Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, 52242, USA. jess-fi
Am J Psychiatry. 2011 Jan;168(1):40-8. doi: 10.1176/appi.ajp.2010.10030328. Epub 2010 Nov 15.
The authors assessed whether subthreshold hypomanic symptoms in patients with major depression predicted new-onset mania or hypomania.
The authors identified 550 individuals followed for at least 1 year in the National Institute of Mental Health Collaborative Depression Study with a diagnosis of major depression at intake. All participants were screened at baseline for five manic symptoms: elevated mood, decreased need for sleep, unusually high energy, increased goal-directed activity, and grandiosity. Participants were followed prospectively for a mean of 17.5 years and up to 31 years. The Longitudinal Interval Follow-up Examination was used to monitor course of illness and to identify any hypomania or mania. The association of subthreshold hypomanic symptoms at baseline with subsequent hypomania or mania was determined in survival analyses using Cox proportional hazards regression.
With a cumulative probability of one in four on survival analysis, 19.6% (N=108) of the sample experienced hypomania or mania, resulting in revision of diagnoses for 12.2% to bipolar II disorder and 7.5% to bipolar I disorder. Number of subthreshold hypomanic symptoms, presence of psychosis, and age at illness onset predicted progression to bipolar disorder. Decreased need for sleep, unusually high energy, and increased goal-directed activity were specifically implicated.
Symptoms of hypomania, even when of low intensity, were frequently associated with subsequent progression to bipolar disorder, although the majority of patients who converted did not have any symptoms of hypomania at baseline. These results suggest that continued monitoring for the possibility of progression to bipolar disorder is necessary over the long-term course of major depressive disorder.
作者评估了重度抑郁症患者亚临床轻躁狂症状是否会预测新发躁狂或轻躁狂。
作者在国家心理健康研究所合作抑郁症研究中确定了 550 名至少随访 1 年的个体，他们在入组时被诊断为重度抑郁症。所有参与者在基线时均接受了五种躁狂症状的筛查：情绪升高、睡眠需求减少、异常高能量、增加目标导向活动和夸大。参与者前瞻性随访平均 17.5 年，最长 31 年。纵向间隔随访检查用于监测疾病过程，并识别任何轻躁狂或躁狂。使用 Cox 比例风险回归的生存分析确定基线时亚临床轻躁狂症状与随后的轻躁狂或躁狂之间的关联。
在生存分析中，累积概率为四分之一，样本中有 19.6%（N=108）经历了轻躁狂或躁狂，导致 12.2%的诊断修订为双相 II 障碍，7.5%的诊断修订为双相 I 障碍。亚临床轻躁狂症状的数量、精神病存在和发病年龄预测向双相障碍的进展。睡眠需求减少、异常高能量和增加的目标导向活动是具体的预测因素。
即使强度较低，轻躁狂症状也经常与随后发展为双相障碍相关，尽管大多数转换的患者在基线时没有任何轻躁狂症状。这些结果表明，在重度抑郁症的长期病程中，需要持续监测进展为双相障碍的可能性。
