright © 2020. Published by Elsevier B.V.)

Background: Burnout and clinical depression have been variably viewed as synonymous or as distinctly differing entities - but with few distinguishing features provided. Failure to differentiate the two conditions can lead to compromised clinical management. We sought to enhance the differentiation of burnout and clinical depression by assembling a list of candidate differentiating features., Methods: In assembling a set of distinguishing clinical features we compared burnout states against the two principal depressive sub-types (i.e. melancholic and non-melancholic depression) rather than against 'major depression' per se. Our candidate features were assembled from a review of salient literature, our clinical observations and from a sub-sample of subjects who self-identified as having experienced both burnout and depression and who volunteered differentiating features., Results: We judged that burnout shares few features with melancholic depression. While burnout and non-melancholic depression share a set of symptoms, differences were greater than commonalities., Limitations: Our findings were based on clinical observation and exploratory research rather than being empirical, and thus future studies are needed to evaluate the validity of our results., Conclusions: We position burnout and clinical depression as categorically distinct and suggest that application of our nominated parameters should assist clinical differentiation of the two syndromes., (Copyright © 2020. Published by Elsevier B.V.)

Background: It is unclear whether the bipolar disorders (i.e. BP-I/BP-II) differ dimensionally or categorically. This study sought to clarify this issue., Methods: We recruited 165 patients, of which 69 and 96 had clinician-assigned diagnoses of BP-I and BP-II respectively. Their psychiatrists completed a data sheet seeking information on clinical variables about each patient, while the patients completed a different data sheet and scored a questionnaire assessing the prevalence and severity of 96 candidate manic/hypomanic symptoms., Results: We conducted a series of analyses examining a set (and two sub-sets) of fifteen symptoms that were significantly more likely to be reported by the clinically diagnosed BP-I patients. Latent class analyses favoured two-class solutions, while mixture analyses demonstrated bimodality, thus arguing for a BP-I/BP-II categorical distinction. Statistically defined BP-I class members were more likely when manic to have experienced psychotic features and over-valued ideas. They were also more likely to have been hospitalised, and to have been younger when they received their bipolar diagnosis and first experienced a depressive or manic episode., Limitations: The lack of agreement between some patients and managing clinicians in judging the presence of psychotic features could have compromised some analyses. It is also unclear whether some symptoms (e.g. grandiosity, noting mystical events) were capturing formal psychotic features or not., Conclusions: Findings replicate our earlier study in providing evidence to support the modelling of BP-I and BP-II as categorically discrete conditions. This should advance research into aetiological factors and determining optimal (presumably differing) treatments for the two conditions., (Copyright © 2020. Published by Elsevier B.V.)

Whether depression and burnout are synonymous or not has been a longstanding debate. Many studies have examined for similarities and differences, but findings have overall been inconclusive, with most studies being quantitative in design. We therefore undertook a qualitative study in which participants who self-identified as having experienced both burnout and depression were asked how they distinguished between the two conditions. Thematic qualitative analysis was undertaken and while a fifth of the sample stated that their burnout and depression experiences were indistinguishable or were very similar, we also identified 11 key themes of difference. The most prevalent themes captured differences in the perceived cause of each condition, in experiencing hopelessness as against helplessness, and impacts on levels of functioning, sadness, anger, anxiety and emotional lability. We also identified differences in suicidal ideation between the two conditions. While some differences identified could be dimensional and suggest that burnout is simply synonymous with or a developmental phase of depression, the several categorical symptom differences nominated by participants suggest that most sufferers who have experienced both conditions perceive them as distinct. Such 'lived experience' reports are therefore intrinsically informative and should shape further quantitative analyses., Competing Interests: Declaration of Competing Interest The authors declare no potential conflicts of interest with respect to the research, authorship and/or publication of this article., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Burnout is generally defined as a triad of emotional exhaustion, lack of empathy, and reduced professional accomplishment constructs. We sought to determine in an exploratory, qualitative study whether these three constructs adequately represent burnout. Participants who self-identified as experiencing burnout completed a questionnaire that asked about their experiences of the condition. A qualitative thematic analysis was undertaken to determine the primary symptom constructs nominated by participants. The thematic analysis resulted in 12 symptom clusters or "themes" being identified as putative burnout features, with several of these themes overlapping with features identified in our independent quantitative analysis. Although we found emotional exhaustion, lack of empathy, and reduced professional accomplishment to be commonly nominated symptoms of burnout, the distinctive presence of several additional themes suggests that the burnout syndrome comprises a broader set of symptom constructs than those currently accepted as the defining features of the condition.

