Department of Psychiatry, CHUV, Lausanne, Switzerland.
Department of Psychiatry, CHUV, Lausanne, Switzerland.
J Affect Disord. 2014;167:198-205. doi: 10.1016/j.jad.2014.06.004. Epub 2014 Jun 12.
To 1) establish the lifetime and 12-month prevalence of DSM-5 bipolar and related disorders including the new algorithmically defined conditions grouped within Other Specified Bipolar and Related Disorders (OSBARD) as well as hyperthymic personality in a randomly selected community sample, and 2) determine the clinical relevance of the OSBARD category in terms of sociodemographic characteristics, course, comorbidity and treatment patterns by comparing the subjects of this category to those with bipolar-I (BP-I), bipolar-II (BP-II), major depressive disorder (MDD), and those with no history of mood disorders.
The semi-structured Diagnostic Interview for Genetic Studies was administered by masterslevel psychologists to a random sample of an urban area (n=3'719).
The lifetime prevalence was 1.0% for BP-I, 0.8% for BP-II, 1.0% for OSBARD and 3% for hyperthymic personality. Subjects with OSBARD were more severely affected than subjects without a history of mood disorders regarding almost all clinical correlates. Compared to those with MDD, they also revealed an elevated risk of suicidal attempts, lower global functioning, more treatment seeking and more lifetime comorbidity including anxiety, substance use and impulse-control disorders. However, they did not differ from subjects with BP-II.
Small sample sizes for bipolar and related disorders and potential inaccurate recall of symptoms.
The modifications of diagnostic criteria for manic/hypomanic episodes according to the DSM-5 only marginally affect the prevalence estimates for BP-I and BP-II. The new DSM-5 OSBARD category is associated with significant clinical burden, is hardly distinct from BP-II with respect to clinical correlates and deserves similar clinical attention.
1）在随机选择的社区样本中建立 DSM-5 双相及相关障碍的终身患病率和 12 个月患病率，包括新的算法定义的条件，这些条件被归类为其他特定的双相及相关障碍（OSBARD）以及高功能人格；2）通过比较该类别中的受试者与双相 I 型（BP-I）、双相 II 型（BP-II）、重性抑郁障碍（MDD）和无心境障碍史的受试者，确定 OSBARD 类别的临床相关性，包括社会人口统计学特征、病程、共病和治疗模式。
由硕士水平的心理学家对城市地区的随机样本（n=3719）进行半结构式遗传研究诊断访谈。
BP-I 的终身患病率为 1.0%，BP-II 为 0.8%，OSBARD 为 1.0%，高功能人格为 3.0%。OSBARD 组的受试者在几乎所有的临床相关性方面都比无心境障碍史的受试者受到更严重的影响。与 MDD 患者相比，他们也有更高的自杀企图风险、更低的总体功能、更多的治疗寻求和更多的终身共病，包括焦虑、物质使用和冲动控制障碍。然而，他们与 BP-II 患者没有差异。
双相和相关障碍的样本量较小，以及症状的潜在不准确回忆。
DSM-5 对躁狂/轻躁狂发作的诊断标准的修改仅对 BP-I 和 BP-II 的患病率估计产生轻微影响。新的 DSM-5 OSBARD 类别与显著的临床负担相关，与临床相关性方面与 BP-II 几乎没有区别，值得给予类似的临床关注。
