Iwanami Takao, Maeshima Hitoshi, Baba Hajime, Satomura Emi, Namekawa Yuki, Shimano Takahisa, Suzuki Toshihito, Arai Heii
Department of Psychiatry, Juntendo University, School of Medicine, Tokyo, Japan.
Juntendo University Mood Disorder Project (JUMP), Department of Psychiatry, Juntendo Koshigaya Hospital, 560 Fukuroyama, Koshigaya-shi, Saitama 343-0032, Japan; Department of Psychiatry, Juntendo University, School of Medicine, Tokyo, Japan.
J Affect Disord. 2015 Jan 1;170:185-9. doi: 10.1016/j.jad.2014.09.001. Epub 2014 Sep 8.
The relationship between psychomotor agitation in unipolar depression and mood-switching from depression to manic, hypomanic and mixed states has been controversial. We investigated the future risk of initial mood-switching as a function of psychomotor agitation in unipolar depression.
We identified 189 participants diagnosed with major depressive disorder (MDD). We divided all patients with MDD into two categories (1) agitated patients (n=74), and (2) non-agitated patients (n=115). These groups were prospectively followed and compared by time to mood-switching. Kaplan-Meier survival curves, log-rank test for trend for survivor functions, and Cox proportional hazard ratio estimates for a multivariate model were conducted to examine the risk of mood-switching by psychomotor agitation.
During follow-up, mood-switching occurred in 20.3% of the agitated patients and 7.0% of the non-agitated patients. In the Kaplan-Meier survival estimates for time to incidence of mood-switching with agitated or non-agitated patients, the cumulative probability of developing mood-switching for agitated patients was higher than those for non-agitated patients (log-rank test: χ(2)=7.148, df=1, p=0.008). Survival analysis was also performed using Cox proportional hazards regression within a multivariate model. The agitation remained significantly associated with incidence of mood-switching (HR=2.98, 95% CI: 1.18-7.51).
We did not make a clear distinction between antidepressant-induced mood-switching and spontaneous switching.
The main finding demonstrated that MDD patients with agitation were nearly threefold as likely to experience mood-switching, suggesting that psychomotor agitation in MDD may be related to an indicator of bipolarity.
单相抑郁症中的精神运动性激越与从抑郁状态转换为躁狂、轻躁狂和混合状态之间的关系一直存在争议。我们研究了单相抑郁症中精神运动性激越作为初始心境转换未来风险的函数。
我们确定了189名被诊断为重度抑郁症（MDD）的参与者。我们将所有MDD患者分为两类：（1）激越患者（n = 74），和（2）非激越患者（n = 115）。对这些组进行前瞻性随访，并比较心境转换的时间。进行了Kaplan-Meier生存曲线、生存函数趋势的对数秩检验以及多变量模型的Cox比例风险比估计，以研究精神运动性激越导致心境转换的风险。
在随访期间，20.3%的激越患者和7.0%的非激越患者发生了心境转换。在激越或非激越患者心境转换发生率的Kaplan-Meier生存估计中，激越患者发生心境转换的累积概率高于非激越患者（对数秩检验：χ(2)=7.148，自由度=1，p = 0.008）。还在多变量模型中使用Cox比例风险回归进行了生存分析。激越仍然与心境转换的发生率显著相关（HR = 2.98，95% CI：1.18 - 7.51）。
我们没有明确区分抗抑郁药引起的心境转换和自发转换。
主要发现表明，伴有激越的MDD患者经历心境转换的可能性几乎是其三倍，这表明MDD中的精神运动性激越可能与双相性的一个指标有关。
