Medical news
of the North Caucasus
Scientific journal
Mass media registration certificate dated December 7, 2006.
Series ПИ #ФС 77-26521.
Federal service for surveillance over non-violation of the legislation in the sphere of mass communications and protection of cultural heritage.
ISSN 2073-8137

Site search

Correspondence address
310 Mira Street, Stavropol, Russia, 355017

+7 8652 352524; +7 8652 353229.

+7 8652 352524.


Hypomanic states in adolescent patients with anorexia nervosa

Vitaliy Grachev; Yury Shevchenko; Vladimir Malygin; Yury Antropov; Vadim Zaycev;

Last decades considerable attention is paid to the comorbidity of anorexia nervosa (AN) and affective pathology, with the vast majority of studies devoted to the different aspects of depressive states, while the maniacal affect is rarely the focus of the authors. The objective of this study was to clarify clinical manifestations of manic/hypomanic states and to analyze their influence on the clinical picture and dynamics of adolescent AN. The study included 62 girls aged 13–17 years who met the criteria for a typical AN on ICD-10 (F50.0), who had hypomanic states at various stages of the illness. The study demonstrated a significant prevalence of hypomania in adolescents with typical AN. Maniacal states were not observed in any case. Hypomanias appeared in the form of a core comorbid disorder, manifested by repeated episodes throughout the course of the disease, and in the period of remission often acquired the character of chronic hypomania, forming stable «hypomaniacal» remissions of AN. The study showed that comorbid hypomanic states in the period of remission of AN are a significant factor in stability of remission and the favorable outcome of the disease.


1. Suleimanov R. A., Artemyeva M. S. Comorbidity of depression and anorexia nervosa. Zh. Nevrol. Psikhiatr. im. S. S. Korsakova. – Journal of Neurology and Psychiatry named after S. S. Korsakov. 2007;107(4):73-77. (In Russ.).
2. Siegel D. M. Bulimia, tricyclic antidepressants, and mania. Clin. Pediatr. (Phila). 1989;28(3):123-126. https://doi.org/10.1177/000992288902800303
3. Briukhin A. E., Onegina E. Iu. Affective disorders in patients with anorexia nervosa and bulimia. Zh. Nevrol. Psikhiatr. Im. S. S. Korsakova. – Journal of Neurology and Psychiatry named after S. S. Korsakov. 2011;111(1):21-26. (In Russ.).
4. Ozten M., Erol A. Fluoxetine induced hypomanic shift in a bulimic patient: case report. Bulletin of Clinical Psychopharmacology. 2013;23(2):183-185. https://doi.org/10.5455/bcp.20130112010027
5. Cabetas Hernández I. Malnutrition in anorexia nervosa: psychosomatic approach and multidisciplinary treatment. Nutr. Hosp. 2004;19(4):225-228.
6. Nozaki T., Motoyama S., Arimura T., Morita C., Koreeda-Arimura C. [et al.]. Psychopathological features of anorectic patients who dropped out of inpatient treatment as assessed by the Minnesota multiphasic personality inventory. Biopsychosoc. Med. 2007;1(15):1-5. https://doi.org/10.1186/1751-0759-1-15
7. Hirschfeld R. M. Differential diagnosis of bipolar disorder and major depressive disorder. J. Affect. Disord. 2014;169(Suppl1):12-16. https://doi.org/10.1016/S0165-0327(14)70004-7
8. Perugi G., Fornaro M., Akiskal H. S. Are atypical depression, borderline personality disorder and bipolar II disorder overlapping manifestations of a common cyclothymic diathesis? World Psychiatry. 2011;10(1):45-51.
9. Yerevanian B. I., Koek R. J., Mintz J., Akiskal H. S. Bipolar pharmacotherapy and suicidal behavior Part 2. The impact of antidepressants. J. Affect. Disord. 2007;103(1-3):13-21. https://doi.org/10.1016/j.jad.2007.05.017
10. Garner D. M. The Eating Disorder Inventory-3 Professional Manual. Odessa FL: Psychological Assessment Resources Inc; 2004.
11. Gajdyshev I. P. AtteStat data analysis software. User guide. Version 13. Moscow; 2012. (In Russ.). Available at: http://биостатистика.рф/files/13.pdf. Accessed September 21, 2018. (In Russ.).
12. Shevchenko Yu. S., Bazdyrev E. I. Nature and manifestations of psychopathological diathesis (evolutionary-biological view). In: Shevchenko Yu. S., eds. Child and adolescent psychiatry. Clinical lectures for professionals. 2nd ed. Moscow: «Medicinskoe informacionnoe agentstvo»; 2011:34-59. (In Russ.).
13. Akiskal H. S., Mallaya G. Criteria for the «soft» bipolar spectrum: treatment implications. Psychopharmacology Bulletin. 1987;23(3):68-73.
14. Vazquez G. H., Gonda X. Affective temperaments and mood disorders: a review of current knowledge. Current Psychiatry Reviews. 2013;9(1):21-32. https://doi.org/10.2174/1573400511309010004
15. Smulevich A. B., Rotshtejn V. G. Psychogenic diseases. Moscow; 2001. (In Russ.).
16. Belokrylov I. V. Psychogenic manias (A clinico-catamnestic study). Zh. Nevrol. Psikhiatr. im. S. S. Korsakova. – Journal of Neurology and Psychiatry named after S. S. Korsakov. 1996;96(1):53-57. (In Russ.).
17. Grachev V. V. Depressive states at the stage of broad clinical presentations of anorexia nervosa in adolescents. Zh. Nevrol. Psikhiatr. im. S. S. Korsakova. – Journal of Neurology and Psychiatry named after S. S. Korsakov. 2014;114(9):9-15. (In Russ.).
18. Wildes J. E., Marsha D. M., Fagiolini A. Prevalence and correlates of eating disorder co-morbidity in patients with bipolar disorder. Psychiatry Res. 2008;161(1):51-58. https://doi.org/10.1016/j.psychres.2007.09.003
19. Bobrov A. E. Psychopathological aspects of anorexia nervosa. Al’manah klinicheskoj mediciny. – Almanac of Clinical Medicine. 2015;1(1):13-23. (In Russ.).
20. Kaye W. H. Neurobiology of anorexia and bulimia nervosa. Physiol. Behav. 2008;94(1):121-135. https://doi.org/10.1016/j.physbeh.2007.11.037
21. Mattar L., Thiébaud M. R., Huas C., Cebula C., Godart N. Depression, anxiety and obsessive-compulsive symptoms in relation to nutritional status and outcome in severe anorexia nervosa. Psychiatry Res. 2012;200(2-3):513-517. https://doi.org/10.1016/j.psychres.2012.04.032
22. Zandian M., Ioakimidis I., Bergh C., Södersten P. Cause and treatment of anorexia nervosa. Physiol. Behav. 2007;91(1-2):283-290. https://doi.org/10.1016/j.physbeh.2007.05.052

Keywords: anorexia nervosa, hypomania, affective bipolar disorder, thymopathic diathesis, affective temperament

Stavropol State Medical Academy
Pyatigorsk State Research Institute of Balneotherapeutics
Pyatigorsk State Pharmaceutical Academy