Mula Marco, Jauch Regina, Cavanna Andrea, Collimedaglia Laura, Barbagli Davide, Gaus Verena, Kretz Rebekka, Viana Michele, Tota Grazia, Israel Heike, Reuter Uwe, Martus Peter, Cantello Roberto, Monaco Francesco, Schmitz Bettina
Department of Neurology, Amedeo Avogadro University, Novara, Italy.
Epilepsia. 2008 Apr;49(4):650-6. doi: 10.1111/j.1528-1167.2007.01434.x. Epub 2007 Dec 18.
Different authors suggested the occurrence of a pleomorphic affective syndrome in patients with epilepsy named interictal dysphoric disorder (IDD). We sought to investigate whether IDD occurs only in patients with epilepsy and to validate IDD features against DSM-IV criteria.
Consecutive patients with a diagnosis of epilepsy (E) or migraine (M) have been assessed using the BDI, MDQ, and the Interictal Dysphoric Disorder Inventory (IDDI), a questionnaire specifically created to evaluate IDD symptoms. Diagnosis of current and lifetime DSM-IV Axis I disorders was established using the MINI Plus version 5.0.0.
A total of 229 patients (E = 117; M = 112) were evaluated. Females were significantly more represented in the migraine group (E = 46.5% vs. M = 73.3% p = 0.009), but there was no difference in age, duration of the disease, or education level. Patients with epilepsy were more likely to screen positively at MDQ (E = 17% vs. M = 5.3% p = 0.006) and to have a diagnosis of bipolar disorder (E = 14.5% vs. M = 4.5% p = 0.013) as compared to migraine patients. There was no between-groups difference in IDD prevalence (E = 17%; M = 18.7%) and IDDI total scores (E = 4.1 +/- 2.0 vs. M = 3.8 +/- 2.0). Validation of IDD against DSM-IV categories showed current major depression being the foremost diagnostic category correlated with IDD in both epilepsy (OR = 0.32-0.12-0.88, p = 0.028) and migraine (OR = 0.10, 95% CI = 0.02-0.49, p = 0.004) samples. Current anxiety disorder correlated with IDD only in migraine patients (OR = 0.19, 95% CI = 0.05-0.77, p = 0.02).
IDD represents a homogenous construct that can be diagnosed in a relevant proportion of patients but it is not typical only of epilepsy, occurring in other central nervous system disorders such as migraine.
不同作者提出癫痫患者中存在一种多形性情感综合征，称为发作间期烦躁障碍（IDD）。我们试图调查IDD是否仅发生于癫痫患者，并根据《精神疾病诊断与统计手册》第四版（DSM-IV）标准验证IDD的特征。
连续纳入诊断为癫痫（E组）或偏头痛（M组）的患者，使用贝克抑郁量表（BDI）、偏头痛残疾评定问卷（MDQ）以及发作间期烦躁障碍量表（IDDI）进行评估，IDDI是专门为评估IDD症状而编制的问卷。使用MINI Plus 5.0.0版确定当前和终生的DSM-IV轴I障碍诊断。
共评估了229例患者（E组 = 117例；M组 = 112例）。偏头痛组女性比例显著更高（E组 = 46.5% 对 M组 = 73.3%，p = 0.009），但年龄、病程或教育水平无差异。与偏头痛患者相比，癫痫患者在MDQ筛查中呈阳性的可能性更高（E组 = 17% 对 M组 = 5.3%，p = 0.006），且被诊断为双相情感障碍的可能性更高（E组 = 14.5% 对 M组 = 4.5%，p = 0.013）。IDD患病率（E组 = 17%；M组 = 18.7%）和IDDI总分（E组 = 4.1 ± 2.0对M组 = 3.8 ± 2.0）在两组间无差异。根据DSM-IV类别对IDD进行验证显示，当前重度抑郁症是癫痫（比值比[OR] = 0.32 - 0.12 - 0.88，p = 0.028）和偏头痛（OR = 0.10，95%置信区间[CI] = 0.02 - 0.49，p = 0.004）样本中与IDD最相关的诊断类别。当前焦虑障碍仅在偏头痛患者中与IDD相关（OR = 0.19，95% CI = 0.05 - 0.77，p = 0.02）。
IDD是一种同质的结构，在相当比例的患者中可被诊断，但并非癫痫所特有，在偏头痛等其他中枢神经系统疾病中也会出现。
