Manning J S, Haykal R F, Akiskal H S
Department of Family Medicine, University of Tennessee, Memphis, USA.
Psychiatr Clin North Am. 1999 Sep;22(3):689-703, x. doi: 10.1016/s0193-953x(05)70103-9.
The literature suggests that bipolar spectrum disorders are more prevalent than previously thought but still poorly recognized. In the primary care setting, this poor recognition is largely the result of an insensitive, cross-sectional approach and clinicians' lack of familiarity with the phenomenology of bipolar II. Failure to recognize the role of bipolarity in depressive illness is more often a cause of the poor outcome of this illness in this setting than under dosing with antidepressants. Hypomania is easily missed in clinical evaluations and, as currently defined by DSM-IV, may not represent the most diagnostic marker for all variants of bipolar illness: Mood lability and energetic activity, temperamental traits embodied in the construct of cyclothymia, have emerged as more specific. Given emerging data that as much as one third of depressions in both psychiatric and primary care settings belong to the soft bipolar spectrum, practitioner education on the necessity to consider course, temperament, and family history in the approach to depression may improve the identification of bipolar spectrum disorders and limit unproductive or potentially harmful antidepressants use unprotected with mood stabilizers.
文献表明，双相谱系障碍比之前认为的更为普遍，但仍未得到充分认识。在初级保健环境中，这种认识不足很大程度上是由于采用了缺乏敏感性的横断面研究方法，以及临床医生对双相II型障碍的现象学缺乏了解。在这种情况下，未能认识到双相性在抑郁症中的作用，比抗抑郁药剂量不足更常导致抑郁症治疗效果不佳。轻躁狂在临床评估中很容易被漏诊，而且按照《精神疾病诊断与统计手册》第四版（DSM-IV）目前的定义，它可能并非所有双相障碍变体的最具诊断性的标志：情绪不稳定和精力充沛的活动，即环性心境障碍概念中所体现的气质特征，已被证明更具特异性。鉴于新出现的数据表明，在精神科和初级保健环境中，多达三分之一的抑郁症属于软双相谱系，对从业者进行教育，使其认识到在处理抑郁症时考虑病程、气质和家族史的必要性，可能会改善双相谱系障碍的识别，并限制在未使用心境稳定剂保护的情况下无成效或可能有害的抗抑郁药的使用。
