Sani Gabriele, Vöhringer Paul A, Napoletano Flavia, Holtzman Niki S, Dalley Shannon, Girardi Paolo, Ghaemi S Nassir, Koukopoulos Athanasios
NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy; Centro LucioBini, Rome, Italy; IRCCS Santa Lucia Foundation, Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, Rome, Italy.
Mood Disorders Program, Department of Psychiatry, Tufts Medical Center, Boston, MA, USA; Departamento Psiquiatria Hospital Clinico, Facultad de Medicina, Universidad Chile, Santiago, Chile.
J Affect Disord. 2014 Aug;164:14-8. doi: 10.1016/j.jad.2014.03.054. Epub 2014 Apr 12.
Mixed depression (MxD) is one subtype of depressive experiences within the depressive spectrum. MxD definition is debated among experts. Koukopoulos׳ proposed diagnostic criteria focused primarily on psychic agitation, marked irritability, and intense mood lability as markers of a mixed depressive episode. The present study validates Koukopoulos׳ criteria as diagnostic for MxD.
A sample of 435 patients from the International Mood Network (IMN), multi-center, international network of sites, and the Centro LucioBini of Rome was analyzed. Koukopoulos׳ criteria were assessed in all patients.
The most prevalent MxD criteria were "absence of psychomotor retardation" (84%), "mood lability or marked reactivity" (78%), and "psychic agitation or inner tension" (75%). Multivariable predictors of a MxD (+) diagnosis were: higher current CGI (OR=1.23, 95% CI 1.23, 2.84), lower rates of previous bipolar type I diagnosis (OR=0.54, 95% CI -3.28, -0.13), mixed symptoms on the index episode (OR=10.02, 95% CI 2.32, 24.12), rapid cycling course (OR=2.6 95% CI 1.45, 3.56), past substance abuse (OR=3.02, 95% CI 2.01, 5.67) and lower education status (OR=0.44, 95% CI -3.23, -0.98). This model showed a sensitivity of 76.4%, specificity of 86.3%, negative predictive value of 75%, and positive predictive value of 86%.
An external validation of these criteria in an independent sample is warranted.
A broad definition of mixed depression was internally validated with multiple diagnostic validators and was sensitively and specifically predicted. Contrary to DSM-5, Koukopoulos׳ broad criteria include agitation, irritability and mood lability as core features.
混合性抑郁（MxD）是抑郁谱系中抑郁体验的一种亚型。专家们对MxD的定义存在争议。库科普洛斯提出的诊断标准主要集中在精神运动性激越、明显的易激惹性和强烈的情绪不稳，作为混合性抑郁发作的标志。本研究验证了库科普洛斯的标准对MxD的诊断价值。
对来自国际情绪网络（IMN）、多中心国际站点网络以及罗马卢西奥·比尼中心的435例患者样本进行了分析。对所有患者评估了库科普洛斯的标准。
最常见的MxD标准是“无精神运动性迟缓”（84%）、“情绪不稳或明显反应性”（78%）以及“精神运动性激越或内心紧张”（75%）。MxD（+）诊断的多变量预测因素为：当前CGI评分较高（OR=1.23，95%CI 1.23，2.84）、既往I型双相障碍诊断率较低（OR=0.54，95%CI -3.28，-0.13）、本次发作有混合症状（OR=10.02，95%CI 2.32，24.）、快速循环病程（OR=2.6，95%CI 1.45，3.56）、既往药物滥用（OR=3.02，95%CI 2.01，5.67）以及较低的教育程度（OR=0.44，95%CI -3.23，-0.98）。该模型的敏感性为76.4%，特异性为86.3%，阴性预测值为75%，阳性预测值为86%。
有必要在独立样本中对这些标准进行外部验证。
混合性抑郁的广义定义通过多种诊断验证指标在内部得到了验证，且具有较高的敏感性和特异性预测能力。与《精神疾病诊断与统计手册》第5版（DSM-5）不同，库科普洛斯的广义标准将激越、易激惹性和情绪不稳作为核心特征。
