Angst Jules, Azorin Jean-Michel, Bowden Charles L, Perugi Giulio, Vieta Eduard, Gamma Alex, Young Allan H
The University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
Arch Gen Psychiatry. 2011 Aug;68(8):791-8. doi: 10.1001/archgenpsychiatry.2011.87.
Major depressive disorder, the most common psychiatric illness, is often chronic and a major cause of disability. Many patients with major depressive episodes who have an underlying but unrecognized bipolar disorder receive pharmacologic treatment with ineffective regimens that do not include mood stabilizers.
To determine the frequency of bipolar disorder symptoms in patients seeking treatment for a major depressive episode.
Multicenter, multinational, transcultural, cross-sectional, diagnostic study. The study arose from the initiative Bipolar Disorders: Improving Diagnosis, Guidance and Education (BRIDGE).
Community and hospital psychiatry departments.
Participants included 5635 adults with an ongoing major depressive episode.
The frequency of bipolar disorder was determined by applying both DSM-IV-TR criteria and previously described bipolarity specifier criteria. Variables associated with bipolarity were assessed using logistic regression.
A total of 903 patients fulfilled DSM-IV-TR criteria for bipolar disorder (16.0%; 95% confidence interval, 15.1%-17.0%), whereas 2647 (47.0%; 95% confidence interval, 45.7%-48.3%) met the bipolarity specifier criteria. Using both definitions, significant associations (odds ratio > 2; P < .001) with bipolarity were observed for family history of mania/hypomania and multiple past mood episodes. The bipolarity specifier additionally identified significant associations for manic/hypomanic states during antidepressant therapy, current mixed mood symptoms, and comorbid substance use disorder.
The bipolar-specifier criteria in comparison with DSM-IV-TR criteria were valid and identified an additional 31% of patients with major depressive episodes who scored positive on the bipolarity criteria. Family history, illness course, and clinical status, in addition to DSM-IV-TR criteria, may provide useful information for physicians when assessing evidence of bipolarity in patients with major depressive episodes. Such an assessment is recommended before deciding on treatment.
重度抑郁症是最常见的精神疾病，通常呈慢性，是导致残疾的主要原因。许多患有重度抑郁发作且存在潜在但未被识别的双相情感障碍的患者接受了不包括心境稳定剂的无效药物治疗方案。
确定寻求重度抑郁发作治疗的患者中双相情感障碍症状的发生率。
多中心、跨国、跨文化的横断面诊断研究。该研究源于双相情感障碍：改善诊断、指导与教育（BRIDGE）倡议。
社区和医院精神科。
参与者包括5635名患有持续性重度抑郁发作的成年人。
通过应用《精神疾病诊断与统计手册》第四版修订版（DSM-IV-TR）标准和先前描述的双相性说明符标准来确定双相情感障碍的发生率。使用逻辑回归评估与双相性相关的变量。
共有903名患者符合DSM-IV-TR双相情感障碍标准（16.0%；95%置信区间，15.1%-17.0%），而2647名（47.0%；95%置信区间，45.7%-48.3%）符合双相性说明符标准。使用这两种定义，对于躁狂/轻躁狂家族史和既往多次情绪发作，均观察到与双相性有显著关联（优势比>2；P<.001）。双相性说明符还额外确定了抗抑郁治疗期间的躁狂/轻躁狂状态、当前混合情绪症状以及共病物质使用障碍之间的显著关联。
与DSM-IV-TR标准相比，双相性说明符标准是有效的，并且在双相性标准上呈阳性的重度抑郁发作患者中又额外识别出了31%。除了DSM-IV-TR标准外，家族史、病程和临床状态可能为医生在评估重度抑郁发作患者的双相性证据时提供有用信息。在决定治疗之前，建议进行这样的评估。
