Kim Kyung Ran, Cho Hyun-Sang, Kim Se Joo, Seok Jeong-Ho, Lee Eun, Jon Duk-In
Department of Psychiatry, College of Medicine, Yonsei University, Seoul, South Korea.
J Nerv Ment Dis. 2013 Aug;201(8):686-90. doi: 10.1097/NMD.0b013e31829c505a.
Mixed manic/depressive episodes in patients with bipolar disorder are underdiagnosed because of restrictive diagnostic criteria. Using the broader definition of a mixed episode represented by the Cincinnati criteria, we reevaluated the medical records of patients with bipolar disorder hospitalized for a manic episode. We also examined the predictive power of previously unrecognized depressive symptoms. Of 520 inpatients with mania, we retrospectively diagnosed 59 (11.3%) as having a probable mixed episode. Compared with the patients with pure mania, the patients with mixed episodes were more likely to have a family history of psychiatric illness, comorbid personality disorder, and a history of suicide attempts. Binary logistic regression revealed that loss of interest, loss of energy, feelings of worthlessness, and feelings of helplessness had good positive predictive value (>0.7) for mixed episodes. Accurate diagnosis of mixed episodes may require a broadening of diagnostic criteria and emphasis on symptoms such as loss of interest, loss of energy, and feelings of worthlessness and helplessness.
由于诊断标准严格，双相情感障碍患者的混合躁狂/抑郁发作常被漏诊。采用辛辛那提标准所代表的更宽泛的混合发作定义，我们重新评估了因躁狂发作住院的双相情感障碍患者的病历。我们还研究了此前未被认识到的抑郁症状的预测能力。在520名躁狂症住院患者中，我们回顾性诊断出59例（11.3%）可能为混合发作。与单纯躁狂患者相比，混合发作患者更可能有精神疾病家族史、共病的人格障碍以及自杀未遂史。二元逻辑回归显示，兴趣丧失、精力丧失、无价值感和无助感对混合发作具有良好的阳性预测价值（>0.7）。准确诊断混合发作可能需要拓宽诊断标准，并重视兴趣丧失、精力丧失、无价值感和无助感等症状。
