Department of Psychiatry, University at Buffalo, Buffalo, NY, USA.
Postgrad Med. 2011 Sep;123(5):129-33. doi: 10.3810/pgm.2011.09.2468.
To examine the prevalence and treatment of typical and subsyndromal bipolar disorder (BD) in depressed primary care patients.
Patients with a diagnosis of a mood disorder being treated with antidepressants in 2 academic family practice clinics underwent a structured diagnostic interview (Mini International Neuropsychiatric Inventory) for manic and hypomanic symptoms.
Of 58 patients evaluated, 19% met full criteria for bipolar I disorder and 8.6% for bipolar II disorder; 31% had subsyndromal BD (ie, persistent elation or irritability accompanied by additional symptoms of hypomania but not enough symptoms to meet full criteria for bipolar I or II disorder). Only 5 patients with BD were receiving mood stabilizers, which had not been instituted in any patient by the primary care physician.
The high prevalence of patients meeting full criteria for BD and the low rate of identification of BD in primary care patients are consistent with estimates using self-administered questionnaires, but the interview revealed a substantial additional population that could be considered to have subsyndromal BD. Because subsyndromal forms of BD are associated with significant impairment and comorbidity as well as progression to frank BD, recognition of both full and subthreshold BD in primary care practice should be improved.
调查抑郁初级保健患者中典型和亚综合征双相情感障碍（BD）的患病率和治疗情况。
在 2 家学术家庭实践诊所中，正在接受抗抑郁药治疗的心境障碍患者接受了躁狂和轻躁狂症状的结构化诊断访谈（Mini 国际神经精神访谈）。
在 58 名接受评估的患者中，19%符合双相 I 型障碍的全部标准，8.6%符合双相 II 型障碍的全部标准；31%存在亚综合征 BD（即持续兴奋或易怒，伴有轻躁狂的其他症状，但没有足够的症状符合双相 I 或 II 型障碍的全部标准）。只有 5 名 BD 患者正在服用情绪稳定剂，而初级保健医生并未在任何患者中使用这些药物。
符合 BD 全部标准的患者患病率较高，初级保健患者中 BD 的识别率较低，这与使用自我管理问卷的估计一致，但访谈显示存在大量可被视为亚综合征 BD 的患者。由于亚综合征形式的 BD 与显著的损害和共病以及向明显 BD 的进展有关，因此应改善初级保健实践中对完整和亚阈值 BD 的识别。
