Shabani Amir, Zolfigol Fatemeh, Akbari Mehdi
Iran Hospital of Psychiatry, Iran University of Medical Sciences, Tehran, Iran.
J Res Med Sci. 2009 Jan;14(1):29-35.
A bipolar spectrum definition presented to help the designation of more appropriate diagnostic criteria for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) is Ghaemi et al. Bipolar Spectrum Disorder (BSD). The present study evaluates the BSD frequency among inpatients with major depressive disorder (MDD) and tries to elucidate the contribution of second degree diagnostic items of BSD in the BSD definition.
One hundred individuals aged 18-65 with current MDD consecutive admitted in three university affiliated psychiatric center were clinically interviewed. The patients with mental retardation or the history of substance dependence/ abuse were excluded. The interviews were carried out by a trained general practitioner according to an 11-item checklist comprised of criteria C (2 items) and D (9 items) of Ghaemi et al. BSD.
Fifty three males and 47 females entered the study. Patients' mean age was 34.16 ± 9.58. Thirty eight patients (39.2%: 18 males and 20 females) met the complete diagnostic criteria of BSD. Early onset depression (53.0%), recurrent depression (40.0%) and treatment resistant depression (38.8%) were the most frequent accessory items of BSD, but using logistic regression three items recurrent major depressive episodes (MDEs), treatment resistant depression, and brief MDE- had the significant weight to predict the BSD. Then, three mentioned items were simultaneously entered the logistic regression model: brief MDE (β = 1.5, EXP (β) = 4.52, p = 0.007), treatment resistant depression (β = 1.28, EXP (β) = 3.62, p = 0.01), and recurrent MDEs (β = 1.28, EXP (β) = 3.62, p = 0.01) had the highest strength in predicting BSD and account for 21-30% of BSD diagnosis variance in sum.
Regarding the greater diagnostic strength of some accessory items - especially brief MDE - to predict the BSD, it is suggested that these items were considered as the main ones in the BSD criterion C.
为帮助《精神疾病诊断与统计手册》第五版（DSM-V）制定更合适的诊断标准而提出的双相谱系定义是由加埃米等人提出的双相谱系障碍（BSD）。本研究评估了重度抑郁症（MDD）住院患者中BSD的发生率，并试图阐明BSD二级诊断项目在BSD定义中的作用。
对连续入住三家大学附属医院精神科中心的100名年龄在18 - 65岁且患有当前MDD的个体进行临床访谈。排除有智力障碍或物质依赖/滥用史的患者。访谈由一名经过培训的全科医生根据一份由加埃米等人的BSD标准C（2项）和D（9项）组成的11项检查表进行。
53名男性和47名女性进入研究。患者的平均年龄为34.16±9.58。38名患者（39.2%：18名男性和20名女性）符合BSD的完整诊断标准。早发性抑郁（53.0%）、复发性抑郁（40.0%）和难治性抑郁（38.8%）是BSD最常见的辅助项目，但使用逻辑回归分析，复发性重度抑郁发作（MDEs）、难治性抑郁和短暂MDE这三个项目对预测BSD具有显著权重。然后，将上述三个项目同时纳入逻辑回归模型：短暂MDE（β = 1.5，EXP(β) = 4.52，p = 0.007）、难治性抑郁（β = 1.28，EXP(β) = 3.62，p = 0.01）和复发性MDEs（β = 1.28，EXP(β) = 3.62，p = 0.01）在预测BSD方面具有最高强度，总计占BSD诊断方差的21 - 30%。
鉴于一些辅助项目——尤其是短暂MDE——在预测BSD方面具有更强的诊断效力，建议将这些项目视为BSD标准C中的主要项目。
