Department of Psychiatry/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
J Affect Disord. 2011 Jun;131(1-3):224-32. doi: 10.1016/j.jad.2010.12.012. Epub 2011 Feb 4.
The dichotomous distinction between unipolar and bipolar disorders may be challenged by heterogeneity within diagnoses and overlap between different diagnoses. A broad mood disorder category in which patients differ as a result of variation along separate manic and depressive mood dimensions can be proposed. To test this, it is hypothesized that heterogeneity in clinical and other features of subjects selected for unipolar depression can be partly explained by coexisting manic symptoms.
A cohort selected for unipolar depressive disorder was followed up for two years at which time co-occurring manic symptoms were assessed, yielding four groups with increasing manic symptomatology: i) pure unipolar depressive disorder (n=1598), ii) unipolar depressive disorder with subthreshold manic symptomatology (n=64), iii) bipolar II disorder (n=39), and iv) bipolar I disorder (n=86). Multivariate logistic regression and analyses of covariance controlled for depression severity were used to investigate whether patients with increasing manic symptomatology could be differentiated from patients with pure depressive disorder.
Male gender, a lower age at first episode, a history of suicide attempts and increased aggressive cognitions were independently associated with an increase in manic symptoms. The additional presence of (hypo)mania was associated with greater depression severity and more disability than pure depressive disorder.
The groups with manic symptomatology (subthreshold, hypomania and mania) were considerably smaller compared to the pure depression group.
The heterogeneity in depressive illness can be partly explained by the coexisting variation along the manic symptom dimension. Co-occurring manic symptoms should be taken into account in depression and a symptom dimensional approach of mood disorders may provide phenotypes that are more informative than current mood disorder categories.
单相和双相障碍之间的二分法可能受到诊断内的异质性和不同诊断之间的重叠的挑战。可以提出一个广泛的心境障碍类别，其中患者由于沿着单独的躁狂和抑郁情绪维度的变化而有所不同。为了检验这一点，假设选择单相抑郁障碍的患者的临床和其他特征的异质性可以部分由共存的躁狂症状来解释。
对单相抑郁障碍患者进行了为期两年的随访，在此期间评估了同时存在的躁狂症状，得出了四个具有不同躁狂症状的组别：i）单纯单相抑郁障碍（n=1598），ii）单相抑郁障碍伴有阈下躁狂症状（n=64），iii）双相 II 型障碍（n=39），iv）双相 I 型障碍（n=86）。采用多变量逻辑回归和协方差分析来控制抑郁严重程度，以研究是否可以根据躁狂症状的增加来区分具有不同严重程度的患者。
男性性别、首发年龄较低、自杀未遂史和攻击性认知增加与躁狂症状的增加独立相关。（轻）躁狂的额外存在与更高的抑郁严重程度和更多的残疾有关，而不是单纯的抑郁障碍。
具有躁狂症状的组（阈下、轻躁狂和躁狂）与单纯抑郁障碍组相比要小得多。
抑郁障碍的异质性可以部分由沿躁狂症状维度的共存变化来解释。在抑郁中应考虑到共存的躁狂症状，而心境障碍的症状维度方法可能提供比当前心境障碍类别更具信息量的表型。
