Boschloo Lynn, Spijker Annet T, Hoencamp Erik, Kupka Ralph, Nolen Willem A, Schoevers Robert A, Penninx Brenda W J H
University of Groningen, University Medical Center Groningen (UMCG), Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE)/University Center Psychiatry (UCP), Groningen, The Netherlands; Vrije University Medical Center (VUMC), Department of Psychiatry and Extramuraal Geneeskundig Onderzoek (EMGO) Institute for Health and Care Research, Amsterdam, The Netherlands.
PsyQ, Department of Mood Disorders, The Hague, The Netherlands.
PLoS One. 2014 Sep 26;9(9):e106871. doi: 10.1371/journal.pone.0106871. eCollection 2014.
One third of patients with a major depressive episode also experience manic symptoms or, even, a (hypo)manic episode. Retrospective studies on the temporal sequencing of symptomatology suggest that the majority of these patients report depressive symptoms before the onset of manic symptoms. However, prospective studies are scarce and this study will, therefore, prospectively examine the onset of either manic symptoms or a (hypo)manic episode in patients with a major depressive disorder. In addition, we will consider the impact of a large set of potential risk factors on both outcomes.
Four-year follow-up data were used to determine the onset of manic symptoms as well as a CIDI-based (hypo)manic episode in a large sample (n = 889, age: 18-65 years) of outpatients with a major depressive disorder and without manic symptoms at baseline. Baseline vulnerability (i.e., sociodemographics, family history of depression, childhood trauma, life-events) and clinical (i.e., isolated manic symptoms, depression characteristics, and psychiatric comorbidity) factors were considered as potential risk factors.
In our sample of depressed patients, 15.9% developed manic symptoms and an additional 4.7% developed a (hypo)manic episode during four years. Baseline isolated manic symptoms and comorbid alcohol dependence predicted both the onset of manic symptoms and a (hypo)manic episode. Low education only predicted the onset of manic symptoms, whereas male gender, childhood trauma and severity of depressive symptoms showed strong associations with, especially, the onset of (hypo)manic episodes.
A substantial proportion (20.6%) of patients with a major depressive disorder later developed manic symptoms or a (hypo)manic episode. Interestingly, some identified risk factors differed for the two outcomes, which may indicate that pathways leading to the onset of manic symptoms or a (hypo)manic episode might be different. Our findings indirectly support a clinical staging model.
三分之一的重度抑郁发作患者还会出现躁狂症状，甚至是一次（轻）躁狂发作。对症状时间顺序的回顾性研究表明，这些患者中的大多数在躁狂症状发作之前报告有抑郁症状。然而，前瞻性研究很少，因此，本研究将前瞻性地检查重度抑郁症患者躁狂症状或（轻）躁狂发作的起始情况。此外，我们将考虑大量潜在风险因素对这两种结果的影响。
利用四年的随访数据来确定在一大样本（n = 889，年龄：18 - 65岁）基线时无躁狂症状的重度抑郁症门诊患者中躁狂症状的起始情况以及基于复合性国际诊断交谈检查表（CIDI）的（轻）躁狂发作情况。基线易感性（即社会人口统计学、抑郁症家族史、童年创伤、生活事件）和临床（即孤立的躁狂症状、抑郁特征和精神共病）因素被视为潜在风险因素。
在我们的抑郁症患者样本中，15.9%出现了躁狂症状，另有4.7%在四年期间出现了（轻）躁狂发作。基线时孤立的躁狂症状和共病酒精依赖既预测了躁狂症状的起始，也预测了（轻）躁狂发作。低教育程度仅预测了躁狂症状的起始，而男性、童年创伤和抑郁症状的严重程度与（轻）躁狂发作的起始尤其密切相关。
相当一部分（20.6%）重度抑郁症患者后来出现了躁狂症状或（轻）躁狂发作。有趣的是，两种结果的一些已确定风险因素有所不同，这可能表明导致躁狂症状或（轻）躁狂发作起始的途径可能不同。我们的研究结果间接支持了一种临床分期模型。
