Phelps James, Angst Jules, Katzow Jacob, Sadler John
Corvallis Psychiatric Clinic, Corvallis, OR 97330, USA.
Bipolar Disord. 2008 Feb;10(1 Pt 2):179-93. doi: 10.1111/j.1399-5618.2007.00562.x.
The bipolar spectrum model suggests that several patient presentations not currently recognized by the DSM warrant consideration as part of a mood disorders continuum. These include hypomania or mania associated with antidepressants; manic symptoms which fall short of the current DSM threshold for hypomania; and depression attended by multiple non-manic markers that are associated with bipolar course. Evidence supporting the inclusion of these groups within the realm of bipolar disorder (BP) is examined. Several diagnostic tools for detecting and characterizing these patient groups are described. Finally, options for altering DSM-IV criteria to allow some of the above patient presentations to be recognized as bipolar are considered. More data on the validity and utility of these alterations would be useful, but limited changes appear warranted now. We describe an additional BP Not Otherwise Specified (BP NOS) example which creates a subthreshold hypomanic analogue to cyclothymia, consistent with existing BP NOS criteria. This change should be accompanied by additional requirements for the assessment and reporting of non-manic bipolar markers.
双相谱模型表明，目前未被《精神疾病诊断与统计手册》（DSM）认可的几种患者表现值得作为心境障碍连续体的一部分加以考虑。这些表现包括与抗抑郁药相关的轻躁狂或躁狂；未达到当前DSM轻躁狂阈值的躁狂症状；以及伴有与双相病程相关的多种非躁狂标志物的抑郁。本文考察了支持将这些群体纳入双相情感障碍（BP）范畴的证据。描述了几种用于检测和描述这些患者群体的诊断工具。最后，考虑了修改DSM-IV标准以使上述部分患者表现被认可为双相情感障碍的选项。关于这些修改的有效性和实用性的更多数据将很有用，但目前似乎有必要进行有限的修改。我们描述了另一个未另行规定的双相情感障碍（BP NOS）示例，它创建了一个与环性心境障碍类似的阈下轻躁狂，符合现有的BP NOS标准。这一改变应伴随着对非躁狂双相标志物评估和报告的额外要求。
