Faravelli Carlo, Rosi Simone, Alessandra Scarpato Maria, Lampronti Lorenzo, Amedei Silvia Gorini, Rana Nusrat
Department of Neurology and Psychiatry and Department of Psychology, Florence University, Italy.
J Affect Disord. 2006 Aug;94(1-3):111-9. doi: 10.1016/j.jad.2006.01.031. Epub 2006 May 15.
The DSM IV lifetime prevalence for bipolar affective disorders is reported to be between 0.4% and 1% in most surveys. DSM IV, however, fails to identify the cases clinically significant described as bipolar spectrum. The few researches that have attempted to evaluate the prevalence of these disorders in the community report lifetime prevalence figures of 5% to 10% for the whole spectrum.
The data from the Sesto Fiorentino Study, a community survey conducted by clinical interviewers using a typically clinical instrument, have been re-analysed. 2363 people out of the 2500 randomly selected in order to be representatives of the population aged 14 or more living in Sesto Fiorentino (44,000 inhabitants, Central Italy) could be evaluated according to a two-phase design.
The lifetime prevalence rates were 0.47% for bipolar I disorder, 0.38% for bipolar II (0.85% for DSM IV bipolar disorders). A much greater number of subjects had clinically significant hypomanic symptoms that failed to fully satisfy the diagnostic criteria, totalling to 4.66% of the population. Compared with depressives without any sign of bipolarity (N=297), these "subthreshold bipolar" cases had significantly greater comorbidity for Generalised Anxiety Disorder, Obsessive-Compulsive Disorders and Anorexia Nervosa, as well as with Obsessive-Compulsive Passive-Aggressive, Paranoid, Borderline personality disorders. Their depressive symptom pattern cases differed from that of the "pure" unipolar cases for a significantly greater frequency of psychic agitation, psychotic symptoms and hyperphagia.
The main limitation of the study is its retrospective nature, whereas it confirms the clinical relevance of even softer forms of bipolarity on epidemiological grounds.
在大多数调查中，双相情感障碍在《精神疾病诊断与统计手册》第四版（DSM-IV）中的终生患病率据报告在0.4%至1%之间。然而，DSM-IV未能识别出临床上具有重要意义的双相谱系病例。少数试图评估这些障碍在社区中患病率的研究报告称，整个谱系的终生患病率为5%至10%。
对塞斯托·菲奥伦蒂诺研究的数据进行了重新分析，该研究是由临床访谈者使用典型的临床工具进行的社区调查。在随机抽取的2500名14岁及以上、居住在塞斯托·菲奥伦蒂诺（意大利中部，有44000名居民）的居民中，有2363人可根据两阶段设计进行评估。
双相I型障碍的终生患病率为0.47%，双相II型障碍为0.38%（DSM-IV双相障碍为0.85%）。有更多受试者有临床上具有重要意义的轻躁狂症状，但未完全符合诊断标准，总计占人口的4.66%。与没有任何双相特征迹象的抑郁症患者（N = 297）相比，这些“阈下双相”病例在广泛性焦虑障碍、强迫症和神经性厌食症以及强迫性被动攻击型、偏执型、边缘型人格障碍方面的共病率显著更高。他们的抑郁症状模式与“纯”单相病例不同，精神激动、精神病性症状和贪食的频率显著更高。
该研究的主要局限性在于其回顾性，不过它在流行病学基础上证实了即使是较轻微形式的双相性的临床相关性。
