Cassidy Frederick, Yatham Lakshmi N, Berk Michael, Grof Paul
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
Bipolar Disord. 2008 Feb;10(1 Pt 2):131-43. doi: 10.1111/j.1399-5618.2007.00558.x.
To review issues surrounding the diagnosis and validity of bipolar manic states.
Studies of the manic syndrome and its diagnostic subtypes were reviewed emphasizing historical development, conceptualizations, formal diagnostic proposals, and validation.
Definitions delineating mixed and pure manic states derive some validity from external measures. DSM-IV and ICD-10 diagnosis of bipolar mixed states are too rigid and less restrictive definitions can be validated. Anxiety is a symptom often overlooked in diagnosis of manic subtypes and may be relevant to the mixed manic state. The boundary for separation of mixed mania and depression remains unclear. A 'pure' non-psychotic manic state similar to Kraepelin's 'hypomania' has been observed in several independent studies.
Issues surrounding diagnostic subtyping of manic states remain complex and the debates surrounding categorical versus dimensional approaches continue. To the extent that categorical approaches for mixed mania diagnosis are adopted, both DSM-IV and ICD-10 are too rigid. Inclusion of non-specific symptoms in definitions of mixed mania, such as psychomotor agitation, does not facilitate and may hinder the diagnostic separation of pure and mixed mania. The inclusion of a diagnostic seasonal specifier for DSM-IV, which is currently based on seasonal patterns for depression might be expanded to include seasonal patterns for mania. Boundaries between subtypes may be 'fuzzy' rather than crisp, and graded approaches could be considered. With the continued development of new tools, such as imaging and genetics, alternative approaches to diagnosis other than the purely symptom-centric paradigms might be considered.
回顾双相躁狂状态的诊断及有效性相关问题。
对躁狂综合征及其诊断亚型的研究进行回顾，重点关注其历史发展、概念化、正式诊断建议及验证。
界定混合性和纯躁狂状态的定义从外部测量中获得了一定的有效性。《精神疾病诊断与统计手册》第四版（DSM-IV）和《国际疾病分类》第十版（ICD-10）对双相混合状态的诊断过于严格，而限制较少的定义可得到验证。焦虑是躁狂亚型诊断中常被忽视的症状，可能与混合性躁狂状态相关。混合性躁狂与抑郁的区分界限仍不明确。在多项独立研究中观察到一种类似于克雷佩林“轻躁狂”的“纯”非精神病性躁狂状态。
躁狂状态诊断亚型相关问题依然复杂，围绕分类法与维度法的争论仍在继续。就采用混合性躁狂诊断的分类法而言，DSM-IV和ICD-10都过于严格。在混合性躁狂的定义中纳入非特异性症状，如精神运动性激越，无助于且可能阻碍纯躁狂与混合性躁狂的诊断区分。目前基于抑郁季节模式的DSM-IV诊断季节性说明可能会扩大，以纳入躁狂的季节模式。亚型之间的界限可能是“模糊的”而非清晰明确的，可考虑采用分级方法。随着成像和遗传学等新工具的不断发展，除了纯粹以症状为中心的范式外，可考虑其他诊断方法。
