Besnier N, Fakra E, Kaladjian A, Adida M, Maurel M, Azorin J-M
Pôle de Psychiatrie Adultes, CHU Sainte Marguerite, 13009 Marseille.
Encephale. 2010 Jan;36 Suppl 1:S18-22. doi: 10.1016/S0013-7006(10)70005-1.
Both retrospective and high-risk individuals prospective studies show that a high percentage of patients experience one or more depressive episodes previous the diagnosis of bipolar disorder. Depressive onset bipolar disorders begin earlier than the ones with a manic onset, have a higher duration, a chronic course with frequent recurrences, a depressive dominant polarity, a higher lifetime rate of suicidal behaviour, less psychotic symptoms and more rapid cycling. A relation between frequent rapid cycling and previous prescription of antidepressants was suggested but not rigorously demonstrated. Thus, a high percentage of patients presenting a first depressive episode will later develop bipolar disorder. Several risk factors of bipolarity have been identified and might be detected during each depressive episode by using standardised evaluations and family interviews, if necessary. Among them, an early age at first episode, frequent recurrences, a family history of bipolar disorder, atypical features and hypomanic symptoms are particularly associated with the subsequent development of a bipolar disorder. The impact of a high risk of bipolarity on drug prescription is unclear ; however, one can strongly recommend to intensifying clinical monitoring and to proposing adjunctive psychoeducation.
回顾性研究和针对高危个体的前瞻性研究均表明，很大比例的患者在双相情感障碍确诊之前经历过一次或多次抑郁发作。抑郁起病的双相情感障碍比躁狂起病的发病更早，病程更长，呈慢性病程且频繁复发，以抑郁为主导极性，自杀行为的终生发生率更高，精神病性症状较少且快速循环发作更为频繁。虽然有人提出频繁快速循环发作与先前使用抗抑郁药之间存在关联，但尚未得到严格证实。因此，出现首次抑郁发作的患者中有很大比例随后会发展为双相情感障碍。已经确定了双相情感障碍的几个危险因素，如有必要，可在每次抑郁发作期间通过标准化评估和家庭访谈进行检测。其中，首次发作年龄早、频繁复发、双相情感障碍家族史、非典型特征和轻躁狂症状与随后发展为双相情感障碍尤其相关。双相情感障碍高风险对药物处方的影响尚不清楚；然而，可以强烈建议加强临床监测并提供辅助心理教育。
