EA 4166, Service du Pr d'Amato, CH le vinatier, 95 bd Pinel 69677 Bron cedex France.
Compr Psychiatry. 2013 Aug;54(6):605-10. doi: 10.1016/j.comppsych.2012.12.023. Epub 2013 Jan 31.
It is currently assumed that there are no important differences between the clinical presentations of unipolar and bipolar depression. Failure to distinguish bipolar from unipolar depression may lead to inappropriate treatment and poorer outcomes. We hereby compare unipolar and bipolar depressed subjects, in order to identify distinctive clinical specificities of bipolar depression.
Two independent samples of depressed patients (unipolar and bipolar) were recruited, with 55 patients in one sample, and 49 in the other. In both samples, unipolar and bipolar patients were compared on a broad range of parameters, including sociodemographic characteristics, comorbidities, Montgomery and Asberg Depression Scale (MADRS; assessing depression severity), CORE (assessing psychomotor disturbance) and Bipolar Depression Rating Scale (assessing specific bipolar depression symptoms).
Results were similar in both samples. MADRS scores were similar in bipolar and unipolar subjects (median score 33 vs 34; p=0.74). On the CORE, there was a trend to higher scores among the bipolar subjects. BDRS scores were higher in bipolar than in unipolar subjects (median score 33 vs 27; p<0.001). The difference was particularly marked on the "mixed" subscale of the BDRS. We tested the ability of the mixed subscale of the BDRS to distinguish bipolar from unipolar depression, using different cut off points: a cut off point of 3 can predict bipolar depression, with a sensibility of 62% and a specificity of 82%.
Presence of mixed symptoms during a depressive episode is in favour of bipolar depression. The BDRS scale should be integrated in a probabilistic approach to distinguish bipolar from unipolar depression.
目前认为单相和双相抑郁的临床表现没有重要区别。未能区分双相和单相抑郁可能导致治疗不当和预后较差。我们在此比较单相和双相抑郁患者，以确定双相抑郁的独特临床特征。
招募了两组抑郁患者（单相和双相），一组 55 例，另一组 49 例。在两组样本中，我们比较了单相和双相患者的一系列广泛参数，包括社会人口统计学特征、共病、蒙哥马利-阿斯伯格抑郁量表（MADRS；评估抑郁严重程度）、CORE（评估精神运动障碍）和双相抑郁评定量表（评估特定的双相抑郁症状）。
两组结果相似。MADRS 评分在双相和单相患者中相似（中位数 33 分与 34 分；p=0.74）。在 CORE 上，双相患者的评分有升高的趋势。BDRS 评分在双相患者中高于单相患者（中位数 33 分与 27 分；p<0.001）。BDRS 的“混合”子量表上的差异更为显著。我们使用不同的截断值测试了 BDRS 的混合子量表区分单相和双相抑郁的能力：截断值为 3 可以预测双相抑郁，其敏感性为 62%，特异性为 82%。
在抑郁发作期间出现混合症状有利于双相抑郁。BDRS 量表应纳入区分单相和双相抑郁的概率方法中。
