Matza Louis S, Revicki Dennis A, Davidson Jonathan R, Stewart Jonathan W
MEDTAP International, Inc, Bethesda, MD 20814, USA.
Arch Gen Psychiatry. 2003 Aug;60(8):817-26. doi: 10.1001/archpsyc.60.8.817.
Atypical depression has been found to be distinct from other types of depression in terms of psychiatric symptom profile and treatment response. However, debate continues regarding its specific characteristics, impact, and diagnostic criteria. The current study was conducted to increase understanding of atypical depression diagnosed using only the reversed vegetative symptoms of hypersomnia and hyperphagia.
An atypical depression group (n = 304 [36.4% of the depressed sample; 39.0% when weighted to approximate the national population]) was identified within the US National Comorbidity Survey, which assessed psychiatric disorders among a nationally representative sample using the Composite International Diagnostic Interview. The atypical group was identified based on DSM-III-R criteria for a major depressive episode, in addition to atypical features of hypersomnia and hyperphagia. Comparison groups were those with nonatypical depression (n = 532) and individuals without a psychiatric disorder (n = 4071).
Compared with nonatypical depression, atypical depression was associated with a greater percentage of women and an earlier age of onset. The atypical group also reported higher rates of most depressive symptoms, suicidal thoughts and attempts, psychiatric comorbidity (panic disorder, social phobia, and drug dependence), disability and restricted activity days, use of some health care services, paternal depression, and childhood neglect and sexual abuse (P<.05). Compared with people without psychiatric disorders, the atypical group reported higher rates of disability and restricted activity days, use of all mental health care services, parental depression, and childhood abuse (P<.001).
This analysis of a nationally representative US sample suggests that overeating and oversleeping can be used to identify an atypical depression subgroup that is distinct from other depressed patients in terms of demographics, psychiatric comorbidities, and abuse history. Findings also suggest that atypical depression is associated with increased distress, suicidal ideation, and disability compared with nonatypical depression.
非典型抑郁症在精神症状特征和治疗反应方面已被发现与其他类型的抑郁症不同。然而，关于其具体特征、影响和诊断标准的争论仍在继续。当前的研究旨在增进对仅使用嗜睡和贪食这两种反向植物神经症状诊断出的非典型抑郁症的理解。
在美国国家共病调查中确定了一个非典型抑郁症组（n = 304 [占抑郁症样本的36.4%；加权后约占全国人口的39.0%]），该调查使用复合国际诊断访谈评估了全国代表性样本中的精神障碍。除了嗜睡和贪食的非典型特征外，非典型组是根据DSM-III-R中重度抑郁发作的标准确定的。比较组为非非典型抑郁症患者（n = 532）和无精神障碍个体（n = 4071）。
与非非典型抑郁症相比，非典型抑郁症女性比例更高，发病年龄更早。非典型组还报告了大多数抑郁症状、自杀念头和企图、精神共病（惊恐障碍、社交恐惧症和药物依赖）、残疾和活动受限天数、某些医疗服务的使用、父亲患抑郁症以及童年期忽视和性虐待的发生率更高（P<0.05）。与无精神障碍的人相比，非典型组报告的残疾和活动受限天数、所有心理健康服务的使用、父母患抑郁症以及童年期虐待的发生率更高（P<0.001）。
对美国全国代表性样本的这项分析表明，暴饮暴食和睡眠过多可用于识别一个非典型抑郁症亚组，该亚组在人口统计学、精神共病和虐待史方面与其他抑郁症患者不同。研究结果还表明，与非非典型抑郁症相比，非典型抑郁症与更高的痛苦、自杀意念和残疾相关。
