Kinds Of Depression Research Articles

A phenomenologically grounded specification of varieties of adolescent depression.

Researchers are increasingly acknowledging that psychopathological conditions usually grouped together under the generic label "depression" are highly diverse. However, no differential therapeutic approach currently exists that is sensitive to the varieties of depression afflicting young people. In fact, the discussion is missing something much more fundamental: a specification of the types of adolescent depression. Recent research that has aimed to classify different kinds of depression has mainly studied adult populations and predominantly used technically complicated measurements of biological markers. The neglect of the potential particularities of dysphoric disorders affecting youths is unfortunate, and the exclusive focus on biological parameters unnecessarily restrictive. Moreover, this one-sidedness obfuscates more directly available sources of clinically relevant data that could orient conceptualization efforts in child and adolescent psychiatry. Particularly, clues for discriminating different types of adolescent depression may be obtained by analyzing personally articulated accounts of how affected young people experience changes in their relation to the world and to themselves. Thus, here we present and discuss the findings of a study that explored the possibility of specifying types of adolescent depression in a phenomenological way. The study investigated the association between these types and the vicissitudes of personality development. In accounts given by youths diagnosed with depression during semi-structured interviews, we identified themes and examined their phenomenological centrality. Specifically, our qualitative analyses aimed to determine the relative importance of certain themes with respect to the overall intelligibility of the described changes to the relational space. Based on the findings of these analyses, we differentiate three specifiers of adolescent depression and suggest an association between particular types of experiences and the trajectory of affected adolescents' personality development. To our knowledge, this is the first phenomenologically grounded specification of types of adolescent depression with potential therapeutic significance. Thus, based on this contribution, we propose that modes of scientific exploration that are close to phenomenological philosophy-which have been ignored in the context of developmental psychopathology-could offer a foundation to theories developed in the field of child and adolescent psychiatry.

Training model for engineering applied talents to improve students’ depression

Background Depression is a kind of depression with the primary clinical manifestation and the duration of the mental and psychological disease, with insomnia, low mood, lack of pleasure, and other symptoms. Presently, the tendency of depression among students from different colleges, universities, and majors is apparent and varies. To better improve the depression situation of college students, the study proposes to guide their mental health from the intervention perspective of education and training mode.Subjects and Methods Depressed engineering college students were selected as research subjects and randomly divided into an experimental group (psychological intervention combined with engineering applied talent cultivation model) and a control group (conventional psychological intervention), in which the talent cultivation model was docked with an example of the engineering project. During the experiment, the data were processed and analyzed with the help of the Self Depression Scale (SDS) and SPSS22.0 statistical tools.ResultsAfter the experimental intervention, it was found that there was a statistically significant difference between the depression scale scores of the two groups of patients (P<0.05), and the improvement of depression in the subjects of the experimental group was significantly better than that of the control group.ConclusionsThe combination of talent cultivation mode and psychological intervention can better help engineering college students to improve their depression, enhance the level and quality of their mental health, and view their studies and work in a more positive frame of mind.

POST-STROKE DEPRESSION AMONG STROKE SURVIVORS ATTENDING THERAPY CENTERS IN CHITWAN

Background: The neuropsychiatric side effect of post-stroke depression is one of the most prevalent in stroke survivors. The purpose of this study was to determine the extent of post-stroke depression and the factors that influence post-stroke depression among stroke survivors attending therapy centers at various hospitals in Chitwan. Methods: A hospital-based cross-sectional study using the face-to-face interview method was carried out in different therapy centers in Chitwan, Nepal. A total of 137 stroke survivors were considered as a sample. The data was collected from November 25, 2021 to January 29, 2021. We used Pearson’s Chi-square test and binary logistic regression analysis to assess the factors influencing post-stroke depression among stroke survivors in Chitwan. Results: Among 137 stroke survivors, just more than half i.e., 54.70% (75) suffered from any kind of depression, and the remaining participants i.e. 45.30% (62) did not have depression. Result showed that current depression status among stroke survivors were significantly associated with age group [above 60 years (COR =2.88; CI=1.17-7.10)], educational status [primary and below (COR =4.02; CI=1.47-10.95)], past employment status [unemployment (COR=2.79; CI=1.37-5.69)], past alcohol intake [alcohol intake (COR=1.04; CI=0.52-2.10)] and current BMI status [underweight (COR =1.23; CI=0.24-6.07)]. Conclusions: More than half, or 54.70% (75), suffered from depression, which is an unacceptable rate. Increased literacy, improved socioeconomic status, and lifestyle changes among stroke survivors would reduce the severity of depression. It is necessary to provide comprehensive, up-to-date information as well as supportive interventions with the goal of reducing depression among stroke survivors.

