Benazzi Franco
Hecker Psychiatry Research Center, University of California at San Diego, San Diego, CA, USA.
Psychopathology. 2007;40(1):54-60. doi: 10.1159/000096513. Epub 2006 Oct 25.
Recent studies found that overactivity (increased goal-directed activities) may be as important as mood change (elevated and/or irritable mood) for the diagnosis of mania/hypomania (on family history and psychometric grounds), questioning DSM-IV-TR criteria always requiring mood change and listing overactivity among the other symptoms. The aim of the study was to find out if overactivity was at least as important as mood change for the diagnosis of hypomania.
A consecutive sample of 137 bipolar II disorder (BP-II) and 76 major depressive disorder remitted outpatients were interviewed with the Structured Clinical Interview for DSM-IV by a senior clinical and research psychiatrist in a private practice. Patients were asked if they had had hypomanic symptoms and episodes, and which were the most common hypomanic symptoms during the various episodes. The study aim had not been planned when variables were collected for different study goals.
Overactivity was the most common hypomanic symptom in BP-II, more common than elevated mood, and had the strongest association with BP-II among all the hypomanic symptoms (overactivity odds ratio = 15.4, elevated mood odds ratio = 12.6). Three factors were found: an 'elevated mood' factor including elevated mood and increased self-esteem; a 'mental activation' factor including racing/crowded thoughts, and a 'behavioral activation' factor including overactivity. There was no relationship between overactivity and mood change. Irritable mood was not associated with overactivity and elevated mood. BP-II was present in 21.6%of patients without a history of overactivity, and in 81.0% of patients with a history of overactivity. BP-II was present in 25.0% of patients without elevated mood, and in 63.3% of patients with elevated mood. As a predictor of BP-II, overactivity had a sensitivity of 90.5%, a specificity of 61.8%, and a positive predictive value of 81.0% (elevated mood: 72.2, 82.8, and 88.3%, respectively). Five or more hypomanic symptoms had the most balanced combination of sensitivity (82.4%) and specificity (85.5%) for BP-II, and a positive predictive value of 91.1%. Overactivity was present in 89.5% of patients with a history of > or = 5 hypomanic symptoms, while elevated mood was present in 76.6%.
Theresults seem to support the view that overactivity may be a core feature of hypomania, suggesting the upgrading of overactivity to a stem criterion for hypomania.
近期研究发现，对于躁狂/轻躁狂的诊断（基于家族病史和心理测量依据），过度活跃（目标导向活动增加）可能与情绪变化（情绪高涨和/或易怒）同样重要，这对始终要求有情绪变化并将过度活跃列为其他症状之一的《精神疾病诊断与统计手册》第四版修订版（DSM-IV-TR）标准提出了质疑。该研究的目的是查明在轻躁狂的诊断中，过度活跃是否至少与情绪变化同样重要。
一位在私人诊所工作的资深临床及研究精神科医生，使用《精神疾病诊断与统计手册》第四版的结构化临床访谈，对137例双相II型障碍（BP-II）门诊缓解期患者和76例重度抑郁症门诊缓解期患者进行了连续抽样访谈。询问患者是否有轻躁狂症状及发作，以及在不同发作期间最常见的轻躁狂症状是什么。在为不同研究目标收集变量时，尚未规划该研究目的。
过度活跃是BP-II中最常见的轻躁狂症状，比情绪高涨更常见，并且在所有轻躁狂症状中与BP-II的关联最强（过度活跃优势比 = 15.4，情绪高涨优势比 = 12.6）。发现了三个因素：一个“情绪高涨”因素，包括情绪高涨和自尊增强；一个“精神激活”因素，包括思维奔逸/杂乱；以及一个“行为激活”因素，包括过度活跃。过度活跃与情绪变化之间没有关系。易怒情绪与过度活跃和情绪高涨均无关联。在无过度活跃病史的患者中，21.6%患有BP-II，而在有过度活跃病史的患者中，这一比例为81.0%。在无情绪高涨的患者中，25.0%患有BP-II，而在有情绪高涨的患者中，这一比例为63.3%。作为BP-II的预测指标，过度活跃的敏感度为90.5%，特异度为61.8%，阳性预测值为81.0%（情绪高涨分别为72.2%、82.8%和88.3%）。对于BP-II，五个或更多轻躁狂症状的敏感度（82.4%）和特异度（85.5%）组合最为平衡，阳性预测值为91.1%。在有≥5次轻躁狂症状病史的患者中，89.5%存在过度活跃，而76.6%存在情绪高涨。
研究结果似乎支持以下观点，即过度活跃可能是轻躁狂的核心特征，这表明应将过度活跃提升为轻躁狂的一项基本标准。