There is widespread debate as to how to accurately define and measure burnout. The present study sought to address these issues by inviting participants who self-identified as experiencing burnout to complete a questionnaire covering a large item set of putative burnout features. Bifactor modelling identified a 'general' factor with items capturing exhaustion as well as psychological and cognitive dysfunction. Three additional 'specific' factors were also generated that delineated work-focused, inability to feel and compromised work functioning constructs. Similar factors were found when those still working and those no longer working were compared. Results indicate a new heuristic diathesis-stress model of burnout., Competing Interests: Declaration of Competing Interest The authors declare no potential conflicts of interest with respect to the research, authorship and/or publication of this article., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Differentiating melancholic and non-melancholic depressive disorders and evaluating whether they differ categorically or dimensionally has had a lengthy history, but has not previously been evaluated in a non-clinical adolescent sample., Methods: We studied a sample of 1579 senior high school students and evaluated the capacity of the Sydney Melancholia Prototype Index (SMPI) to differentiate melancholic from non-melancholic depression, both using a 'top down' strategy of imposing a pre-established cut-off score and a 'bottom up' strategy of employing latent class analyses., Results: The two strategies respectively generated prevalence figures of 3.4% and 8.1% of the students having experienced a melancholic depressive episode and with the difference reflecting the LCA assigning some students who did not reach the pre-established cut-off score for the SMPI in the putative melancholic class. The principal latent class analysis failed to generate pristine melancholic and non-melancholic depressive classes, in that it also generated an 'intermediate' as well as a non-clinical depressive class. Both SMPI strategies identified similar symptoms-such as anhedonia and anergia-and several illness correlates that best differentiated those assigned melancholia status, and both strategies confirmed melancholia assignment being associated with factors indicative of more severe depressive disorders and of likely melancholic depression., Limitations: Data were assessed by self-report only, only lifetime depression was assessed, and no other depressive diagnostic validating measure was administered., Conclusions: The SMPI appears capable of identifying and differentiating melancholic from non-melancholic depression in a non-clinical adolescent sample., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: To derive new criteria sets for defining manic and hypomanic episodes (and thus for defining the bipolar I and II disorders), an international Task Force was assembled and termed AREDOC reflecting its role of Assessment, Revision and Evaluation of DSM and other Operational Criteria. This paper reports on the first phase of its deliberations and interim criteria recommendations., Method: The first stage of the process consisted of reviewing Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition , and recent International Classification of Diseases criteria, identifying their limitations and generating modified criteria sets for further in-depth consideration. Task Force members responded to recommendations for modifying criteria and from these the most problematic issues were identified., Results: Principal issues focussed on by Task Force members were how best to differentiate mania and hypomania, how to judge 'impairment' (both in and of itself and allowing that functioning may sometimes improve during hypomanic episodes) and concern that rejecting some criteria (e.g. an imposed duration period) might risk false-positive diagnoses of the bipolar disorders., Conclusion: This first-stage report summarises the clinical opinions of international experts in the diagnosis and management of the bipolar disorders, allowing readers to contemplate diagnostic parameters that may influence their clinical decisions. The findings meaningfully inform subsequent Task Force stages (involving a further commentary stage followed by an empirical study) that are expected to generate improved symptom criteria for diagnosing the bipolar I and II disorders with greater precision and to clarify whether they differ dimensionally or categorically.

Mood disorders may lead to major life consequences. This study builds on our preliminary examination of the impact of an extensive set of consequences and was undertaken in a larger clinical sample. Two hundred and forty four adults diagnosed with either unipolar depressive disorder or a bipolar disorder (type I or II) were administered an online survey of 60 items, listing potential consequences of having a mood disorder. Participants estimated the degree of impact (0-100) of each consequence on their life initially, and in the longer term. Items loading highly on the first 'general' factor of a bi-factor analysis were examined. Most items were affirmed by at least 75% of the sample. Significant group differences emerged on ten items. The bipolar group was 1.44-2.27 times more likely to experience difficulty with debts, education, speeding fines, increased risk of harm and delayed family planning. The unipolar group was 1.11-1.67 times more likely to experience social withdrawal, lowered life satisfaction, decreased overall wellbeing and ambition, and missed opportunities. Only one positive consequence (i.e. increased empathy) was identified. This extensive range of mood disorder consequences was highly endorsed by both BP and UP patients and with substantial immediate and ongoing impacts reported., (Copyright © 2018. Published by Elsevier B.V.)

