Department of Psychiatry, Sainte Marguerite Hospital, Marseilles 13274, France.
J Affect Disord. 2012 Dec 20;143(1-3):109-17. doi: 10.1016/j.jad.2012.05.036. Epub 2012 Jul 30.
Studies on mixed depression have been conducted so far on the basis of DSM-IV manic symptoms, i.e., a list of 7 symptoms which may provide limited information on the subsyndromal features associated with a full depressive episode.
As part of the EPIDEP National Multisite French Study of 493 consecutive DSM-IV major depressive patients evaluated in at least two semi-structured interviews 1 month apart, 102 (23.8%) were classified as mixed depressives (≥3 hypomanic symptoms), and 146 (34%) as pure depressives (0 hypomanic symptom), after exclusion of bipolar I patients; hypomanic symptoms were assessed with the Multiple Visual Analog Scales of Bipolarity (MVAS-BP, 26 items) of Ahearn-Carroll in a self assessment format. A narrower definition of mixed depression, resting on those MVAS-BP items referring to DSM-IV hypomanic symptoms was also tested, as a sensitivity analysis.
Compared to pure depressives, mixed depressive patients had more psychotic symptoms, atypical features and suicide attempts during their index episode; their illness course was characterized by early age at onset, frequent episodes, rapid cycling, and comorbidities. Mixed depressive patients were more frequently bipolar with a family history of bipolar disorder, alcohol abuse, and suicide. A dose-response relationship was found between intradepression hypomania and several clinical features, including temperament measures. The following independent variables were associated with mixed depression: hyperthymic temperament, cyclothymic temperament, irritable temperament, and alcohol abuse. Using the narrower definition of mixed depression missed risk factors such as suicidality and comorbidities.
The following are the limitations of this study: retrospective design, recall bias, lack of sample homogeneity, no cross-validation of findings by hetero-evaluation of hypomanic symptoms.
EPIDEP data showed the feasibility and face validity of self-assessment of intradepressive hypomania. They replicated previous findings on the severity and high suicidal risk of mixed depression profile. They confirmed, for mixed depression, that mixed states occur when mood episodes are superimposed upon temperaments of opposite polarity. They finally suggested that a definition of mixed depression only based on DSM-IV-TR hypomanic symptoms may not allow to identify the most unstable subforms of the entity.
迄今为止，混合性抑郁的研究是基于 DSM-IV 躁狂症状进行的，即一组 7 种症状的列表，这些症状可能提供与完整抑郁发作相关的亚综合征特征的有限信息。
作为 EPIDEP 国家多地点法国研究的一部分，该研究对至少两次相隔一个月的半结构化访谈中评估的 493 例连续 DSM-IV 主要抑郁患者进行了评估，排除双相 I 型患者后，102 例（23.8%）被分类为混合性抑郁（≥3 项轻躁狂症状），146 例（34%）为单纯性抑郁（0 项轻躁狂症状）；使用 Ahearn-Carroll 的多相视觉模拟量表（MVAS-BP，26 项）进行自我评估，评估轻躁狂症状。还测试了混合性抑郁的更窄定义，该定义基于那些与 DSM-IV 轻躁狂症状相关的 MVAS-BP 项目，作为敏感性分析。
与单纯性抑郁患者相比，混合性抑郁患者在其首发发作期间具有更多的精神病症状、非典型特征和自杀企图；他们的疾病过程以发病年龄较早、发作频繁、快速循环和合并症为特征。混合性抑郁患者更常为双相，有双相障碍家族史、酒精滥用和自杀。在抑郁内轻躁狂与多种临床特征之间发现了剂量反应关系，包括气质测量。以下独立变量与混合性抑郁相关：高气质、环性气质、易怒气质和酒精滥用。使用混合性抑郁的更窄定义可能会错过自杀和合并症等风险因素。
本研究的局限性如下：回顾性设计、回忆偏倚、样本同质性缺乏、轻躁狂症状的异性评估无交叉验证。
EPIDEP 数据显示，抑郁内轻躁狂的自我评估具有可行性和表面有效性。他们复制了先前关于混合性抑郁特征严重程度和高自杀风险的发现。他们为混合性抑郁确认，当心境发作叠加在相反极性的气质之上时，就会发生混合状态。他们最终表明，仅基于 DSM-IV-TR 轻躁狂症状的混合性抑郁定义可能无法识别该实体的最不稳定亚型。
