Chen F Z, Xiang Y T, Lu Z, Wang G, Hu C, Kilbourne A M, Ungvari G S, Fang Y R, Si T M, Yang H C, Lai K Yc, Hu J, Chen Z Y, Huang Y, Sun J, Wang X P, Li H C, Zhang J B, Zhang X Y, Chiu H F K
Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
East Asian Arch Psychiatry. 2013 Dec;23(4):139-43.
Bipolar disorder is often misdiagnosed as major depressive disorder. Such misdiagnosis partly depends on the type of treatment setting. This study compared general hospital psychiatric units with psychiatric hospitals in China with respect to basic demographic and clinical characteristics of patients with unrecognised bipolar disorder who are treated for major depressive disorder.
Patients treated for major depressive disorder were consecutively examined in 13 health centres (6 general hospital psychiatric units and 7 psychiatric hospitals) in China. Their socio-demographic and clinical features were recorded using a standardised protocol and data collection procedure. The DSM-IV diagnoses were established using the Mini-International Neuropsychiatric Interview.
Of the 1487 patients included in the study, 309 (20.8%) were diagnosed with bipolar disorder. There was no significant difference between general hospital psychiatric units and psychiatric hospitals in the ratio of all types of unrecognised bipolar disorders (χ2 = 0.008, degrees of freedom = 1, p = 0.9) and bipolar II disorders (χ2 = 3.1, degrees of freedom = 1, p = 0.08). The proportions of unrecognised bipolar I disorders (χ2 = 4.1, degrees of freedom = 1, p = 0.04) differed significantly between the 2 types of study site. Multivariate analyses showed that patients with bipolar I disorders with more seasonal depressive episodes were more likely to receive treatment in general hospital psychiatric units (odds ratio = 3.3, 95% confidence interval = 1.1-9.8).
Patients with bipolar I disorders receiving treatment in general hospital psychiatric units had different clinical characteristics compared to their counterparts treated in psychiatric hospitals in China.
双相情感障碍常被误诊为重度抑郁症。这种误诊部分取决于治疗机构的类型。本研究比较了中国综合医院精神科与精神病医院中因重度抑郁症接受治疗但未被识别为双相情感障碍患者的基本人口统计学和临床特征。
在中国的13个医疗中心（6个综合医院精神科和7个精神病医院）对因重度抑郁症接受治疗的患者进行连续检查。使用标准化方案和数据收集程序记录他们的社会人口统计学和临床特征。采用简易国际神经精神访谈建立《精神疾病诊断与统计手册》第四版（DSM-IV）诊断。
在纳入研究的1487例患者中，309例（20.8%）被诊断为双相情感障碍。综合医院精神科与精神病医院在各类未被识别的双相情感障碍比例（χ² = 0.008，自由度 = 1，p = 0.9）和双相II型障碍比例（χ² = 3.1，自由度 = 1，p = 0.08）方面无显著差异。两种研究机构中未被识别的双相I型障碍比例（χ² = 4.1，自由度 = 1，p = 0.04）存在显著差异。多变量分析显示，季节性抑郁发作较多的双相I型障碍患者更有可能在综合医院精神科接受治疗（优势比 = 3.3，95%置信区间 = 1.1 - 9.8）。
在中国，与在精神病医院接受治疗的双相I型障碍患者相比，在综合医院精神科接受治疗的患者具有不同的临床特征。
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