中国被误诊为重度抑郁症的双相情感障碍患者的人口统计学和临床特征。

Sociodemographic and clinical features of bipolar disorder patients misdiagnosed with major depressive disorder in China.

机构信息

Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, China.

出版信息

Bipolar Disord. 2013 Mar;15(2):199-205. doi: 10.1111/bdi.12052.

DOI:10.1111/bdi.12052

PMID:23437963

Abstract

OBJECTIVES

Bipolar disorder (BD) is frequently misdiagnosed as major depressive disorder (MDD), which may lead to inappropriate treatment and poor outcomes. This study aimed to compare demographic and clinical features between patients with MDD and those with BD, but being misdiagnosed as MDD, in China.

METHODS

A total of 1487 patients diagnosed with MDD were consecutively evaluated in 13 psychiatric hospitals or psychiatric units of general hospitals nationwide in China. The patients' sociodemographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. The Mini-International Neuropsychiatric Interview (MINI) was used to establish DSM-IV diagnoses, and identify patients with MDD and those with BD, but being misdiagnosed with MDD.

RESULTS

The proportions of BD (all types), bipolar I disorder (BD-I), and bipolar II disorder (BD-II) misdiagnosed as MDD in clinical practice were 20.8%, 7.9%, and 12.8%, respectively. Multiple logistic regression analyses revealed that compared to MDD patients, BD-I was characterized by more atypical depressive features (increased appetite, increased sleep, and weight gain) [odds ratio (OR) = 2.0, 95% confidence interval (CI): 1.2-3.2], more psychotic symptoms (OR = 2.1, 95% CI: 1.3-3.5), more lifetime depressive episodes (OR = 1.1, 95% CI: 1.1-1.2), and earlier age of onset (OR = 0.97, 95% CI: 0.9-0.99); BD-II was characterized by more psychotic symptoms (OR = 2.1, 95% CI: 1.4-3.1) and earlier age of onset (OR = 0.96, 95% CI: 0.9-0.97). In addition, compared to BD-II patients, BD-I patients were characterized by more frequent depressive episodes per year (OR = 3.1, 95% CI: 1.5-6.6).

CONCLUSIONS

Depressive episodes in the context of BD-I and BD-II, among those who were misclassified as MDD, present some different clinical features compared to MDD. This finding should be taken into account in guiding diagnostic practices in China.

摘要

目的

双相情感障碍（BD）常被误诊为重度抑郁症（MDD），这可能导致治疗不当和预后不良。本研究旨在比较中国 MDD 患者和误诊为 MDD 的 BD 患者的人口统计学和临床特征。

方法

在中国全国 13 家精神病院或综合医院的精神病科，连续评估了 1487 例被诊断为 MDD 的患者。使用标准化协议和数据收集程序记录患者的社会人口统计学和临床特征。使用 Mini-国际神经精神访谈（MINI）建立 DSM-IV 诊断，并确定误诊为 MDD 的 MDD 患者和 BD 患者。

结果

BD（所有类型）、双相 I 型障碍（BD-I）和双相 II 型障碍（BD-II）误诊为 MDD 的比例分别为 20.8%、7.9%和 12.8%。多因素逻辑回归分析显示，与 MDD 患者相比，BD-I 患者的特点是更典型的抑郁特征（食欲增加、睡眠增加和体重增加）[比值比（OR）=2.0，95%置信区间（CI）：1.2-3.2]、更多的精神病症状（OR=2.1，95%CI：1.3-3.5）、更多的终生抑郁发作（OR=1.1，95%CI：1.1-1.2）和更早的发病年龄（OR=0.97，95%CI：0.9-0.99）；BD-II 的特点是更多的精神病症状（OR=2.1，95%CI：1.4-3.1）和更早的发病年龄（OR=0.96，95%CI：0.9-0.97）。此外，与 BD-II 患者相比，BD-I 患者每年的抑郁发作次数更多（OR=3.1，95%CI：1.5-6.6）。