Benazzi Franco
Hecker Psychiatry Research Center, Forli, Italy.
Prog Neuropsychopharmacol Biol Psychiatry. 2006 Aug 30;30(6):1043-50. doi: 10.1016/j.pnpbp.2006.03.037. Epub 2006 May 8.
A recent series of studies has questioned the current categorical split of mood disorders into bipolar and depressive disorders. Mixed states, especially mixed depression (i.e., depression plus co-occurring, noneuphoric, hypomanic symptoms) might support a continuity between bipolar II (BP-II) depression and major depressive disorder (MDD). The aim of the study was to assess the distribution of intradepressive hypomanic symptoms rating between BP-II and MDD depressions. A bi-modal distribution would support a categorical distinction, and no bi-modality would support continuity.
Consecutive 389 BP-II and 261 MDD major depressive episode (MDE) outpatients were interviewed (off psychoactive drugs) with the Structured Clinical Interview for DSM-IV, the Hypomania Interview Guide (HIG, to assess intradepressive hypomanic symptoms), and the Family History Screen, by a mood specialist psychiatrist in a private practice. Mixed depression was defined as MDE plus 3 or more intradepressive, noneuphoric hypomanic symptoms, a definition validated by Akiskal and Benazzi. The distribution of intradepressive hypomanic symptoms rating was studied by Kernel density estimate and by histogram.
BP-II depression, versus MDD depression, had significantly lower age at onset, was significantly more likely to be atypical and mixed, had more depression recurrences, and a higher bipolar family history loading. BP-II depression, versus MDD depression, had significantly more irritability, racing/crowded thoughts, distractibility, psychomotor agitation, talkativeness, increased goal-directed activity, and excessive risky activities. HIG scores were significantly higher in BP-II. The distribution of intradepressive hypomanic symptoms rating showed no bi-modality in the entire depression sample.
Interpretation of study findings relies on the method used to define a categorical disorder. By using classic diagnostic validators (such as family history and age at onset), BP-II and MDD depressions would seem to be distinct disorders. Instead, by using the 'bi-modality' approach, a continuity would seem to be supported. Which of these methods for classification is the best has yet to be shown.
最近一系列研究对当前将心境障碍分为双相情感障碍和抑郁障碍的分类方式提出了质疑。混合状态，尤其是混合性抑郁（即抑郁加上同时出现的、非欣快的轻躁狂症状）可能支持双相 II 型（BP-II）抑郁和重度抑郁障碍（MDD）之间的连续性。本研究的目的是评估 BP-II 抑郁和 MDD 抑郁之间抑郁期内轻躁狂症状评分的分布情况。双峰分布将支持分类区别，而无双峰则支持连续性。
对 389 例 BP-II 和 261 例 MDD 重度抑郁发作（MDE）门诊患者（停用精神活性药物）进行访谈，由一名私人执业的心境专科精神科医生使用《精神疾病诊断与统计手册》第四版（DSM-IV）结构化临床访谈、轻躁狂访谈指南（HIG，用于评估抑郁期内轻躁狂症状）和家族史筛查。混合性抑郁定义为 MDE 加上 3 种或更多抑郁期内、非欣快的轻躁狂症状，这一定义已由阿基斯卡尔和贝纳齐验证。通过核密度估计和直方图研究抑郁期内轻躁狂症状评分的分布情况。
与 MDD 抑郁相比，BP-II 抑郁起病年龄显著更低，更可能是非典型和混合性的，有更多抑郁复发，且双相家族史负荷更高。与 MDD 抑郁相比，BP-II 抑郁有显著更多的易激惹、思维奔逸/杂乱、注意力分散、精神运动性激越、健谈、目标导向活动增加和过度冒险活动。BP-II 组的 HIG 评分显著更高。抑郁期内轻躁狂症状评分的分布在整个抑郁样本中未显示出双峰。
对研究结果的解释依赖于用于定义分类障碍的方法。通过使用经典诊断验证指标（如家族史和起病年龄），BP-II 抑郁和 MDD 抑郁似乎是不同的障碍。相反，通过使用“双峰”方法，似乎支持连续性。这些分类方法中哪种是最佳的尚未明确。
