Benazzi Franco
Hecker Psychiatry Research Center, Forli, Italy.
Prog Neuropsychopharmacol Biol Psychiatry. 2007 Jan 30;31(1):97-103. doi: 10.1016/j.pnpbp.2006.08.003. Epub 2006 Sep 15.
Mixed states, i.e., opposite polarity symptoms in the same mood episode, question the categorical splitting of mood disorders in bipolar disorders and unipolar depressive disorders, and may support a continuum between these disorders. Study aim was to find if there were a continuum between hypomania (defining BP-II) and depression (defining MDD), by testing mixed depression as a 'bridge' linking these two disorders. A correlation between intradepressive hypomanic symptoms and depressive symptoms could support such a continuum, but other explanations of a correlation are possible.
Consecutive 389 BP-II and 261 MDD major depressive episode (MDE) outpatients were interviewed, cross-sectionally, with the Structured Clinical Interview for DSM-IV, the Hypomania Interview Guide (to assess intradepressive hypomanic symptoms) and the Family History Screen, by a mood disorders specialist psychiatrist in a private practice. Patients presented voluntarily for treatment of depression when interviewed drug-free and had many subsequent follow-ups after treatment start. Mixed depression (depressive mixed state) was defined as the combination of MDE (depression) and three or more DSM-IV intradepressive hypomanic symptoms (elevated mood and increased self-esteem were always absent by definition), a definition validated by Akiskal and Benazzi.
BP-II, versus MDD, had significantly lower age at onset, more recurrences, atypical and mixed depressions, bipolar family history, MDE symptoms and intradepressive hypomanic symptoms. Mixed depression was present in 64.5% of BP-II and in 32.1% of MDD (p=0.000). There was a significant correlation between number of MDE symptoms and number of intradepressive hypomanic symptoms. A dose-response relationship between frequency of mixed depression and number of MDE symptoms was also found.
Differences on classic diagnostic validators could support a division between BP-II and MDD. Presence of intradepressive hypomanic symptoms by itself, and correlation between intradepressive hypomanic symptoms and depressive symptoms could instead support a continuum. Other explanations of such a correlation are possible. Depending on the method used, a BP-II-MDD continuum could be supported or not.
混合状态，即在同一心境发作中出现相反极性的症状，对双相情感障碍和单相抑郁障碍中情绪障碍的分类划分提出了质疑，并可能支持这些障碍之间的连续性。研究目的是通过将混合性抑郁作为连接这两种障碍的“桥梁”进行测试，来探究轻躁狂（定义为双相II型障碍）和抑郁（定义为重度抑郁障碍）之间是否存在连续性。抑郁发作期内的轻躁狂症状与抑郁症状之间的相关性可能支持这种连续性，但相关性也可能有其他解释。
一位在私人诊所执业的心境障碍专科精神科医生，采用《精神疾病诊断与统计手册》第四版的结构化临床访谈、轻躁狂访谈指南（以评估抑郁发作期内的轻躁狂症状）和家族史筛查，对389例双相II型障碍和261例重度抑郁障碍的门诊患者进行了横断面访谈。患者在接受访谈时自愿前来接受抑郁治疗，且未服用药物，治疗开始后进行了多次后续随访。混合性抑郁（抑郁混合状态）被定义为重度抑郁发作（抑郁）与三种或更多《精神疾病诊断与统计手册》第四版中抑郁发作期内的轻躁狂症状（根据定义，始终不存在情绪高涨和自尊增强）的组合，这一定义已得到阿基斯卡尔和贝纳齐的验证。
与重度抑郁障碍相比，双相II型障碍患者的起病年龄显著更低，复发次数更多，存在非典型和混合性抑郁、双相家族史、重度抑郁发作症状以及抑郁发作期内的轻躁狂症状。64.5%的双相II型障碍患者和32.1%的重度抑郁障碍患者存在混合性抑郁（p = 0.000）。重度抑郁发作症状的数量与抑郁发作期内轻躁狂症状的数量之间存在显著相关性。还发现了混合性抑郁的频率与重度抑郁发作症状数量之间的剂量反应关系。
经典诊断验证指标上的差异可能支持双相II型障碍和重度抑郁障碍的区分。抑郁发作期内轻躁狂症状的存在本身，以及抑郁发作期内轻躁狂症状与抑郁症状之间的相关性，反而可能支持连续性。这种相关性也可能有其他解释。根据所采用的方法，双相II型障碍 - 重度抑郁障碍的连续性可能得到支持，也可能得不到支持。
