Department of Psychiatry/ EMGO Institute, VU University Medical Centre, Amsterdam, The Netherlands.
J Affect Disord. 2010 Oct;126(1-2):252-6. doi: 10.1016/j.jad.2010.02.130. Epub 2010 Mar 24.
Previous studies found that patients with depressive disorders frequently have lifetime manic symptoms or even an unrecognized bipolar disorder and that these patients have more severe illness. In this study we investigated whether the presence of significant manic symptoms among patients presenting with depressive and/or anxiety disorders is associated with more severe illness, more comorbidity, more suicidality and more atypical symptoms.
In a large cohort (n=2012) of persons with lifetime depressive and/or anxiety disorders (as confirmed with the Composite International Diagnostic interview (CIDI)) we used the 15-item Mood Disorder Questionnaire (MDQ) to assess the presence of lifetime manic symptoms. Patients with clinically recognized bipolar disorders were excluded from the study.
Lifetime manic symptoms were present among 6.3% of the persons with depressive or anxiety disorders. Persons with lifetime manic symptoms more frequently had comorbid social phobia, generalized anxiety disorder and alcohol dependence, more frequently reported previous serious suicide attempts and their current depressive symptoms were more severe. Atypical depression symptoms were not more prevalent in persons with lifetime manic symptoms.
The presence of a lifetime manic or hypomanic episode was not assessed with the CIDI.
Identifying lifetime manic symptoms with the MDQ in persons presenting with (unipolar) depressive or anxiety disorders, can not only help the recognition of actual bipolar disorder (as described in previous studies), but also the identification of a subgroup of patients with more severe symptomatology, more comorbid anxiety and alcohol dependence disorders, and more suicidality.
先前的研究发现，患有抑郁症的患者常有终生躁狂症状，甚至有未被识别的双相障碍，且这些患者的病情更严重。在这项研究中，我们调查了在出现抑郁和/或焦虑障碍的患者中，是否存在显著的躁狂症状与更严重的疾病、更多共病、更高的自杀风险和更多非典型症状有关。
在一项大型队列研究（n=2012）中，我们对有终生抑郁和/或焦虑障碍的患者（通过复合国际诊断访谈（CIDI）确认），使用 15 项心境障碍问卷（MDQ）评估一生中是否存在躁狂症状。患有临床公认的双相障碍的患者被排除在研究之外。
在患有抑郁或焦虑障碍的患者中，有 6.3%的患者存在一生中的躁狂症状。有一生中躁狂症状的患者更常伴有社交恐惧症、广泛性焦虑症和酒精依赖，更常报告以前有过严重自杀企图，且当前抑郁症状更严重。有一生中躁狂症状的患者并不更常出现非典型抑郁症状。
CIDI 并未评估一生中躁狂或轻躁狂发作的存在。
在出现（单相）抑郁或焦虑障碍的患者中，使用 MDQ 识别一生中的躁狂症状，不仅有助于识别实际的双相障碍（如先前研究所述），而且有助于识别出一组症状更严重、焦虑和酒精依赖共病更多、自杀风险更高的患者。