VARIED MANIFESTATION OF DEPRESSION IN WOMEN

Men and women might experience various kinds of depression in varied ways, and while they do share many signs and symptoms, experts argue that deeper insights into distinctions can benefit affected individuals. The death rate amongst women due to depression has been twice the rate of men during the Covid 19 pandemic, be at home or at frontlines. Our paper aimed to evaluate the disparities found at the onset of Covid 19 in the areas of mental health and domestic violence between men and women. During Covid-19 pandemic very limited research was conducted on the mental health issues of women. We believe that this paper will contribute to recognise the role that women play both at home and at work.

Postpartum Depression and Cognitive Behavioral Therapy from Face to Face Group Sessions to Online Group Sessions

Cognitive behavioral therapy (CBT) is one of the most common used therapy techniques especially among people suffering depression. It was developed by Aeron Beck in 1960s and it has continued to improve itself on different relations with other therapeutic approaches. In addition, cognitive behavioral therapy (CBT) has been used for individual and group therapy sessions. Postpartum depression is a kind of depression which has specific interval of emergence. Almost every stage of pregnancy and after birth is inevitably important to intervene postpartum depression. With the development of technology, online platforms have become more prevalent and common including treatment of postpartum depression as a supplement to face to face therapy sessions. It is important to note that postpartum depression is vital not only mothers experience, but also children’s development. This study includes literature review about cognitive behavioral therapy (CBT) and postpartum depression from face to face group sessions to online group session. In the study, it is focused on firstly postpartum depression, cognitive behavioral (CBT) and online cognitive behavioral therapy (CBT) group interventions and finally alternative strategies to cognitive behavioral therapy (CBT) in treatment postpartum depression with different cultural perspectives as well. Outstanding alternatives to cognitive behavioral therapy (CBT) are interpersonal therapy group sessions, peer support groups and music and yoga.

WOMEN AND MEN IN MIDLIFE CRISIS

Uncomfortable period, which men and women experience between the age of 35 and 55, psychologists define as a midlife crisis. At that period some people are getting anxious and loose the nerves over a small issue. They consider it a kind of depression. For them, this period is a true "crisis" and they question every choice they've made during the first half of their life and look back on it with remorse and regret. They are struggling with their mortality, confidence, identity, and accomplishments thus far in life. Negative emotions often evoke them to start radical changes to their current lifestyle. Sometimes they change their life for a better, sometimes they make big mistakes. In my presentation, I would like to take a psychological look at this issue and pay special attention to the differences in experiencing a midlife crisis by women and men. I am also going to define reasons that may lead to this emotional crisis.

Knowledge and attitudes associated with menopause among women aged 45 to 60 years: a pilot study among rural and urban women in Bangladesh.

To assess knowledge and attitudes associated with the menopause transition among women in Bangladesh. A cross-sectional survey was conducted among women (age range 45-60 y), 160 participants were selected from both urban and rural settings using a systematic sampling procedure. We used face-to-face interview techniques employing a semistructured questionnaire. Bivariate and multivariate regression analyses were done to assess the associated factors. Around one-fourth (23%) of the participants did not have a basic understanding about symptoms of menopause. Knowledge about menopause increased proportionately with higher education levels (primary education, risk ratio [RR] = 3.91, 95% confidence interval [CI] = 0.66-22.92; secondary education, RR = 6.10, 95% CI = 1.26-29.41; higher education, RR = 6.74, 95% CI = 1.33-34) and was more common among urban than rural women (P = 0.001). In addition, women who were service holders had greater knowledge about menopause compared with women who worked in the home (RR = 8.67, 95% CI = 1.94-38.58). Most of the women (96%) suffered from different kinds of depression during the menopause transition. Key barriers to gaining knowledge about menopause included access to information (63%), social stigma (57%), and shame (52%). Menopause is a neglected issue in Bangladesh. Accurate and appropriate information regarding premenopause and menopause can help women cope with this life transition. Social and familial support may also play a role in minimizing isolation and depression. Public health messaging to increase awareness and knowledge about menopause should be undertaken to overcome the stigma and shame associated with menopause in Bangladesh. : Video Summary:http://links.lww.com/MENO/A556.

