Bader Cynthia D, Dunner David L
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
Bipolar Disord. 2007 Dec;9(8):860-7. doi: 10.1111/j.1399-5618.2007.00378.x.
The purpose of this study was to determine the clinical characteristics of patients who are diagnosed with bipolar disorder not otherwise specified (BPD NOS) and who are considered to represent part of the bipolar spectrum. The lifetime prevalence of BPD in the general population may be as high as 6% when the full spectrum of bipolar disorders is accounted for. Correct identification of true bipolar patients in clinical settings may result in more appropriate treatment. Our hypothesis was that patients with BPD NOS would be more similar to other bipolar patients than major depressive disorder (MDD) patients in terms of age of onset, history of suicidal behavior and family history of BPD.
We conducted a retrospective chart review to extract and analyze data on the family history, disease course and clinical characteristics of 305 bipolar disorder I (BPD I), bipolar disorder II (BPD II), bipolar disorder not otherwise specified (BPD NOS) or major depressive disorder (MDD) patients who were then grouped by diagnosis for analysis. Nominal variables were compared between groups using chi-square tests and ANOVA was used to compare means between groups for continuous variables. Significant F values were followed by independent-samples t-tests.
Patients with BPD I, BPD II and BPD NOS were all found to have a significantly earlier mean age of onset of depression than MDD patients. A significantly higher incidence of bipolar illness in a first-degree relative was found in all BPD groups (27-32%) compared with MDD patients (11%). Only the BPD I group had a significantly higher rate of suicide attempts (42%), compared with the BPD NOS (17%) and MDD recurrent (16%) groups.
Our data support the conclusions of others that an early age of onset and a positive family history of bipolar illness are associated not only with BPD I and II but also with 'softer' forms of bipolar illness, which DSM-IV classifies as BPD NOS and the current literature refers to as a category of 'bipolar spectrum disorder', albeit with varying proposed definitions and diagnostic criteria. Suicide attempt history may be more useful in identifying the severity of illness than distinguishing the bipolar spectrum from depressive disorders. Further research is needed to clearly define the boundaries of the bipolar spectrum.
本研究旨在确定被诊断为未特定型双相情感障碍（BPD NOS）且被认为属于双相情感障碍谱系一部分的患者的临床特征。当考虑双相情感障碍的全谱系时，普通人群中BPD的终生患病率可能高达6%。在临床环境中正确识别真正的双相情感障碍患者可能会带来更恰当的治疗。我们的假设是，在发病年龄、自杀行为史和双相情感障碍家族史方面，BPD NOS患者与其他双相情感障碍患者比与重度抑郁症（MDD）患者更相似。
我们进行了一项回顾性病历审查，以提取和分析305例双相情感障碍I型（BPD I）、双相情感障碍II型（BPD II）、未特定型双相情感障碍（BPD NOS）或重度抑郁症（MDD）患者的家族史、病程和临床特征数据，然后按诊断分组进行分析。使用卡方检验比较组间的名义变量，对于连续变量，使用方差分析比较组间均值。显著的F值之后进行独立样本t检验。
发现BPD I型、BPD II型和BPD NOS患者的平均抑郁发病年龄均显著早于MDD患者。与MDD患者（11%）相比，所有双相情感障碍组（27 - 32%）的一级亲属中双相情感障碍的发病率显著更高。与BPD NOS组（17%）和复发性MDD组（
