Benazzi F
Via Pozzetto 17, 48010 Castiglione di Cervia RA, Italy.
Eur Arch Psychiatry Clin Neurosci. 2003 Aug;253(4):203-8. doi: 10.1007/s00406-003-0433-6.
Mood disorders included into the bipolar spectrum are increasing, and overactivity (increased goal-directed activity) has reached the status of mood change for the diagnosis of hypomania in the recent studies by Angst and Akiskal.
was to find frequency of bipolar spectrum in remitted depressed outpatients by including sub-syndromal hypomania.
111 depression-remitted outpatients were interviewed for history of hypomania and hypomanic symptoms with the Structured Clinical Interview for DSM-IV-Clinician Version (a partly semistructured interview), as modified by Benazzi and Akiskal. Bipolar I patients were not included. All past hypomanic symptoms (especially overactivity) were systematically assessed. Wording of the questions could be changed to increase/check understanding. Subsyndromal hypomania was defined as an episode of overactivity (increased goal-directed activity) plus at least 2 hypomanic symptoms.
Frequency of bipolar II (BPII) was 68/111 (61.2%, 95% confidence interval 52% to 69.8 %), frequency of major depressive disorder (MDD) was 43/111. The most common hypomanic symptom was overactivity. In the MDD sample, sub-syndromal hypomania was present in 39.5% (15.3% of the entire sample), and had 4 median symptoms. Bipolar spectrum frequency was 76.5% (95% confidence interval 67.9% to 83.5 %). Overactivity had higher sensitivity than elevated mood for predicting BPII diagnosis.
Single interviewer.
By systematic probing more focused on past overactivity than mood change, and by inclusion of sub-syndromal hypomania, bipolar spectrum frequency was higher than the near 1 to 1 ratio versus MDD reported up to now (Angst et al.). Given the wide confidence interval, the value in the depression population should be around 70%. Better probing skills by clinicians, and use of semi-structured interviews could much reduce the current high underdiagnosis of BPII and related disorders in usual clinical practice.
双相谱系中的心境障碍正在增加，在安格斯特和阿基斯卡尔最近的研究中，过度活动（目标导向活动增加）已达到作为轻躁狂诊断中情绪变化的地位。
通过纳入亚综合征性轻躁狂来确定缓解期抑郁门诊患者中双相谱系的频率。
采用经贝纳齐和阿基斯卡尔修改的《精神疾病诊断与统计手册》第四版临床医师版本结构化临床访谈（部分半结构化访谈），对111名缓解期抑郁门诊患者进行轻躁狂病史和轻躁狂症状访谈。不包括双相I型患者。对所有既往轻躁狂症状（尤其是过度活动）进行系统评估。问题措辞可更改以增进/检查理解。亚综合征性轻躁狂定义为一次过度活动发作（目标导向活动增加）加至少2种轻躁狂症状。
双相II型（BPII）的频率为68/111（61.2%，95%置信区间52%至69.8%），重度抑郁症（MDD）的频率为43/111。最常见的轻躁狂症状是过度活动。在MDD样本中，亚综合征性轻躁狂的发生率为39.5%（占整个样本的15.3%），且有4个中位症状。双相谱系频率为76.5%（95%置信区间67.9%至83.5%）。在预测BPII诊断方面，过度活动比情绪高涨具有更高的敏感性。
由单一访谈者进行访谈。
通过更系统地探究过去的过度活动而非情绪变化，并纳入亚综合征性轻躁狂，双相谱系频率高于目前报道的与MDD接近1比1的比例（安格斯特等人）。鉴于较宽的置信区间，在抑郁人群中的比例应约为70%。临床医生更好的探究技巧以及使用半结构化访谈可大大减少目前在常规临床实践中BPII及相关障碍的高漏诊率。
