Zürich University Psychiatric Hospital, Lenggstrasse 31, P.O. Box 1931, 8032, Zurich, Switzerland,
Eur Arch Psychiatry Clin Neurosci. 2013 Dec;263(8):663-73. doi: 10.1007/s00406-013-0393-4. Epub 2013 Jan 31.
The definitions of bipolar-I (BP-I) and bipolar-II (BP-II) disorders are currently under revision by the APA and by the WHO. We provide evidence of a revised set of criteria for bipolar disorders and major depressive disorder (MDD) which could serve to strengthen the construct and predictive validity of both disorders and enable more incisive studies of treatments and courses of both disorders. In the diagnostic Bridge Study of 5,635 patients with major depressive episodes from 18 countries (Europe, North Africa, Near East and Far East) leading psychiatrists in each country assessed a pre-specified group of symptoms, illness course, family history and duration of episodes; these data allowed tests of several definitions of bipolarity. The primary revised specifier diagnosis of BP-I disorder included manic episodes based on an additional category A criterion (increased activity/energy) and did not apply any exclusion criteria. The revised BP-II disorders included hypomanic episodes of 1-3 days. Family history and illness course validators (history of mania/hypomania among first degree relatives, 2 or more lifetime episodes and first symptoms having occurred before age 30) discriminated clearly between patients with bipolar-I or bipolar-II disorders meeting bipolarity specifier criteria and those with MDD. Specifier definitions provided better discrimination between MDD and the two bipolar subgroups. Patterns of concurrent comorbidities also differed significantly between patients meeting criteria for MDD compared with those meeting bipolar specifier criteria. Comorbidity patterns differed between bipolar-I and bipolar-II patients. This study provides evidence for the validity of modified (specifier) BP-I and BP-II definitions that incorporate illness course and family history which reduce ambiguities of major depressive episodes between bipolar-I and bipolar-II disorders and MDD.
APA 和世界卫生组织（WHO）目前正在修订双相 I 型（BP-I）和双相 II 型（BP-II）障碍的定义。我们提供了一套修订后的双相障碍和重性抑郁障碍（MDD）的诊断标准，这些标准可以增强这两种障碍的结构和预测效度，并能够更深入地研究这两种障碍的治疗方法和病程。在这项来自 18 个国家（欧洲、北非、近东和远东）的 5635 名重性抑郁发作患者的诊断桥接研究中，每个国家的主要精神科医生评估了一组预先指定的症状、病程、家族史和发作持续时间；这些数据可用于测试几种双相性定义。BP-I 障碍的主要修订后的特定诊断标准包括基于额外 A 类标准（增加的活动/能量）的躁狂发作，并且不应用任何排除标准。修订后的 BP-II 障碍包括持续 1-3 天的轻躁狂发作。家族史和病程验证器（一级亲属中有躁狂/轻躁狂病史、2 次或以上的终生发作以及首次症状发生在 30 岁之前）可明确区分符合双相性特定诊断标准的 BP-I 或 BP-II 障碍患者和 MDD 患者。特定诊断标准提供了更好的 MDD 和两种双相亚组之间的区分。同时患有共病的模式也在符合 MDD 标准的患者与符合双相特定诊断标准的患者之间存在显著差异。双相-I 和双相-II 患者的共病模式存在差异。这项研究为纳入病程和家族史的改良（特定）BP-I 和 BP-II 定义提供了有效性证据，这些定义减少了 MDD 与 BP-I 和 BP-II 障碍之间的躁狂发作的模糊性。
