Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room FG 29 Toronto, Ontario, Canada M4N 3M5.
J Affect Disord. 2010 Sep;125(1-3):103-10. doi: 10.1016/j.jad.2010.02.118. Epub 2010 Mar 12.
Many people with bipolar disorder (BD) in the community are misdiagnosed with major depressive disorder (MDD). A probabilistic model has been proposed to assist in the identification of BD among patients with depressive symptoms, however there are limited population-based data on the key distinguishers of BD from MDD. The objective of this study was to identify distinguishers of BD from MDD in a population-based sample.
Population-based data were extracted from the Canadian Community Health Survey: Mental Health and Well-Being. Sociodemographic variables, clinical variables, and depressive symptomatology were compared between subjects with BD (N=467) and MDD (N=4145). Logistic regression analysis was used to identify significant correlates of BD, and areas under the receiver operating characteristic curves (AUCs) were determined for each model.
BD and MDD subjects differed across a number of characteristics. Clinical variables significantly associated with BD included greater number of lifetime depressive episodes, earlier age of first depressive episode, lifetime anxiety disorder, problematic substance use, and lifetime suicide attempt. Symptoms significantly more common during a major depressive episode among BD subjects included agitation, suicidal ideation, anxious symptoms, and irritability. AUCs for these models ranged from 0.72 to 0.81.
Data were not available for all potential distinguishers; subgroups of BD could not be determined; cross-sectional data.
These population-based results reinforce the effort to establish a generalizable probabilistic model that incorporates clinical and symptom variables in order to assist clinicians in the diagnostic assessment of BD.
许多社区中的双相情感障碍（BD）患者被误诊为重度抑郁症（MDD）。已经提出了一种概率模型来协助识别有抑郁症状的 BD 患者，但关于 BD 与 MDD 的关键区别的基于人群的数据有限。本研究的目的是在基于人群的样本中确定 BD 与 MDD 的区别。
从加拿大社区健康调查：心理健康和幸福感中提取基于人群的数据。比较 BD（N=467）和 MDD（N=4145）患者的社会人口统计学变量、临床变量和抑郁症状。使用逻辑回归分析确定 BD 的显著相关因素，并为每个模型确定接收者操作特征曲线（AUC）下的面积。
BD 和 MDD 患者在许多特征上存在差异。与 BD 显著相关的临床变量包括更多的终生抑郁发作次数、首发抑郁发作的年龄更早、终生焦虑障碍、有问题的物质使用和终生自杀未遂。BD 患者在重度抑郁发作期间更常见的症状包括激越、自杀意念、焦虑症状和易怒。这些模型的 AUC 范围为 0.72 至 0.81。
并非所有潜在区别因素的数据都可用；BD 的亚组无法确定；横断面数据。
这些基于人群的结果加强了努力，建立一个可推广的概率模型，该模型纳入临床和症状变量，以协助临床医生对 BD 进行诊断评估。
