Bipolar Disorder Programme, Institut Clínic de Neurociencies, Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBERSAM, Barcelona, Catalonia, Spain.
J Affect Disord. 2010 Sep;125(1-3):61-73. doi: 10.1016/j.jad.2009.12.019.
Mixed episodes are a combination of depressive and manic symptoms in bipolar disorder (BD). We want to identify the proportion of patients who have depressive symptoms during an acute episode and also the validity of current methods for its diagnosis.
Cross-sectional multicentre study of patients with type I BD who are admitted to specialized units. 368 patients in 76 centres were included. The patients should have a well established diagnosis of BD and need hospitalisation. The severity of the disorder and clinical status were evaluated upon admission and discharge using CGI-BP-M clinical impression scales, the Hamilton depression scale (HAMD-17) and the Young mania rating scale (YMRS). Upon admission, the necessary criteria for diagnosing a mixed type episode were recorded according to DSM-IV-TR, ICD-10 and McElroy criteria. Clinical judgment of the current type of episode was also recorded.
Prevalence estimations for mixed episodes were: 12.9% according to DSM-IV-TR (n=45), 9% according to ICD-10 (n=31), 16.7% according to McElroy criteria (n=58), and 23.2% according to clinical judgment (n=81). Statistically significant differences were found between the estimated prevalence rates (Cochrane's Q-test, p<0.0001), with the maximum concordance level found between the McElroy and ICD-10 (Kappa=0.66, 95% CI, 0.54-0.77). The DSM-IV-TR criteria only present moderate concordance with ICD-10 (Kappa=0.65, 95% CI, 0.52 to 0.78) and McElroy criteria (Kappa=0.62, 95% CI, 0.50 to 0.74).
The definition of mixed episodes for BD must be revised to improve consensus and, consequently, therapeutic management. Current diagnostic systems, based on DSM-IV and IDC-10, only capture a limited proportion of patients suffering from mixed episodes, giving rise to important limitations concerning the therapeutic management of BP patients.
双相障碍（BD）的混合发作是抑郁和躁狂症状的组合。我们希望确定在急性发作期间出现抑郁症状的患者比例，以及当前诊断方法的有效性。
这是一项横断面多中心研究，纳入了 76 个中心的 368 例 I 型 BD 住院患者。患者应具有明确的 BD 诊断且需要住院治疗。入院和出院时使用 CGI-BP-M 临床印象量表、汉密尔顿抑郁量表（HAMD-17）和 Young 躁狂评定量表（YMRS）评估疾病严重程度和临床状况。入院时，根据 DSM-IV-TR、ICD-10 和 McElroy 标准记录诊断混合发作所需的必要标准。还记录了当前发作类型的临床判断。
根据 DSM-IV-TR（n=45）、ICD-10（n=31）、McElroy 标准（n=58）和临床判断（n=81），混合发作的患病率估计分别为 12.9%、9%、16.7%和 23.2%。估计患病率之间存在统计学显著差异（Cochrane's Q 检验，p<0.0001），McElroy 和 ICD-10 之间的最大一致性水平（Kappa=0.66，95%CI，0.54-0.77）。DSM-IV-TR 标准与 ICD-10 （Kappa=0.65，95%CI，0.52-0.78）和 McElroy 标准（Kappa=0.62，95%CI，0.50-0.74）仅有中度一致性。
BD 混合发作的定义必须修订，以提高共识，从而改善 BP 患者的治疗管理。基于 DSM-IV 和 IDC-10 的当前诊断系统仅捕获有限比例的混合发作患者，这对 BP 患者的治疗管理产生了重要限制。
