Oedegaard Ketil J, Neckelmann Dag, Benazzi Franco, Syrstad Vigdis E G, Akiskal Hagop S, Fasmer Ole Bernt
Department of Clinical Medicine, Section for Psychiatry, Faculty of Medicine, University of, Bergen, Bergen, Norway.
J Affect Disord. 2008 Jun;108(3):207-16. doi: 10.1016/j.jad.2007.10.018. Epub 2008 Feb 20.
BACKGROUND: Dissociative symptoms are often seen in patients with mood disorders, but there is little information on possible association with subgroups and temperamental features of these disorders. METHODS: The Dissociative Experience Scale was administered to 85 patients with a DSM-IV Major Depressive Disorder (MDD) or Bipolar-II Disorder (BP-II). Both broad-spectrum dissociation (DES total score) and clearly pathological forms of dissociation (DES-Taxon) were assessed. Temperament was assessed using Akiskal and Mallya;s criteria of Affective Temperaments and the Jenkins Activity Survey (JAS) for Type A Behaviour. RESULTS: Sixty-five patients gave valid answers to DES. The mean DES and DES-T scores were higher in BP-II (16.8 and 12.7 respectively) compared to MDD (9.0 and 5.7); DES odds ratio (OR)=1.58 (95% CI 1.15-2.18) and DES-T OR=1.60 (95% CI 1.14-2.25) using univariate logistic regression analyses. There was no significant difference in DES score in patients with (n=30) and without an affective temperament (n=35): mean (95% CI), 13.5 vs. 10.5 (-7.8 to 1.9), p=0.224. However the subgroup with a cyclothymic temperament (n=18) had higher DES scores (mean (95% CI): 17.8 vs. 9.7 (2.9-13.3), p=0.003), compared to patients without such a temperament. There was no significant difference in DES scores for patients with (n=35) or without (n=28) a Type A behaviour pattern (JAS>0): mean (95% CI) 12. 7 vs. 10.9 (-6.8 to 3.3), p=0.491), but a positive JAS factor S score (speed and impatience subscale) was associated with significantly higher DES scores than a negative S-score: mean (95% CI) 14.9 vs. 9.0 (1.1-10.7), p=0.017), and this was still significant (p=0.005) using multiple linear regression of DES scores vs. the JAS subscale scores. DES-T scores were significantly higher in patients with OCD (n=9) (mean (95% CI) 18.4 vs. 6.6 (6.0-17.7), p<0.001); eating disorder (n=13) (14.0 vs. 6.8 (1.8-12.6), p=0.009), psychotic symptoms during depressions (n=9) (16.6 vs. 6.9 (3.7-15.8), p=0.002), and in those with a history of suicide attempt (n=28) (11.9 vs. 5.4 (2.2-10.8), p=0.003), but only OCD was an independent predictor after multiple linear regression of DES-T scores vs. all co-morbid disorders (p=0.043). LIMITATIONS: The major limitation of the present study is a non-blind evaluation of affective diagnosis and temperaments, and assessment in a non-remission clinical status. CONCLUSIONS: Dissociative symptoms measured with the Dissociative Experience Scale are associated with bipolar features, using formal DSM-IV criteria, cyclothymic temperament and the speed and impatience subscale of the JAS.
背景:分离症状在心境障碍患者中较为常见,但关于其与这些障碍的亚组及气质特征之间可能存在的关联,相关信息较少。 方法:对85例符合《精神疾病诊断与统计手册》第四版(DSM-IV)中重度抑郁症(MDD)或双相II型障碍(BP-II)诊断标准的患者施测分离体验量表。同时评估了广泛的分离症状(DES总分)和明显的病理性分离形式(DES分类)。使用阿基斯卡尔和马利亚的情感气质标准以及詹金斯活动调查表(JAS)评估A型行为来评定气质。 结果:65例患者对DES给出了有效回答。与MDD患者(分别为9.0和5.7)相比,BP-II患者的DES平均分和DES-T分更高(分别为16.8和12.7);单因素逻辑回归分析显示,DES优势比(OR)=1.58(95%置信区间1.15 - 2.18),DES-T的OR = 1.60(95%置信区间1.14 - 2.25)。有情感气质(n = 30)和无情感气质(n = 35)的患者在DES得分上无显著差异:平均值(95%置信区间),13.5对10.5(-7.8至1.9),p = 0.224。然而,与没有环性气质的患者相比,具有环性气质的亚组(n = 18)的DES得分更高(平均值(95%置信区间):17.8对9.7(2.9 - 13.3),p = 0.003)。有(n = 35)或无(n = 28)A型行为模式(JAS>0)的患者在DES得分上无显著差异:平均值(95%置信区间)12.7对10.9(-6.8至3.3),p = 0.491),但JAS因子S得分(速度和不耐烦分量表)为正的患者其DES得分显著高于S得分为负的患者:平均值(95%置信区间)14.9对9.0(1.1 - 10.7),p = 0.017),并且在对DES得分与JAS分量表得分进行多元线性回归分析时,这一差异仍然显著(p = 0.005)。强迫症患者(n = 9)的DES-T得分显著更高(平均值(95%置信区间)18.4对6.6(6.0 - 17.7),p<0.001);进食障碍患者(n = 13)(14.0对6.8(1.8 - 12.6),p = 0.009),抑郁发作时有精神病性症状的患者(n = 9)(16.6对6.9(3.7 - 15.8),p = 0.002),以及有自杀未遂史的患者(n = 28)(11.9对5.4(2.2 - 10.8),p = 0.003),但在对DES-T得分与所有共病进行多元线性回归分析后,只有强迫症是独立预测因子(p = 0.043)。 局限性:本研究的主要局限性在于对情感诊断和气质的评估未采用盲法,且是在非缓解期临床状态下进行评估。 结论:使用分离体验量表测量的分离症状与双相特征、符合正式的DSM-IV标准、环性气质以及JAS的速度和不耐烦分量表相关。
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