Akiskal Hagop S, Akiskal K, Allilaire J-F, Azorin J-M, Bourgeois M L, Sechter D, Fraud J-P, Chatenêt-Duchêne L, Lancrenon S, Perugi G, Hantouche E G
International Mood Center, VA Psychiatry Service, VA Hospital, University of California at San Diego, 3350 La Jolla Village Dr. (116-A), San Diego, CA 92161, USA.
J Affect Disord. 2005 Mar;85(1-2):29-36. doi: 10.1016/j.jad.2003.12.009.
One of the major objectives of the French National EPIDEP Study was to show the feasibility of systematic assessment of bipolar II (BP-II) disorder and beyond. In this report we focus on the utility of the affective temperament scales (ATS) in delineating this spectrum in its clinical as well as socially desirable expressions.
Forty-two psychiatrists working in 15 sites in four regions of France made semi-structured diagnoses based on DSM IV criteria in a sample of 452 consecutive major depressive episode (MDE) patients (from which bipolar I had been removed). At least 1 month after entry into the study (when the acute depressive phase had abated), they assessed affective temperaments by using a French version of the precursor of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS). Principal component analyses (PCA) were conducted on hyperthymic (HYP-T), depressive (DEP-T) and cyclothymic (CYC-T) temperament subscales as assessed by clinicians, and on a self-rated cyclothymic temperament (CYC-TSR). Scores on each of the temperament subscales were compared in unipolar (UP) major depressive disorder versus BP-II patients, and in the entire sample subdivided on the basis of family history of bipolarity.
PCAs showed the presence of a global major factor for each clinician-rated subscale with respective eigenvalues of the correlation matrices as follows: 7.1 for HYP-T, 6.0 for DEP-T, and 4.7 for CYC-T. Likewise, on the self-rated CYC-TSR, the PCA revealed one global factor (with an eigenvalue of 6.6). Each of these factors represented a melange of both affect-laden and adaptive traits. The scores obtained on clinician and self-ratings of CYC-T were highly correlated (r=0.71). The scores of HYP-T and CYC-T were significantly higher in the BP-II group, and DEP-T in the UP group (P<0.001). Finally, CYC-T scores were significantly higher in patients with a family history of bipolarity.
These data uphold the validity of the affective temperaments under investigation in terms of face, construct, clinical and family history validity. Despite uniformity of depressive severity at entry into the EPIDEP study, significant differences on ATS assessment were observed between UP and BP-II patients in this large national cohort. Self-rating of cyclothymia proved reliable. Adding the affective temperaments-in particular, the cyclothymic-to conventional assessment methods of depression, a more enriched portrait of mood disorders emerges. More provocatively, our data reveal socially positive traits in clinically recovering patients with mood disorders.
法国国家EPIDEP研究的主要目标之一是证明对双相II型（BP-II）障碍及其他情况进行系统评估的可行性。在本报告中，我们重点关注情感气质量表（ATS）在描述该谱系的临床及社会期望表现方面的效用。
在法国四个地区15个地点工作的42名精神科医生，根据DSM-IV标准，对452例连续的重度抑郁发作（MDE）患者（已排除双相I型）样本进行半结构化诊断。在进入研究至少1个月后（急性抑郁期消退时），他们使用孟菲斯、比萨、巴黎和圣地亚哥气质评估量表（TEMPS）前身的法语版本评估情感气质。对临床医生评估的轻躁狂（HYP-T）、抑郁（DEP-T）和环性心境（CYC-T）气质子量表以及自评环性心境气质（CYC-TSR）进行主成分分析（PCA）。比较单相（UP）重度抑郁症患者与BP-II患者以及根据双相情感障碍家族史细分的整个样本中各气质子量表的得分。
主成分分析显示，每个临床医生评定的子量表都存在一个总体主要因素，相关矩阵的特征值如下：HYP-T为7.1，DEP-T为6.0，CYC-T为4.7。同样，在自评CYC-TSR上，主成分分析揭示了一个总体因素（特征值为6.6）。这些因素中的每一个都代表了充满情感和适应性特征的混合体。临床医生评定和自评的CYC-T得分高度相关（r = 0.71）。BP-II组的HYP-T和CYC-T得分显著高于UP组，而DEP-T得分则相反（P < 0.001）。最后，有双相情感障碍家族史的患者CYC-T得分显著更高。
这些数据在表面效度、结构效度、临床效度和家族史效度方面支持了所研究的情感气质的有效性。尽管EPIDEP研究入组时抑郁严重程度一致，但在这个大型国家队列中，UP和BP-II患者在ATS评估上存在显著差异。环性心境自评被证明是可靠的。将情感气质——尤其是环性心境气质——添加到传统的抑郁症评估方法中，可以更全面地描绘情绪障碍。更具启发性的是，我们的数据揭示了临床康复的情绪障碍患者具有社会积极特征。