Vitamin D3 as adjunctive therapy in the treatment of depression in tuberculosis patients: a short-term pilot randomized double-blind controlled study.

ObjectiveWe aimed to evaluate whether high-dose cholecalciferol has beneficial effects on depression in pulmonary tuberculosis (PTB) patients.MethodsThis pilot, randomized, and double-blind trial enrolled 123 recurrent PTB patients (aged ≥18 years) meeting Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria of major depressive disorder from four hospitals in Southeast China. Patients were randomly assigned to 8-week oral treatment with 100,000 IU/week cholecalciferol (Vit D group) or a matching placebo (control group). The primary outcome was treatment response, defined as a 50% reduction in symptoms and change in scores of the Chinese version of Beck Depression Inventory (BDI) from baseline to 8 weeks. Relative risks of depression were estimated using multivariable logistic regression.ResultsFinally, 120 patients were enrolled, including 56 test patients and 64 controls. After 8 weeks, the treatment response or BDI scores did not differ significantly between groups. Multivariate logistic regression showed that BDI scores were not significantly improved in the Vit D group after adjustment for age, time to first negative smear, or 25-hydroxyvitamin D level.ConclusionThe use of high-dose Vit D3 supplementation may not be warranted for reducing depressive symptoms in the PTB population. Nevertheless, this finding should be validated by further large-scale studies according to different kinds of depression or Vit D receptor polymorphism genotype.

MEASURING JOB SATISFACTION, PERFORMANCE CRITERIA AND JOB LIFE QUALITY: BINGOL CITY BANKING CASE

Job satisfaction, performance and quality of life have strong effects on each other. Happy workers are to perform higher productivity and have less stress in their daily life.Two different studies in 2016 were applied to banks in Bingol city/Turkey to learn the level of job satisfaction,performancecriteria and life quality of workers. 42 surveys were applied to determine job satisfaction and expectations and evaluation ofperformance criteria factors. Second survey were applied 19 workers to learn the life quality of workers. Descriptive statistics (means and frequency methods), t-test and Kruskal Wallis methods are applied to analyze data. The average age of staffs is in young period with 2500-3500 TL(₺) average salary and they have 3-8 years bank experience mainly. High salary and job security are the main expectations of workers. Talking freely and discussing issues with 9.19 mean is found to be the most important item with managers according priority of workers as a part of job satisfaction. The physical working conditions and other opportunitiesoffered by the bank and wages are the worst items with lowest scores. Younger workers thinks that they get more feedback about their work while older people getting not enough feedbacks. About 15.8% of them see themselves in a kind of depression and just 36.8% of them are happy according to second survey.Complying with working hours, well-suited appearance and relationships with managers are most effective factors for performance.

Effectiveness of hypnosis therapy and Gestalt therapy as depression treatments

We analyzed the effectiveness of two psychological therapies to treat depression in the Culiacan population, Mexico. According to criteria of MINI (international Neuropsychiatric interview), 30 individuals from a total of 300 were selected and diagnosed with some kind of depression. Patients were divided in three groups: 1) treatment with hypnosis therapy, 2) treatment with Gestalt-hypnosis therapy, and 3) control group. Before and after the treatments the Beck Anxiety Inventory (BAI) was applied to know the depression level of the analyzed groups. The results show that the three groups were presenting a moderated level of depression. The groups under hypnosis therapy and Gestalt-hypnosis therapy show statistical differences between pre-test and post-test. The hypnosis therapy shows significant statistic differences to treat depression with respect to the other two groups. In conclusion, the therapeutic hypnosis is an effective treatment and has relevance to treat depression, while other therapeutic treatments tend to be slow and with minor result. This study is the first of this kind carried out in Culiacan in Sinaloa, Mexico.

Relation of depression with health behaviors and social conditions of dependent community-dwelling older persons in the Republic of Chile.

