Balázs Judit, Benazzi Franco, Rihmer Zoltán, Rihmer Annamária, Akiskal K K, Akiskal H S
Vadaskert Child Psychiatric Hospital and Outpatient Clinic, Budapest, Hungary.
J Affect Disord. 2006 Apr;91(2-3):133-8. doi: 10.1016/j.jad.2005.12.049. Epub 2006 Feb 3.
Previous reports have shown a significant relationship between suicide ideation and mixed depression. The aim of this study was to explore the prevalence and clinical characteristics of mixed depression among non-violent suicide attempters.
Using a structured interview (modified Mini International Neuropsychiatric Interview) and assessing all the symptoms of 16 psychiatric diagnoses, the authors examined 100 consecutive nonviolent suicide attempters (aged 18-65) within 24 h after their attempts. Mixed depression was defined as a major depressive episode (MDE)/dysthymic disorder plus 3 or more co-occurring hypomanic symptoms, according to the definition validated by Akiskal and Benazzi [Akiskal, H.S., Benazzi, F., 2003a. Delineating depressive mixed states: Their therapeutic significance. Clin. Approaches Bipolar Disord. 2, 41-47, Akiskal, H.S., Benazzi, F., 2003b. Family history validation of the bipolar nature of depressive mixed states. J. Affect. Disord. 73, 113-122.].
Current mixed depression was present in 63.0% in the total sample, and in 70.8% among the 89 depressive suicide attempters. Irritability, distractibility and psychomotor agitation were present in more than 90% of the subjects with mixed depression. The rate of mixed depression was significantly higher among bipolar than non-bipolar depressive suicide attempters (90% vs. 62%). Patients with mixed depression had the following concurrent disorders: bipolar disorders 41.0%, panic disorder 30.0%, generalized anxiety disorder 89.0%, alcohol abuse/dependence 56.0%, and substance abuse 27.0%. Mixed depression versus non-mixed depression had the following significant associations (odds ratio=OR): females 2.4, bipolar II disorder 9.3, generalized anxiety disorder 41.3, irritability 101.6 and psychomotor agitation 61.1.
The study didn't include suicide attempters with very high risk of fatality.
The important new finding of this study is the very high prevalence of mixed depression among depressed suicide attempters. The rates of mixed depression among bipolar and non-bipolar depressive suicide attempters were much higher than previously reported among nonsuicidal bipolar II and unipolar depressive outpatients, suggesting that suicide attempters come mainly from mixed depressives with predominantly bipolar II base. Irritability and psychomotor agitation were the strongest predictors of suicide attempt. From a public health standpoint, our data highlight the necessity of detecting and treating mixed (bipolar) depression in the prevention of suicidal behaviour.
既往报告显示自杀观念与混合性抑郁之间存在显著关联。本研究旨在探讨非暴力自杀未遂者中混合性抑郁的患病率及临床特征。
作者采用结构化访谈（改良版迷你国际神经精神访谈）并评估16种精神疾病诊断的所有症状，对100例连续的非暴力自杀未遂者（年龄18 - 65岁）在自杀未遂后24小时内进行检查。根据阿基斯卡尔（Akiskal）和贝纳齐（Benazzi）验证的定义[阿基斯卡尔，H.S.，贝纳齐，F.，2003a。界定抑郁混合状态：它们的治疗意义。《双相情感障碍的临床方法》2，41 - 47；阿基斯卡尔，H.S.，贝纳齐，F.，2003b。抑郁混合状态双相性质的家族史验证。《情感障碍杂志》73，113 - 122。]，混合性抑郁被定义为一次重度抑郁发作（MDE）/恶劣心境障碍加上3种或更多同时出现的轻躁狂症状。
在总样本中，当前混合性抑郁的患病率为63.0%，在89例抑郁自杀未遂者中为70.8%。超过90%的混合性抑郁患者存在易激惹、注意力分散和精神运动性激越。双相抑郁自杀未遂者中混合性抑郁的发生率显著高于非双相抑郁自杀未遂者（90% 对62%）。混合性抑郁患者共患以下疾病：双相情感障碍41.0%、惊恐障碍30.0%、广泛性焦虑障碍89.0%、酒精滥用/依赖56.0%以及物质滥用27.0%。混合性抑郁与非混合性抑郁有以下显著关联（比值比 = OR）：女性2.4、双相II型障碍9.3、广泛性焦虑障碍41.3、易激惹101.6以及精神运动性激越61.1。
本研究未纳入致死风险极高的自杀未遂者。
本研究的重要新发现是抑郁自杀未遂者中混合性抑郁的患病率极高。双相和非双相抑郁自杀未遂者中混合性抑郁的发生率远高于既往报道的非自杀性双相II型和单相抑郁门诊患者，提示自杀未遂者主要来自以双相II型为主的混合性抑郁患者。易激惹和精神运动性激越是自杀未遂最强的预测因素。从公共卫生角度看，我们的数据凸显了在预防自杀行为中检测和治疗混合性（双相）抑郁的必要性。
