Ghaemi S N, Boiman E E, Goodwin F K
Cambridge Hospital, Department of Psychiatry, Harvard Medical School, Mass, USA.
J Clin Psychiatry. 2000 Oct;61(10):804-8; quiz 809. doi: 10.4088/jcp.v61n1013.
To determine if bipolar disorder is accurately diagnosed in clinical practice and to assess the effects of antidepressants on the course of bipolar illness.
Charts of outpatients with affective disorder diagnoses seen in an outpatient clinic during 1 year (N = 85 with bipolar or unipolar disorders) were reviewed. Past diagnostic and treatment information was obtained by patient report and systematic psychiatric history. Bipolar diagnosis was based on DSM-IV criteria using a SCID-based interview.
Bipolar disorder was found to be misdiagnosed as unipolar depression in 37% of patients who first see a mental health professional after their first manic/hypomanic episode. Antidepressants were used earlier and more frequently than mood stabilizers, and 23% of this unselected sample experienced a new or worsening rapid-cycling course attributable to antidepressant use.
These results suggest that bipolar disorder tends be misdiagnosed as unipolar major depressive disorder and that antidepressants seem to be associated with a worsened course of bipolar illness. However, this naturalistic trial was uncontrolled, and more controlled research is required to confirm or refute these findings.
确定双相情感障碍在临床实践中是否得到准确诊断，并评估抗抑郁药对双相情感障碍病程的影响。
回顾了在一年期间门诊所见的情感障碍诊断门诊患者的病历（双相或单相障碍患者共85例）。通过患者报告和系统的精神病史获取既往诊断和治疗信息。双相诊断基于DSM-IV标准，采用基于SCID的访谈。
在首次出现躁狂/轻躁狂发作后首次就诊于心理健康专业人员的患者中，37%的双相情感障碍被误诊为单相抑郁。抗抑郁药的使用比心境稳定剂更早且更频繁，在这个未经过筛选的样本中，23%的患者因使用抗抑郁药而出现新的或恶化的快速循环病程。
这些结果表明，双相情感障碍往往被误诊为单相重度抑郁症，且抗抑郁药似乎与双相情感障碍病程恶化有关。然而，这项自然观察性试验未设对照，需要更多对照研究来证实或反驳这些发现。
