Schwartzmann Angela Maria, Amaral José Antonio, Issler Cilly, Caetano Sheila C, Tamada Renata S, Almeida Karla Mathias de, Soares Marcia Brito de Macedo, Dias Rodrigo da Silva, Rocca Cristiana C, Lafer Beny
Bipolar Disorder Research Program (PROMAN), Institute of Psychiatry, Department of Psychiatry, Universidade de São Paulo Medical School, São Paulo (SP), Brazil.
Braz J Psychiatry. 2007 Jun;29(2):130-3. doi: 10.1590/s1516-44462006005000036.
Mixed episodes have been described as more severe than manic episodes, especially due to their longer duration and their association with higher rates of suicide attempts, hospitalization and psychotic symptoms. The purpose of this study was to compare the severity between mixed and pure manic episodes according to DSM-IV criteria, through the evaluation of sociodemographic data and clinical characteristics.
Twenty-nine bipolar I patients presenting acute mixed episodes were compared to 20 bipolar I patients with acute manic episodes according to DSM-IV criteria. We analyzed (cross-sectionally) episode length, presence of psychotic symptoms, frequency of suicide attempts and hospitalization, Young Mania Rating Scale scores, Hamilton Depression Rating Scale scores and the Clinical Global Assessment Scale scores.
Young Mania Rating Scale scores were higher in manic episodes than in mixed episodes. There were no differences in gender frequency, CGI scores and rates of hospitalization, suicide attempts and psychotic symptoms, when mixed and manic episodes where compared. Patients with mixed episodes were younger.
In our sample, mixed states occurred at an earlier age than manic episodes. Contrary to previous reports, we did not find significant differences between manic and mixed episodes regarding severity of symptomatology, except for manic symptoms ratings, which were higher in acute manic patients. In part, this may be explained by the different criteria adopted on previous studies.
混合发作被认为比躁狂发作更严重，尤其是因其持续时间更长，且与更高的自杀未遂率、住院率及精神病性症状相关。本研究的目的是通过评估社会人口学数据和临床特征，根据《精神疾病诊断与统计手册》第四版（DSM-IV）标准比较混合发作与单纯躁狂发作的严重程度。
根据DSM-IV标准，将29例表现为急性混合发作的双相I型障碍患者与20例急性躁狂发作的双相I型障碍患者进行比较。我们（横断面地）分析了发作时长、精神病性症状的存在情况、自杀未遂和住院的频率、青年躁狂评定量表（Young Mania Rating Scale）得分、汉密尔顿抑郁评定量表（Hamilton Depression Rating Scale）得分以及临床总体评定量表（Clinical Global Assessment Scale）得分。
躁狂发作时的青年躁狂评定量表得分高于混合发作时。比较混合发作和躁狂发作时，在性别频率、临床总体评定量表得分以及住院率、自杀未遂率和精神病性症状发生率方面没有差异。混合发作的患者更年轻。
在我们的样本中，混合状态比躁狂发作出现的年龄更早。与先前的报告相反，除了急性躁狂患者的躁狂症状评分更高外，我们未发现躁狂发作和混合发作在症状严重程度上有显著差异。部分原因可能是先前研究采用的标准不同。
