Goes Fernando S, Sadler Bradley, Toolan Jennifer, Zamoiski Rachel D, Mondimore Francis M, Mackinnon Dean F, Schweizer Barbara, Raymond Depaulo J, Potash James B
Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Bipolar Disord. 2007 Dec;9(8):901-6. doi: 10.1111/j.1399-5618.2007.00460.x.
While some prior studies have found higher rates of psychotic depression in those with bipolar disorder or a bipolar relative, others have failed to confirm these observations. We examined the relationship of psychotic depression to polarity in several large familial samples of mood disorder.
A total of 4,724 subjects with major mood disorder in three family studies on the genetics of bipolar I disorder (BPI) or recurrent major depressive disorder (MDDR) were administered semi-structured interviews by clinicians. Determination of psychotic features was based on a report of hallucinations and/or delusions during the most severe depressive episode in the Schedule for Affective Disorders and Schizophrenia-Lifetime Version or the Diagnostic Interview for Genetic Studies interview. Rates of psychotic depression were calculated by diagnostic category and comparisons were made between diagnoses within and across studies using the generalized estimating equation.
A diagnosis of BPI disorder was strongly predictive of psychotic features during depression compared to MDDR [odds ratio (OR) = 4.61, p < 0.0005]. Having bipolar II compared to MDDR was not predictive of psychosis (OR = 1.05, p = 0.260), nor was having a family history of BPI in MDDR subjects (OR = 1.20, p = 0.840).
Psychotic features during a depressive episode increased the likelihood of a BPI diagnosis. Prospective studies are needed to confirm these findings. The potential genetic underpinnings of psychotic depression warrant further study.
虽然一些先前的研究发现双相情感障碍患者或有双相情感障碍亲属的人群中，精神病性抑郁的发生率较高，但其他研究未能证实这些观察结果。我们在几个大型情感障碍家族样本中研究了精神病性抑郁与极性的关系。
在三项关于I型双相情感障碍（BPI）或复发性重度抑郁症（MDDR）遗传学的家族研究中，共有4724名患有重度情感障碍的受试者接受了临床医生的半结构化访谈。精神病性特征的判定基于情感障碍与精神分裂症问卷-终身版或基因研究诊断访谈中最严重抑郁发作期间幻觉和/或妄想的报告。按诊断类别计算精神病性抑郁的发生率，并使用广义估计方程在研究内部和研究之间的诊断之间进行比较。
与MDDR相比，BPI障碍的诊断强烈预测抑郁期间的精神病性特征[优势比（OR）=4.61，p<0.0005]。与MDDR相比，患有II型双相情感障碍并不能预测精神病（OR=1.05，p=0.260），MDDR受试者中有BPI家族史也不能预测精神病（OR=1.20，p=0.840）。
抑郁发作期间的精神病性特征增加了BPI诊断的可能性。需要前瞻性研究来证实这些发现。精神病性抑郁的潜在遗传基础值得进一步研究。
