NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
Psychother Psychosom. 2014;83(4):213-21. doi: 10.1159/000358808. Epub 2014 Jun 19.
Mixed depression (MxD) is narrowly defined in the DSM-IV and somewhat broader in the DSM-5, although both exclude psychomotor agitation as a diagnostic criterion. This article proposes a clinical description for defining MxD, which emphasizes psychomotor excitation.
Two hundred and nineteen consecutive outpatients were diagnosed with an MxD episode using criteria proposed by Koukopoulos et al. [Acta Psychiatr Scand 2007;115(suppl 433):50-57]; we here report their clinical features and antidepressant-related effects.
The most frequent MxD symptoms were: psychic agitation or inner tension (97%), absence of retardation (82%), dramatic description of suffering or weeping spells (53%), talkativeness (49%), and racing or crowded thoughts (48%). MxD was associated with antidepressants in 50.7% of patients, with similar frequency for tricyclic antidepressants (45%) versus selective serotonin reuptake inhibitors (38.5%). Positive predictors of antidepressant-associated MxD were bipolar disorder type II diagnosis, higher index depression severity, and higher age at index episode. Antipsychotic or no treatment was protective against antidepressant-associated MxD.
MxD, defined as depression with excitatory symptoms, can be clinically identified, is common, occurs in both unipolar depression and bipolar disorder, and is frequently associated with antidepressant use. If replicated, this view of MxD could be considered a valid alternative to the DSM-5 criteria for depression with mixed features.
DSM-IV 对混合性抑郁（MxD）的定义较为狭隘，而 DSM-5 则稍宽，但两者均将精神运动激越排除在诊断标准之外。本文提出了一种临床定义 MxD 的方法，该方法强调精神运动兴奋。
使用 Koukopoulos 等人提出的标准[Acta Psychiatr Scand 2007;115(suppl 433):50-57]，对 219 例连续门诊患者进行 MxD 发作的诊断；在此报告他们的临床特征和抗抑郁药相关效应。
最常见的 MxD 症状为：精神运动激越或内心紧张（97%）、无迟滞（82%）、戏剧性描述痛苦或哭泣发作（53%）、多话（49%）和思维奔逸或拥挤（48%）。MxD 与抗抑郁药相关的患者占 50.7%，三环类抗抑郁药（45%）与选择性 5-羟色胺再摄取抑制剂（38.5%）的频率相似。抗抑郁药相关 MxD 的阳性预测因子为双相障碍 II 型诊断、较高的指数抑郁严重程度和指数发作时的较高年龄。抗精神病药或无治疗可预防抗抑郁药相关的 MxD。
定义为伴有兴奋症状的抑郁的 MxD 可以通过临床识别，较为常见，发生在单相和双相障碍中，且常与抗抑郁药的使用有关。如果得到证实，这种对 MxD 的看法可以被视为 DSM-5 混合特征性抑郁标准的有效替代方法。
