Perlis Roy H, Brown Eileen, Baker Robert W, Nierenberg Andrew A
Massachusetts General Hospital, ACC 812, 15 Parkman Street, Boston, MA 02114, USA.
Am J Psychiatry. 2006 Feb;163(2):225-31. doi: 10.1176/appi.ajp.163.2.225.
Failure to recognize bipolar disorder in patients who experience a major depressive episode may lead to inappropriate treatment and poorer outcomes. Clinical features that could distinguish bipolar from unipolar depression would facilitate more appropriate treatment selection.
The authors used data from nonpsychotic outpatients participating in three large multicenter clinical trials conducted in the United States for the treatment of major depressive episodes to compare 477 subjects with a diagnosis of bipolar disorder and 1,074 with major depressive disorder.
Bipolar depression was associated with family history of bipolar disorder, an earlier age at onset, a greater previous number of depressive episodes, and eight individual symptom items on the Montgomery-Asberg Depression Rating Scale and the Hamilton Anxiety Rating Scale. Fears were more common in patients with bipolar disorder, whereas sadness; insomnia; intellectual (cognitive), somatic (muscular), respiratory, genitourinary complaints; and depressed behavior were more common in patients with unipolar depression. A logistic regression model correctly classified 86.9% of the subjects.
Bipolar depression and major depressive disorder exhibit subtle differences in presentation, which may help guide the initial diagnosis.
在经历重度抑郁发作的患者中，未能识别双相情感障碍可能导致治疗不当及预后较差。能够区分双相情感障碍与单相抑郁症的临床特征将有助于做出更合适的治疗选择。
作者使用了参与在美国进行的三项大型多中心临床试验以治疗重度抑郁发作的非精神病门诊患者的数据，比较了477名诊断为双相情感障碍的受试者和1074名患有重度抑郁症的受试者。
双相抑郁症与双相情感障碍家族史、发病年龄较早、既往抑郁发作次数较多以及蒙哥马利-阿斯伯格抑郁评定量表和汉密尔顿焦虑评定量表上的八项个体症状项目相关。恐惧在双相情感障碍患者中更为常见，而悲伤、失眠、智力（认知）、躯体（肌肉）、呼吸、泌尿生殖系统主诉以及抑郁行为在单相抑郁症患者中更为常见。一个逻辑回归模型正确分类了86.9%的受试者。
双相抑郁症和重度抑郁症在表现上存在细微差异，这可能有助于指导初始诊断。
