M'Bailara K, Chevrier F, Dutertre T, Demotes-Mainard J, Swendsen J, Henry C
Département de Psychiatrie Adulte, CHS Charles-Perrens, 33076 Bordeaux, France.
Encephale. 2009 Oct;35(5):484-90. doi: 10.1016/j.encep.2008.06.015. Epub 2009 Mar 6.
Euthymic states in bipolar disorders are usually considered to be lacking serious psychiatric disorders. Moreover, recent results prove the need to take an interest in a potential emotional dysregulation during these intercrisis periods. Therefore, it seems relevant not only to focus on the emotions tonality (sadness/euphoria) felt by patients, but also on the intensity of their emotional background. Several reasons argue for a disturbance of emotional reactivity in euthymic bipolar patients. First, most bipolar patients spontaneously claim they have a higher sensitivity than average, which may lead to extreme emotional reactions, even during intercrisis periods. Secondly, the emotional reactivity is a way to raise the question of the bipolar patients' vulnerability to stress in euthymic periods. Several studies have shown the impact of stressful life events on the rate of relapse into bipolar disorders. The aim of this study is to examine the emotional reactivity of euthymic bipolar patients in comparison with a control group, using a test of emotional induction. Our hypothesis is that euthymic bipolar patients have a higher emotional reactivity than controls.
One hundred and forty-five subjects were recruited: 90 controls and 55 euthymic bipolar patients. The patients were interviewed by a trained psychologist using the French version of the DIGS providing DSM-IV diagnosis. The euthymic state was confirmed with both MADRS (score<12) and Bech's Manic Scale (score<4). The subjective emotional reactivity of the subjects was assessed using a method of emotional induction, based on viewing a set of 18 (positive, negative or neutral) pictures. The subjects have to appreciate the valence (pleasant, neutral or unpleasant thoughts) and assess the arousal (degree of emotion triggered by each picture).
On average, euthymic bipolar patients report the same valence and arousal to positive (F [1.143]=0.18, p=0.68) and negative (F [1.143]=0.52, p=0.47) pictures as control subjects. Neutral pictures, however, were considered more pleasant and moving by euthymic bipolar patients than by control subjects (F [1.143]=8.40, p=0.004).
Euthymic bipolar patients seem to present an emotional hyperactivity which occurs especially in neutral situations. These results partly corroborate outcomes of other authors, while providing a new methodology through the emotional induction test. The highlight of emotional hyperreactivity during intercrisis periods allows us to understand differently the topic of specific vulnerability to stress of bipolar patients. This hypersensitivity could lead to thymic decompensations and could be linked with an emotional dysregulation, potential endophenotype of the bipolar pathology. Beyond the interest in understanding the physiopathology of the bipolar disorder, it could be associated with several clinical applications as well as in the psychoeducational field and in the screening of the individual risk within the family of bipolar subjects.
双相情感障碍的心境正常状态通常被认为不存在严重的精神疾病。此外，最近的研究结果表明，在这些发作间期需要关注潜在的情绪调节障碍。因此，不仅关注患者所感受到的情绪基调（悲伤/欣快），而且关注其情绪背景的强度似乎是有意义的。有几个原因表明心境正常的双相情感障碍患者存在情绪反应性障碍。首先，大多数双相情感障碍患者自发声称他们比一般人更敏感，这可能导致极端的情绪反应，即使在发作间期也是如此。其次，情绪反应性是一个引发双相情感障碍患者在心境正常期对压力易感性问题的方式。几项研究表明了应激性生活事件对双相情感障碍复发率的影响。本研究的目的是通过情绪诱导测试，比较心境正常的双相情感障碍患者与对照组的情绪反应性。我们的假设是心境正常的双相情感障碍患者比对照组有更高的情绪反应性。
招募了145名受试者：90名对照组和55名心境正常的双相情感障碍患者。由一名经过培训的心理学家使用法语版的DIGS对患者进行访谈以提供DSM-IV诊断。通过MADRS（得分<12）和贝克躁狂量表（得分<4）确认心境正常状态。基于观看一组18张（积极、消极或中性）图片，采用情绪诱导方法评估受试者的主观情绪反应性。受试者必须评价效价（愉快、中性或不愉快的想法）并评估唤醒度（每张图片引发的情绪程度）。
平均而言，心境正常的双相情感障碍患者对积极（F [1.143]=0.18，p=0.68）和消极（F [1.143]=0.52，p=0.47）图片所报告的效价和唤醒度与对照组受试者相同。然而，心境正常的双相情感障碍患者比对照组受试者认为中性图片更令人愉快且更能引发情感反应（F [1.143]=8.40，p=0.004）。
心境正常的双相情感障碍患者似乎存在情绪活动亢进，尤其在中性情境中出现。这些结果部分证实了其他作者的研究结果，同时通过情绪诱导测试提供了一种新的方法。发作间期情绪反应亢进的突出表现使我们能够以不同方式理解双相情感障碍患者对压力的特定易感性这一主题。这种超敏反应可能导致心境代偿失调，并可能与情绪调节障碍相关，这是双相情感障碍病理学的潜在内表型。除了有助于理解双相情感障碍的生理病理学之外，它还可能与多种临床应用以及心理教育领域和双相情感障碍患者家庭中个体风险的筛查有关。