Depressive symptoms are a leading cause of disability and emotional suffering, particularly in old age. However, evidence on depression and old age in developing countries remains largely ignored. The aim of this study was to examine the relation between health behavior and social conditions with depression among dependent community-dwelling older persons in the Republic of Chile. This is a cross-sectional and inferential study, using nationally representative secondary data. Two models used logistic regression on 640 dependent community-dwelling older persons from all over Chile, who personally answered a depression assessment, excluding those taking antidepressants. The geriatric depression scale (GDS-15) was used as outcome. The first model aims at any kind of depression (GDS 5>). The second aims at severe depression (GDS 10>). As exposure, we used the health behavior and social conditions of the older persons. Socio-demographic and physical conditions were used as adjustment. 44.5% of the older persons presented depressive symptoms. Among them, 11% had severe depression. Logistic regression showed that significant detrimental factors for being depressed in both models were visiting the doctor five times or over because of acute diseases, feeling uncomfortable with their living arrangement, and feeling discriminated. On the other hand, every additional day of physical exercise and living alone had a beneficial and detrimental effect only in model one. Analyses on ways to support older persons living alone and the promotion of physical exercise to avoid depression are needed, along with a deeper understanding of the comfort with their living arrangement. Finally, ways to address the discrimination among older persons should be further explored.

Administration of Lactobacillus helveticus NS8 improves behavioral, cognitive, and biochemical aberrations caused by chronic restraint stress

Increasing numbers of studies have suggested that the gut microbiota is involved in the pathophysiology of stress-related disorders. Chronic stress can cause behavioral, cognitive, biochemical, and gut microbiota aberrations. Gut bacteria can communicate with the host through the microbiota–gut–brain axis (which mainly includes the immune, neuroendocrine, and neural pathways) to influence brain and behavior. It is hypothesized that administration of probiotics can improve chronic-stress-induced depression. In order to examine this hypothesis, the chronic restraint stress depression model was established in this study. Adult specific pathogen free (SPF) Sprague–Dawley rats were subjected to 21days of restraint stress followed by behavioral testing (including the sucrose preference test (SPT), elevated-plus maze test, open-field test (OFT), object recognition test (ORT), and object placement test (OPT)) and biochemical analysis. Supplemental Lactobacillus helveticus NS8 was provided every day during stress until the end of experiment, and selective serotonin reuptake inhibitor (SSRI) citalopram (CIT) served as a positive control. Results showed that L. helveticus NS8 improved chronic restraint stress-induced behavioral (anxiety and depression) and cognitive dysfunction, showing an effect similar to and better than that of CIT. L. helveticus NS8 also resulted in lower plasma corticosterone (CORT) and adrenocorticotropic hormone (ACTH) levels, higher plasma interleukin-10 (IL-10) levels, restored hippocampal serotonin (5-HT) and norepinephrine (NE) levels, and more hippocampal brain-derived neurotrophic factor (BDNF) mRNA expression than in chronic stress rats. Taken together, these results indicate an anti-depressant effect of L. helveticus NS8 in rats subjected to chronic restraint stress depression and that this effect could be due to the microbiota–gut–brain axis. They also suggest the therapeutic potential of L. helveticus NS8 in stress-related and possibly other kinds of depression.

A novel method to improve depressants actions on calcite flotation

In this study, the flotation behavior, contact angle and surface adsorption of calcite were investigated in aqueous solution containing excess lattice ions (Ca2+ and CO32-). Flotation results show that adding lattice ions makes three kinds of depressants more effective. The contact angle test suggests that the use of both Ca2+ and CO32- results in a remarkable decrease in calcite surface hydrophobicity with sodium oleate and depressants, while it has little influence on calcite surface hydrophobicity without sodium oleate. Adsorption data indicates calcium carbonate coating on calcite surfaces may change the adsorption mechanism of depressants. The study presented that added lattice ions change reactivity of the calcite surface and improve depressants actions on calcite flotation.

A Calculation of National Wellness

d d W u t ocrates said of medicine, “This ‘medicine’ this philter, which acts as both remedy and poison . . . This charm, this spellbinding virtue, his power of fascination, can be—alterately or simultaneously—beneficent or aleficent.” The clear implication is that it is not the medication but the choice of how and when to use it, and the social context that leads to its use, that should be considered. But it is not the pharmacology per se upon which I wish to focus. Instead, consider: the usage of antidepressant drugs gives us a read out, as clear as any instrument measuring a patient, and it tells us something important about our national wellness. PsychCentral, the Internet’s largest and oldest fact-based mental health network, defines major depression as, “the kind of depression that will most likely benefit from treatment with medications, (that) is more than just ‘the blues.’ It is a condition that lasts 2 weeks or longer, and interferes with a person’s ability to carry on daily tasks and enjoy activities that previously brought pleasure. Depression is associated with abnormal functioning of the brain. An interaction between genetic tendency and life history appears to determine a person’s chance of becoming depressed. Episodes of depression may be triggered by stress, difficult life events, side effects of medications, or medication/substance withdrawal, or even viral infections that can affect the brain.” They should have