Background: Suicide in international police is 2-3-fold that of the general population. Risk factors include suicidal ideation, diagnosis of mood or post-traumatic stress disorders, family/psychological problems, suffered abuse, alcohol use, service suspension, and stigma. A false stigma-related myth is to believe that suicide does not cause concern within military settings., Methods: We administered post-training to 6103 Italian Police workers a 30-item questionnaire to assess the perception of suicidal phenomena. We conducted descriptive statistics, principal component analysis, and analyses of variance of data., Results: We identified seven factors, i.e., health and environmental risk factors; need for new preventive interventions; emotional reaction to suicide; negation, indifference and minimization; utility of current preventive interventions; risk related to personal factors; intervention difficulties., Conclusions: The questionnaire showed content validity and consistency in investigating perceptions about suicide in the State Police. Data synthesis showed a mature approach and appropriate perception of the suicide problem on behalf of Italian State Police workers.

Background: Trials examining medication efficacy for bipolar II disorder commonly employ a set of standardized interval measures to assess outcomes. The key issue is whether such interval measures pick up changes in the severity, duration and frequency of depressive, hypomanic and euthymic episodes., Method: We examine the application of measures most commonly used to monitor progress in nine studies involving participants with a bipolar II disorder and published in journals with a moderate to high impact factor., Results: Studies rarely provided interval details for assessing depressive and hypomanic symptoms. None specified whether ratings of depressive and hypomanic symptoms were based on severity, duration or number of symptoms, and none recorded any data on euthymic periods., Limitations: Our sample of reviewed studies was small and our analyses focused only on the three most commonly used outcome measures. We advocate for complementary subjective daily mood monitoring strategies but recognize that such strategies need to be validated in future studies., Conclusions: We argue that interval ratings undertaken weekly or over longer periods may compromise efficacy data. We recommend that userguides be developed to ensure standard outcome measures are employed consistently across trials, and that specific details be published in trial papers about how measures were employed and what mood episode characteristics were measured at each assessment. We also argue for daily ratings to be used as an outcome measure to provide data on severity, frequency and duration of depressive, hypomanic and euthymic periods in intervention studies of those with a bipolar II disorder., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Clinicians treating a patient with bipolar disorder who is pregnant or breastfeeding may seek advice from bipolar management guidelines that provide recommendations for perinatal treatment. We examine the consistency of such recommendations across several evidence-based guidelines., Methods: A literature search in the National Guideline Clearinghouse, the Cochrane Database of Systematic Reviews, PsycInfo and PubMed was undertaken using the search terms "bipolar disorder" and "guidelines," which generated 11 sets of evidence-based guidelines published by professional organizations during the 2005-2015 period. Information relevant to management during the perinatal period was reviewed by two independent reviewers, with key themes qualitatively analysed., Results: There was a moderate level of agreement across guidelines regarding the potential teratogenic effects of lithium, sodium valproate and carbamazepine, with most highlighting caution in using these medications during the perinatal period. There was less agreement regarding the safety risks associated with lamotrigine, antipsychotics, and antidepressants, and little agreement regarding the risks and recommendations of medications during breastfeeding., Limitations: Some differences in recommendations are likely due to varying publication dates, with recent guidelines having more up-to-date evidence available to use when formulating recommendations. Further, due to ethical issues surrounding pregnancy and infant research, the evidence used to formulate perinatal recommendations is largely based on retrospective reports and/or case studies. It is therefore unrealistic to expect such recommendations to be entirely consistent and based on rigorous evidence., Conclusions: While there was some consistency across guidelines on key recommendations, there were also substantial inconsistencies, with the latter risking compromising clinical management., (Copyright © 2017 Elsevier B.V. All rights reserved.)