Akiskal Hagop S, Benazzi Franco
International Mood Center, University of California, San Diego, USA.
J Clin Psychiatry. 2005 Jul;66(7):914-21. doi: 10.4088/jcp.v66n0715.
We review a clinical diagnostic approach to validate a redefinition of bipolar II disorder (BPII), which bypasses several conservative steps in the DSM-IV Mood Module of the Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV) to make detection of BPII more "clinician-friendly."
563 consecutive private outpatients presenting with a DSM-IV-diagnosed major depressive episode (MDE) were included in the analyses. We used a modified SCID-CV in a semistructured way, used a duration of hypomania > or =2 days (rather than the 4-day floor cutoff recommended), did not follow the SCID-CV's stem (mood) skip-out instruction, focused more on past history of overactive behavior rather than mood change, and assessed hypomanic features both outside and during index MDE. Validation of BPII so-defined against major depressive disorder (MDD) was undertaken in the Washington University tradition. The study was conducted from June 1999 to December 2003.
BPII occurred in 56.8% of patients. Compared with MDD, BPII had a significantly earlier index age and age at onset of first MDE and higher rates of atypical features, depressive recurrences, hypomanic symptoms during MDE, trait mood lability, and bipolar family history (p = .0000 for all variables).
Our experience suggests that when probing history for past hypomanic episodes, behavioral activation should be inquired first, thereby facilitating the patient's subsequent recall of euphoria and/or irritability during such activated periods. Information from significant others or past records is also crucial. In light of these clinical procedures, BPII emerged as more prevalent than MDD. We submit that clinicians have the distinct advantage of intimate knowledge of their patients, which, coupled with the procedures outlined herein, can maximize the yield of BPII diagnoses.
我们回顾了一种临床诊断方法，以验证双相II型障碍（BPII）的重新定义，该定义绕过了《精神疾病诊断与统计手册》第四版（DSM-IV）轴I障碍临床定式检查问卷（SCID-CV）中DSM-IV心境模块的几个保守步骤，以使BPII的检测对临床医生更“友好”。
分析纳入了563例连续的DSM-IV诊断为重度抑郁发作（MDE）的私立门诊患者。我们以半结构化方式使用了改良的SCID-CV，将轻躁狂发作持续时间设定为≥2天（而非建议的4天下限），未遵循SCID-CV的起始（心境）跳过指令，更多地关注过去过度活跃行为的病史而非心境变化，并在本次MDE期间及之外评估轻躁狂特征。按照华盛顿大学的传统方法，对如此定义的BPII与重度抑郁症（MDD）进行了验证。该研究于1999年6月至2003年12月进行。
56.8%的患者患有BPII。与MDD相比，BPII的首次MDE索引年龄和发病年龄显著更早，非典型特征、抑郁复发、MDE期间的轻躁狂症状、特质性心境不稳定以及双相家族史的发生率更高（所有变量p值均为0.0000）。
我们的经验表明，在探究过去轻躁狂发作的病史时，应首先询问行为激活情况，从而便于患者随后回忆起在此类激活期间的欣快和/或易怒情绪。来自重要他人或既往记录的信息也至关重要。鉴于这些临床程序，BPII比MDD更为普遍。我们认为临床医生具有了解患者的独特优势，结合本文所述的程序，可以最大限度地提高BPII诊断的检出率。
