Smith Daniel J, Muir Walter J, Blackwood Douglas H R
Division of Psychiatry, School of Molecular and Clinical Medicine, University of Edinburgh, Royal Edinburgh Hospital, Morningside Park, Edinburgh EH10 5HF, UK.
J Affect Disord. 2005 Jul;87(1):17-23. doi: 10.1016/j.jad.2005.02.019.
In young adults it can be difficult to differentiate between an early bipolar illness and borderline personality disorder. There are considerable areas of clinical overlap between cyclothymic temperament, bipolar-spectrum disorders and borderline characteristics. The aim of this study was to measure borderline characteristics in young adults during an index depressive episode and to compare three diagnostic groups: DSM-IV bipolar affective disorder (BPAD); bipolar spectrum disorder (BSD); and DSM-IV recurrent major depressive disorder (MDD).
Eighty-seven young adults with a current episode of major depression and at least one previous episode of depression were recruited from consecutive referrals to a psychiatric clinic. Diagnoses were based on the Structured Clinical Interview for DSM-IV (SCID-1) and recently proposed structured diagnostic criteria for BSD. All patients also completed the borderline questions from the screening questionnaire of the International Personality Disorders Examination (IPDE).
Diagnostically, the cohort of 87 patients divided into three groups: 14 with BPAD; 27 with BSD; and 46 with MDD. None of the subjects fulfilled DSM-IV or ICD-10 diagnostic criteria for personality disorder and all three groups were well matched in terms of age, gender distribution, ethnicity, socioeconomic and educational status, age at onset of illness, and severity of index depressive episode. Both of the bipolar-depressed groups reported significantly higher median levels of borderline characteristics than the MDD group (p<0.0001). Three of the borderline characteristics emerged as potentially useful in differentiating bipolar depression from unipolar depression: 'I've never threatened suicide or injured myself on purpose' (sensitivity=0.93; positive predictive value [PPV]=56.7); 'I have tantrums or angry outbursts' (sensitivity 0.66; PPV=65.6%); and 'Giving in to some of my urges gets me into trouble' (sensitivity=0.76; PPV=59.6%).
All of the subjects were recruited from a university health service clinic and as such are unlikely to be representative of patients from more diverse socio-economic backgrounds. No structured diagnostic assessment of personality disorder was administered. The diagnostic criteria for BSD are not yet fully validated.
Young adults with bipolar depression exhibit significantly higher levels of borderline personality pathology than those with unipolar depression. Those borderline screening questions that reflect cyclothymic characteristics or depressive mixed states may be of practical use to clinicians in helping to differentiate between bipolar depression and unipolar depression in young adults.
在年轻成年人中，早期双相情感障碍与边缘型人格障碍可能难以区分。环性心境气质、双相谱系障碍和边缘型特征在临床上有相当大的重叠区域。本研究的目的是测量年轻成年人在首次抑郁发作期间的边缘型特征，并比较三个诊断组：《精神疾病诊断与统计手册》第四版（DSM-IV）双相情感障碍（BPAD）；双相谱系障碍（BSD）；以及DSM-IV复发性重度抑郁症（MDD）。
从连续转诊至精神科诊所的患者中招募了87名患有当前重度抑郁发作且至少有过一次抑郁发作史的年轻成年人。诊断基于DSM-IV的结构化临床访谈（SCID-1）以及最近提出的BSD结构化诊断标准。所有患者还完成了国际人格障碍检查筛查问卷（IPDE）中的边缘型问题。
在诊断上，87名患者的队列分为三组：14名患有BPAD；27名患有BSD；46名患有MDD。没有受试者符合DSM-IV或ICD-10人格障碍诊断标准，并且所有三组在年龄、性别分布族裔、社会经济和教育状况、发病年龄以及首次抑郁发作的严重程度方面匹配良好。两个双相抑郁组报告的边缘型特征中位数水平均显著高于MDD组（p<0.0001）。有三个边缘型特征在区分双相抑郁和单相抑郁方面可能有用：“我从未故意威胁自杀或伤害自己”（敏感性=0.93；阳性预测值[PPV]=56.7）；“我会发脾气或愤怒爆发”（敏感性0.66；PPV=65.6%）；以及“屈服于某些冲动会给我带来麻烦”（敏感性=0.76；PPV=59.6%）。
所有受试者均从大学健康服务诊所招募，因此不太可能代表来自更多样化社会经济背景的患者。未进行人格障碍的结构化诊断评估。BSD的诊断标准尚未完全验证。
双相抑郁的年轻成年人表现出比单相抑郁的年轻成年人显著更高水平的边缘型人格病理学特征。那些反映环性心境特征或抑郁混合状态的边缘型筛查问题可能对临床医生在帮助区分年轻成年人的双相抑郁和单相抑郁方面具有实际用途。
