Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea.
J Affect Disord. 2011 Jun;131(1-3):59-67. doi: 10.1016/j.jad.2010.11.020. Epub 2010 Dec 31.
The present study was designed to investigate whether bipolar II disorder (BP-II) has different characteristics from bipolar I disorder (BP-I), not only in manic severity but also in clinical features, prior course, comorbidity, and family history, sufficiently enough to provide its nosological separation from BP-I.
Comprehensive clinical evaluation was performed based on information available from ordinary clinical settings. Seventy-one BP-I and 34 BP-II patients were assessed using the Diagnostic Interview for Genetic Studies, Korean version. Psychiatric assessment for first-degree relatives (n=374) of the probands was performed using the modified version of the Family History-Research Diagnostic Criteria.
The frequency of depressive episodes was higher in BP-II (p=0.009) compared to BP-I. Further, seasonality (p=0.035) and rapid-cycling course (p=0.062) were more common in BP-II. Regarding manic expression, 'elated mood' was predominant in BP-II whereas 'elated mood' and 'irritable mood' were equally prevalent in BP-I. With regard to depressive symptoms, psychomotor agitation, guilty feeling, and suicidal ideation were more frequently observed in BP-II. BP-II patients exhibited a higher trend of lifetime co-occurrence of an axis I diagnosis (p=0.09), and a significantly higher incidence of phobia and eating disorder. The overall occurrence rate of psychiatric illness in first-degree relatives was 15.4% in BP-I and 26.5% in BP-II (p=0.01). Major depression (p=0.005) and substance-related disorder (p=0.051) were more prevalent in relatives of BP-II probands.
Distinctive characteristics of BP-II were identified in the current study and could be adopted to facilitate the differential diagnosis of BP-I and BP-II in ordinary clinical settings.
本研究旨在探讨双相障碍 II 型（BP-II）是否不仅在躁狂严重程度方面，而且在临床特征、既往病程、共病和家族史方面与双相障碍 I 型（BP-I）存在明显差异，足以支持其与 BP-I 的分类分离。
基于普通临床环境中的可用信息进行全面的临床评估。使用经过韩国改良的诊断访谈为遗传研究（Diagnostic Interview for Genetic Studies, Korean version）对 71 名 BP-I 患者和 34 名 BP-II 患者进行评估。使用改良版家族史研究诊断标准（Family History-Research Diagnostic Criteria）对先证者的一级亲属（n=374）进行精神科评估。
BP-II 患者的抑郁发作频率高于 BP-I（p=0.009）。此外，BP-II 中更常见季节性（p=0.035）和快速循环病程（p=0.062）。在躁狂表现方面，“欣快情绪”在 BP-II 中更为常见，而“欣快情绪”和“易怒情绪”在 BP-I 中同样常见。在抑郁症状方面，BP-II 患者更常出现精神运动性激越、罪恶感和自杀意念。BP-II 患者一生中同时出现一种以上轴 I 诊断的趋势较高（p=0.09），且更易发生恐惧症和饮食障碍。BP-I 患者一级亲属的总体精神疾病发生率为 15.4%，BP-II 为 26.5%（p=0.01）。BP-II 先证者亲属中更常见重度抑郁症（p=0.005）和物质相关障碍（p=0.051）。
本研究确定了 BP-II 的独特特征，可用于促进普通临床环境中 BP-I 和 BP-II 的鉴别诊断。