Jane Eyre fait de la résistance

“Speak I must; I had been trodden on severely and must turn”. It is with these unspoken but no less eloquent words that Jane starts attacking her baffled aunt, who is not used to being addressed in this way by one who is usually obedient and silent. The scene, which follows the incarceration in the red room and Brocklehurst’s visit, can be read as a "Vindication of the rights of Jane” and also as both a metamorphosis and a reversal: Jane is out of herself and rebels against the enemy who gradually turns into a powerless child, ready to cry, unable to recognize this new Jane whom she vainly tries to propitiate. If Jane comes out victorious from this verbal confrontation, her triumph has a bitter after-taste and her previous exaltation is followed by a kind of depression, which is often the case with her. I propose to study this emblematic scene firstly by following three axes: a double metamorphosis where Jane defeats Mrs Reed who loses her composure, in a spectacular reversal of roles, and then by analysing Jane’s ensuing inner monologue, where the narrator’s I takes over from the character’s in this splitting of the narrative voice that is common to both novelistic and fictitious autobiographical forms.

Bipolarity and inadequate response to antidepressant drugs: Clinical and psychopharmacological perspective

The reason why depression may respond poorly to treatment with antidepressant drugs may be connected with the features of bipolarity. Evidence to this effect has accumulated in recent studies of various kinds of depression in mood disorders. Additional evidence for such a connection may be the efficacy of mood-stabilizing drugs in the augmentation of antidepressants in treatment-resistant depression. This review is based on clinical and psychopharmacological research performed over the past five years. The clinical investigation was based on the response to antidepressants of bipolar depression or to symptoms of hypomania, assessed mainly by the Mood Disorder Questionnaire (MDQ) and the Hypomania Checklist-32 (HCL-32). The psychopharmacological research tested the efficacy of augmentation of antidepressants in treatment-resistant depression by mood-stabilizing drugs of the 1st and 2nd generations. A number of studies have pointed to an association between bipolar depression, or symptoms of hypomania and an inadequate response to antidepressants. Such a connection was also found in the Polish TRES-DEP study which included 1051 depressed patients. Pharmacological studies have demonstrated the efficacy of first generation mood-stabilizing drugs (lithium, carbamazepine) and second generation drugs (quetiapine, olanzapine, risperidone, ziprasidone, lamotrigine) for augmentation of antidepressants in treatment-resistant depression. Some evidence has been presented that mixed depressive episodes may also belong to this category. The results of these clinical and psychopharmacological studies appear to confirm an association between bipolarity and a poor response of depression to treatment with antidepressant drugs.

The psychiatrist in the machine [Update

Summary form only given. Psychiatrists make life-altering decisions on the basis of a subjective assessment of a set of symptoms. But many freely admit they have far too little information to answer some critical questions. The paper mentions that software rivals doctors at distinguishing among different kinds of depression and schizophrenia. Psychiatrists want to diagnose patients based on their physiology rather than subjective symptoms. MRI Images of the brain and the electroencephalographic signals that emanate from it could be key to picking the right treatments for depression and schizophrenia.

Study on the polysomnography of the patients with depression

Objective To investigate the variations of polysomnography of the patients with retardative depression and non-retardative depression. Methods Twenty-eight patients with depression without any medicine at least for 1 month and fifteen normal controls were assessed in this study. Based on the scores of retardation of Hamilton Depression Scale( HAMD), the patients were divided into the group of retardative depression and the group of non-retardative depression. Polysomnography was given to all the subjects. Results Compared with the normal controls, the depressive patients both in the retardative depression group and in the non-retardative depression group showed significant differences of lower total sleep time (TST), sleep efficiency (SE), SWS% , rapid eye movement ) sleep time ( RT), REM sleep latency (RL) ( all P ＜ 0. 05 ), and higher sleep latency (SL) , awakening time( AT), awakening number( AN ), the percentage of AT( A/TST% ), the percentage of 1 sleep( S1 % ), the percentage of RT( RT% ), REM activity ( RA), and REM intensity (RI). REM density (RD) in the retardative depression group was significantly higher than both the non-retardative depression group and the control group ( t =2.36, P＜ 0. 05; t = 2.75, P＜ 0. 05 ). Conclusion Abnormalities of PSG in depression are proved, and RD may be relative to retardation. The differences of PSG do not existed between different kinds of depression such as retardative depression and non-retardative depression. Key words: Retardative depression; Non-retardative depression; Polysomnography

