Bertschy G, Gervasoni N, Favre S, Liberek C, Ragama-Pardos E, Aubry J-M, Gex-Fabry M, Dayer A
Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland.
Psychopathology. 2008;41(3):187-93. doi: 10.1159/000120987. Epub 2008 Mar 13.
Mixed states are a complex entity in the field of mood disorders. Dysphoria has been advocated as an important clinical dimension of mixed states. The objective of this work is to study the frequency of dysphoria within a population of patients with DSM-IV major depressive and/or manic episodes and to determine if it may help establish diagnostic criteria for subthreshold cases of depressive or manic mixed states.
A total of 165 patients were assessed using the Mini International Neuropsychiatric Interview complemented by a section defining dysphoria as a constellation of 3 among 4 symptoms (inner tension, irritability, aggressive behavior and hostility).
When classifying patients according to the number of symptoms of the opposite polarity, changes in the frequency of dysphoria revealed a clear contrast between the 2 opposite manic and depressive poles and the full mixed state (DSM-IV definition). The frequency of dysphoria was 17.5% in pure depression, 22.7% in pure mania and 73.3% in full mixed state. Two threshold effects were identified: (1) the frequency of dysphoria increased from 17.5 to 61.1% (p = 0.002) when the number of manic symptoms in DSM-IV depressed patients increased from 0 to 1, and (2) dysphoria increased from 14.3 to 69.2% (p = 0.057) when the number of depressive symptoms increased from 2 to 3 in DSM-IV manic patients.
Dysphoria is strongly but not necessarily associated with mixed states. When used as a clinical marker for mixed states, dysphoria confirms the modern delimitations of sub-threshold mixed states by specifying the required number of symptoms of the opposite polarity (which could be lower for depressive mixed states than for manic mixed states). The study has limitations related to the inclusion of patients who are not drug-free, to the definition of dysphoria and to the sample size.
混合状态是情绪障碍领域中的一个复杂实体。烦躁不安已被视为混合状态的一个重要临床维度。本研究的目的是调查符合《精神疾病诊断与统计手册》第四版（DSM-IV）重度抑郁和/或躁狂发作标准的患者群体中烦躁不安的发生率，并确定其是否有助于为抑郁或躁狂混合状态的阈下病例建立诊断标准。
总共165名患者接受了简明国际神经精神访谈评估，并通过一个部分将烦躁不安定义为4种症状（内心紧张、易怒、攻击行为和敌意）中的3种症状组合。
根据相反极性症状的数量对患者进行分类时，烦躁不安发生率的变化揭示了两个相反的躁狂和抑郁极点与完全混合状态（DSM-IV定义）之间的明显差异。纯抑郁状态下烦躁不安的发生率为17.5%，纯躁狂状态下为22.7%，完全混合状态下为73.3%。确定了两种阈值效应：（1）当DSM-IV抑郁患者的躁狂症状数量从0增加到1时，烦躁不安的发生率从17.5%增加到61.1%（p = 0.002）；（2）当DSM-IV躁狂患者的抑郁症状数量从2增加到3时，烦躁不安的发生率从14.3%增加到69.2%（p = 0.057）。
烦躁不安与混合状态密切相关，但并非必然相关。当用作混合状态的临床标志物时，烦躁不安通过指定相反极性所需的症状数量（抑郁混合状态可能比躁狂混合状态所需的症状数量少），证实了阈下混合状态的现代界定。该研究存在一些局限性，包括纳入了未停用药物的患者、烦躁不安的定义以及样本量。
