INSERM, U 995, IMRB, département de Génétique, Créteil, France.
J Affect Disord. 2010 Dec;127(1-3):300-4. doi: 10.1016/j.jad.2010.04.028. Epub 2010 Jun 9.
Mood state heterogeneity in bipolar disorder leads to confusion in diagnosis and therapeutic strategies. Recently, the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) showed that two-thirds of bipolar-depressed patients had concomitant manic symptoms, these characteristics being linked to a more severe form of bipolar disorder. Moreover, manic symptoms occurring during bipolar depression are associated with mood switches induced by antidepressant. It is thus important to best characterize mood episodes with mixed features in order to improve our understanding of the etiopathology and to choose the most appropriate treatment. As dimensional approach can better describe phenomena that are distributed continuously without clear boundaries, we used the MATHYS scale, constructed on a dimensional approach. The aim of the study is to determine whether two dimensions (activation/inhibition and emotional reactivity) improve assessment of bipolar states in which both manic and depressive symptoms are associated.
We included 189 bipolar patients and 90 controls. Bipolar patients were distinguished between those with a major depressive episode without manic symptoms, a major depressive episode with manic symptoms, a mixed state and a manic state. The MATHYS scale provides a total score, quantifying an inhibition/activation process, and a score for emotional reactivity (intensity of emotions).
We demonstrated that there is a continuum ranging from inhibition to activation (respectively from major depressive episodes without manic symptoms to manic states), with a gradual increase in the severity of the activation. Regarding emotional reactivity, results are quiet different since only major depressive episodes without manic symptoms are characterized by emotional hypo-reactivity while major depressive episodes with manic symptoms, manic and mixed states exhibited emotional hyper-reactivity.
The MATHYS scale, providing a score for inhibition/activation process and a score for emotional reactivity, is clearly useful to distinguish bipolar depressive episodes without manic symptoms from those with manic symptoms. This last type of depression appears to belong to a broad spectrum of mixed state. To go further we need to explore if these two types of depression are underlined by different mechanisms and what is the most appropriate treatment for each of them.
双相情感障碍中的情绪状态异质性导致诊断和治疗策略混乱。最近,双相情感障碍强化治疗研究计划(STEP-BD)显示,三分之二的双相抑郁患者伴有并发的躁狂症状,这些特征与更严重形式的双相情感障碍有关。此外,双相抑郁期间出现的躁狂症状与抗抑郁药引起的情绪转换有关。因此,最好描述具有混合特征的情绪发作,以提高我们对病因病理的理解,并选择最合适的治疗方法。由于维度方法可以更好地描述没有明确边界的连续分布的现象,我们使用了基于维度方法构建的 MATHYS 量表。本研究的目的是确定两个维度(激活/抑制和情绪反应性)是否可以改善对伴有躁狂和抑郁症状的双相状态的评估。
我们纳入了 189 名双相情感障碍患者和 90 名对照。双相情感障碍患者分为无躁狂症状的重度抑郁发作、有躁狂症状的重度抑郁发作、混合状态和躁狂状态。MATHYS 量表提供了一个总评分,量化了抑制/激活过程,以及情绪反应性(情绪强度)的评分。
我们证明了存在一个从抑制到激活的连续体(分别从无躁狂症状的重度抑郁发作到躁狂状态),随着激活程度的逐渐增加。关于情绪反应性,结果截然不同,因为只有无躁狂症状的重度抑郁发作表现为情绪反应低下,而有躁狂症状的重度抑郁发作、躁狂发作和混合状态表现为情绪反应过度。
MATHYS 量表提供了抑制/激活过程的评分和情绪反应性的评分,可清楚地区分无躁狂症状的双相抑郁发作和有躁狂症状的抑郁发作。后一种类型的抑郁似乎属于广泛的混合状态。为了进一步研究,我们需要探讨这两种类型的抑郁是否由不同的机制引起,以及每种抑郁的最佳治疗方法是什么。