Department of Psychology, Northwestern University, Evanston, IL 60208, USA.
Bipolar Disord. 2011 Nov-Dec;13(7-8):587-603. doi: 10.1111/j.1399-5618.2011.00957.x.
Research suggests that current diagnostic criteria for bipolar disorders may fail to include milder, but clinically significant, bipolar syndromes and that a substantial percentage of these conditions are diagnosed, by default, as unipolar major depression. Accordingly, a number of researchers have argued for the upcoming 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to better account for subsyndromal hypomanic presentations.
The present paper is a critical review of research on subthreshold bipolarity, and an assessment of some of the challenges that researchers and clinicians might face if the DSM-5 were designed to systematically document subsyndromal hypomanic presentations.
Individuals with major depressive disorder (MDD) who display subsyndromal hypomanic features, not concurrent with a major depressive episode, have a more severe course compared to individuals with MDD and no hypomanic features, and more closely resemble individuals with bipolar disorder on a number of clinical validators.
There are clinical and scientific reasons for systematically documenting subsyndromal hypomanic presentations in the assessment and diagnosis of mood disorders. However, these benefits are balanced with important challenges, including (i) the difficulty in reliably identifying subsyndromal hypomanic presentations, (ii) operationalizing subthreshold bipolarity, (iii) differentiating subthreshold bipolarity from borderline personality disorder, (iv) the risk of over-diagnosing bipolar spectrum disorders, and (v) uncertainties about optimal interventions for subthreshold bipolarity.
研究表明，目前双相情感障碍的诊断标准可能无法包括更轻微但具有临床意义的双相综合征，而且这些情况下相当大的比例被默认诊断为单相重度抑郁症。因此，许多研究人员认为即将发布的《精神障碍诊断与统计手册》（DSM-5）第五版应更好地考虑亚综合征轻躁狂表现。
本文是对亚双相情感障碍研究的批判性回顾，以及如果 DSM-5 旨在系统地记录亚综合征轻躁狂表现，研究人员和临床医生可能面临的一些挑战的评估。
与没有轻躁狂特征的单相重度抑郁症患者相比，伴有亚综合征轻躁狂特征但不伴有重度抑郁发作的重度抑郁症患者病程更严重，并且在许多临床验证器上更类似于双相情感障碍患者。
在情绪障碍的评估和诊断中系统地记录亚综合征轻躁狂表现具有临床和科学依据。然而，这些益处与重要的挑战相平衡，包括（i）可靠识别亚综合征轻躁狂表现的困难，（ii）亚双相情感障碍的操作性定义，（iii）区分亚综合征双相情感障碍与边缘型人格障碍，（iv）过度诊断双相谱系障碍的风险，以及（v）对亚综合征双相情感障碍的最佳干预措施的不确定性。
