J Clin Psychiatry. 2009 Nov;70(11):1514-21. doi: 10.4088/JCP.09m05090. Epub 2009 Sep 8.
The DSM-IV definition of hypomania, which relies on clinical consensus and historical tradition, includes several "nonspecific" symptoms. The aim of this study was to identify the core symptoms of DSM-IV hypomania.
In an outpatient private practice, 266 bipolar II disorder (BP-II) and 138 major depressive disorder (MDD) remitted patients were interviewed by a bipolar-trained psychiatrist, for different study goals. Patients were questioned, using the Structured Clinical Interview for DSM-IV, about the most common symptoms and duration of recent threshold and subthreshold hypomanic episodes. Data were recorded between 2002 and 2006. Four different samples, assessed with the same methodology, were pooled for the present analyses. Tetrachoric factor analysis was used to identify core hypomanic symptoms. Distribution of symptoms by kernel estimation was inspected for bimodality. Validity of core hypomania was tested by receiver operating characteristic (ROC) analysis.
The distribution of subthreshold and threshold hypomanic episodes did not show bimodality. Tetrachoric factor analysis found 2 uncorrelated factors: factor 1 included the "classic" symptoms elevated mood, inflated self-esteem, decreased need for sleep, talkativeness, and increase in goal-directed activity (overactivity); factor 2 included the "nonspecific" symptoms irritable mood, racing/crowded thoughts, and distractibility. Factor 1 discriminatory accuracy for distinguishing BP-II versus MDD was high (ROC area = 0.94). The distribution of the 5-symptom episodes of factor 1 showed clear-cut bimodality. Similar results were found for episodes limited to 3 behavioral symptoms of factor 1 (decreased need for sleep, talkativeness, and overactivity) and 4 behavioral symptoms of factor 1 (adding elevated mood), with high discriminatory accuracy.
A core, categorical DSM-IV hypomania was found that included 3 to 5 symptoms, ie, behavioral symptoms and elevated mood. Behavioral symptoms (overactivity domain) could be the basic phenotype of hypomania. This finding could help in probing for hypomania and reduce misdiagnosis. Biologic research could focus more on the underpinnings of the overactivity domain specifically.
DSM-IV 对轻躁狂的定义依赖于临床共识和历史传统，包括几个“非特异性”症状。本研究的目的是确定 DSM-IV 轻躁狂的核心症状。
在一家私人门诊，266 名双相情感障碍 II 型（BP-II）和 138 名重性抑郁障碍（MDD）缓解患者由一名双相情感障碍专家进行访谈，用于不同的研究目的。患者使用 DSM-IV 结构临床访谈被问到最近阈下和轻度躁狂发作的最常见症状和持续时间。数据记录于 2002 年至 2006 年之间。为了进行本分析，将使用相同方法评估的四个不同样本合并。使用四次方因素分析来确定核心轻躁狂症状。通过核估计检查症状的分布是否存在双峰性。通过接收者操作特征（ROC）分析测试核心轻躁狂的有效性。
阈下和轻度躁狂发作的分布没有表现出双峰性。四次方因素分析发现 2 个不相关的因素：因素 1 包括“经典”症状，如情绪升高、自尊心膨胀、睡眠需求减少、多话和目标导向活动增加（过度活跃）；因素 2 包括“非特异性”症状，如易怒、思绪奔涌和注意力不集中。区分 BP-II 与 MDD 的因素 1 的判别准确率很高（ROC 面积=0.94）。因素 1 的 5 个症状发作的分布表现出明显的双峰性。因素 1 的 3 个行为症状（睡眠需求减少、多话和过度活跃）和 4 个行为症状（增加情绪升高）的发作也有类似的结果，具有较高的判别准确率。
发现了一个核心的、分类的 DSM-IV 轻躁狂，包括 3 到 5 个症状，即行为症状和情绪升高。行为症状（过度活跃域）可能是轻躁狂的基本表型。这一发现可以帮助探测轻躁狂并减少误诊。生物学研究可以更专注于轻躁狂的过度活跃域的基础。
