Department of Psychiatry, Neurobiology, Pharmacology, and Biotechnology, School of Medicine, University of Pisa, Pisa, Italy.
J Clin Psychiatry. 2012 Jan;73(1):22-8. doi: 10.4088/JCP.11m06946.
Multiple studies indicate that bipolar disorders are often underrecognized, misdiagnosed, and incorrectly treated. The aim of the present report is to determine which combination of clinical, demographic, and psychopathological factors and corresponding cutoff scores best discriminate patients with unipolar disorder from those with bipolar disorders.
The study sample includes outpatients and inpatients (N = 1,158) participating in 5 studies carried out in the United States and Italy between October 2001 and March 2008, one of which was a randomized clinical trial. Diagnostic assessment was carried out with the SCID, which allows diagnoses to be made according to DSM-IV-TR criteria. Using an exploratory statistical approach based on a classification tree, we employed 5 mania spectrum factors and 6 depression spectrum factors derived from the Mood Spectrum Self-Report Instrument (MOODS-SR) in combination with demographic and clinical characteristics to discriminate participants with unipolar versus bipolar disorders.
The psychomotor activation factor, assessing the presence of thought acceleration, distractibility, hyperactivity, and restlessness for 1 or more periods of at least 3 to 5 days in the lifetime, identified subgroups with an increasing likelihood of bipolar disorder diagnosis. Mixed instability and suicidality contributed to further subtyping the sample into mutually exclusive groups, characterized by a different likelihood of receiving a diagnosis of bipolar disorder. Of the demographic and clinical characteristics included in the analysis, only sex proved to be useful to improve the discrimination.
The psychomotor activation factor proved to be the most potent discriminator of those with unipolar versus bipolar diagnoses. The items that constitute this factor, together with those that constitute the mixed instability, suicidality, and euphoria factors, might be useful in making the differential diagnosis.
多项研究表明，双相情感障碍经常被漏诊、误诊和治疗不当。本报告的目的是确定哪些临床、人口统计学和精神病理学因素组合以及相应的截断分数最能区分单相障碍患者和双相障碍患者。
研究样本包括 2001 年 10 月至 2008 年 3 月期间在美国和意大利进行的 5 项研究中的门诊和住院患者（N=1158），其中一项为随机临床试验。诊断评估采用 SCID 进行，根据 DSM-IV-TR 标准进行诊断。我们采用基于分类树的探索性统计方法，使用来自心境谱自我报告量表（MOODS-SR）的 5 个躁狂谱因素和 6 个抑郁谱因素，结合人口统计学和临床特征，来区分单相和双相障碍患者。
评估一生中至少 3-5 天存在思维加速、注意力不集中、多动和不安的精神运动激活因子，确定了具有越来越高的双相障碍诊断可能性的亚组。混合不稳定性和自杀意念有助于进一步将样本分为相互排斥的组，其特征是双相障碍诊断的可能性不同。在纳入分析的人口统计学和临床特征中，只有性别被证明有助于提高区分度。
精神运动激活因子被证明是区分单相和双相诊断的最有力的鉴别因素。构成该因子的项目，以及构成混合不稳定性、自杀意念和欣快因子的项目，可能有助于做出鉴别诊断。
