Prévalence de l’hypomanie dans les dépressions majeures récurrentes ou résistantes : enquêtes Bipolact

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Bipolar II disorder is officially recognized as a mental disorder in DSM-IV-TR and defined by the presence of hypomanic episodes alternating with major depression. Despite data supporting clinical complexity and high morbidity and mortality rates, BP-II disorder is often overlooked or misdiagnosed as unipolar major depression or personality disorder. Moreover, many clinicians still regard it as a milder form of manic-depressive illness. These unsolved problems propose to investigate hypomania prevalence rates in resistant and recurrent depressions, at a large national scale, by means of three large surveys (Bipolact Surveys) carried out in both psychiatric and primary care settings. This research is a part of a national project for medical education on bipolar disorders established in September 2004. Screening of hypomania was done by self-assessment with the hypomania checklist HCL-20; hypomania cases were defined by a score greater or equal to 10 on the HCL-20. Inter-group comparisons (BP-II versus unipolar depression) and multiple logistic regression analyses were conducted on all demographic and clinical factors obtained. Data obtained in the “real world” medical practice (in total, 623 physicians and 2396 patients with major depression) revealed a high rate of hypomania around 62% in both recurrent depression samples (primary care and psychiatric settings) and 55% in resistant major depression. Additionally, the inter-group comparative data allowed drawing the BP-II disorder profile by selecting the most significant differences versus unipolars. “Ups and Downs” (cyclothymic traits) represented the most important and common (in all three different logistic models) risk factor of hypomania. In recurrent major depression, “ups and downs” seemed to act independently from another important risk factor, i.e. “family history of bipolarity”. “Mood switching” was the major risk factor for hypomania in patients with resistant depression; further risk factors were “substance abuse”, “young age of onset”, “agitated – mixed – atypical forms of depression”. These factors are meaningful at clinical and phenomenological levels, and can validate the dimensional approach of hypomania and the cut-off score on the HCL-20.