“Organic” and “psychotic” symptoms in unipolar (UP) vs bipolar (BP) depressions

Abstract

Delusions and hallucinations are often part of the symptomatology in patients with affective disorders. The frequency of these symptoms in an outpatient population has been documented in a recent article by Guze et al. 1 They found that primary bipolar (BP) patients reported delusions and hallucinations in 53% of cases and primary unipolar (UP) patients in only 17% of the cases. These data suggest that there might be differentiating clinical symptoms that could distinguish BP depressed from UP patients. An earlier attempt was made to separate UP from BP depressed patients by Beigel and Murphy 2 on the basis of symptom complex. They found in this inpatient group matched for age, sex, and level of depression that there was no statistical difference ( p > .05) in the psychotic symptoms between UP ( 9 25 –36% ) and BP ( 3 25 –12% ) depressed patients. Though these did not reach statistical significance, the trend was the opposite of that reported by Guze. This contradiction could be explained by the rather apparent differences between these studies. Guze did not distinguish in his paper whether he was working with BP manic phase, BP depressed phase, or both. One would assume both. Beigel rated his BP patients specifically during the depressed phase of illness for at least two weeks. It has been noted that bipolar illness is characterized by a greater family history of affective disorder than unipolar illness; therefore, it may be considered more “genetic” or biological. 3 This finding makes it worthwhile to compare bipolar and unipolar depressions on the variable of organic (sensorium) symptoms as well as on psychotic symptoms.