Guidelines for youth depression: time to incorporate new perspectives

TO THE EDITOR: I cannot argue with the push by Hickie and McGorry for services for young people from 12 to 25 years of age who suffer from “depression”. But I question their sequencing of treatments model that pervades the beyondblue draft clinical practice guidelines about which they editorialise. Their model presupposes a unitary entity of “major depression” that varies in severity, with milder conditions being treated by psychotherapy and more severe conditions being treated with antidepressant medication. Consider the following case to show how the guidelines get it wrong. A 16-year-old girl presents with her first episode of moderately severe major depression. She is treated as per the guidelines for depression with a selective serotonin reuptake inhibitor (SSRI) and rapidly develops a severe psychotic mania. She is certified to a psychiatric facility and requires a prolonged admission. For the next 2 years she remains chronically hypomanic, refusing to try better treatment. Eventually, following a severe depressive episode, her treatment is reorganised and her condition stabilises. However, the trauma and psychosocial damage from the hospitalisation and prolonged period of illness are significant. In the guidelines, bipolar disorder — arguably the only “biological” kind of depression in this age group — is separated from the body of recommendations for managing depression. The possibility that this episode of depression may be part of an asyet-undeclared bipolar disorder needs to be thoroughly integrated into the understanding and management of “depression”. Features that would suggest possible bipolar disorder include psychomotor retardation and cognitive impairment, psychosis, reverse neurovegetative features (hypersomnia or hyperphagia), a few manic symptoms mixed with depression (racing thoughts, distractibility, flight of ideas, increased energy or psychomotor agitation), or the depression not making sense psychologically. Past episodes of depression, brief hypomania, anti-depressant-induced hypomania, or a family history of bipolar disorder also need to be documented. Doctors should then routinely discuss with patients and families the possibility that bipolar disorder could be diagnosed, and warn that the patient may experience a manic switch. If the likelihood is high, as part of a proper process of informed consent, the patient should be offered concurrent lithium or antipsychotic medication. The patient and family can be assured that expert clinical observation over time will clarify the diagnosis and what treatment is appropriate. This approach not only involves the patient and family in decision making, giving knowledge and choices, but, importantly, incorporates the reality of diagnostic uncertainty.

Guidelines for youth depression: time to incorporate new perspectives

TO THE EDITOR: I cannot argue with the push by Hickie and McGorry for services for young people from 12 to 25 years of age who suffer from “depression”. But I question their sequencing of treatments model that pervades the beyondblue draft clinical practice guidelines about which they editorialise. Their model presupposes a unitary entity of “major depression” that varies in severity, with milder conditions being treated by psychotherapy and more severe conditions being treated with antidepressant medication. Consider the following case to show how the guidelines get it wrong. A 16-year-old girl presents with her first episode of moderately severe major depression. She is treated as per the guidelines for depression with a selective serotonin reuptake inhibitor (SSRI) and rapidly develops a severe psychotic mania. She is certified to a psychiatric facility and requires a prolonged admission. For the next 2 years she remains chronically hypomanic, refusing to try better treatment. Eventually, following a severe depressive episode, her treatment is reorganised and her condition stabilises. However, the trauma and psychosocial damage from the hospitalisation and prolonged period of illness are significant. In the guidelines, bipolar disorder — arguably the only “biological” kind of depression in this age group — is separated from the body of recommendations for managing depression. The possibility that this episode of depression may be part of an asyet-undeclared bipolar disorder needs to be thoroughly integrated into the understanding and management of “depression”. Features that would suggest possible bipolar disorder include psychomotor retardation and cognitive impairment, psychosis, reverse neurovegetative features (hypersomnia or hyperphagia), a few manic symptoms mixed with depression (racing thoughts, distractibility, flight of ideas, increased energy or psychomotor agitation), or the depression not making sense psychologically. Past episodes of depression, brief hypomania, anti-depressant-induced hypomania, or a family history of bipolar disorder also need to be documented. Doctors should then routinely discuss with patients and families the possibility that bipolar disorder could be diagnosed, and warn that the patient may experience a manic switch. If the likelihood is high, as part of a proper process of informed consent, the patient should be offered concurrent lithium or antipsychotic medication. The patient and family can be assured that expert clinical observation over time will clarify the diagnosis and what treatment is appropriate. This approach not only involves the patient and family in decision making, giving knowledge and choices, but, importantly, incorporates the reality of diagnostic uncertainty.