Liu Xiaohua, Jiang Kaida
Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University, Shanghai, China.
Shanghai Arch Psychiatry. 2014 Oct;26(5):294-6. doi: 10.11919/j.issn.1002-0829.214146.
The new diagnostic category in the Depressive Disorders chapter of DSM-5 entitled 'Major Depressive Disorder With Mixed Features' is applied to individuals who meet criteria for Major Depressive Disorder and have concurrent subsyndromal hypomanic or manic symptoms. But the operational definition of this new specifier is much closer to that of hypomania and mania than to the definition of atypical depression or the older 'mixed depression.' Moreover, multiple studies have shown that the characteristics of individuals with this condition and the clinical trajectory of their illness is much closer to that of bipolar patients than to that of depressed individuals without comorbid hypomanic or manic symptoms. Thus we believe that this condition would be more appropriately placed in the Bipolar Disorders chapter of DSM-5. We also believe that this blurring of the depressive disorder- bipolar disorder boundary is one cause for the low inter-rater reliability in the diagnosis of Major Depressive Disorder.
《精神疾病诊断与统计手册》第5版(DSM-5)中抑郁障碍章节里名为“伴有混合特征的重度抑郁障碍”的新诊断类别,适用于符合重度抑郁障碍标准且同时伴有亚综合征轻躁狂或躁狂症状的个体。但这一新说明符的操作定义更接近轻躁狂和躁狂的定义,而非非典型抑郁或旧的“混合性抑郁”的定义。此外,多项研究表明,患有这种疾病的个体特征及其疾病的临床轨迹与双相情感障碍患者的更为接近,而非与没有合并轻躁狂或躁狂症状的抑郁个体的接近。因此,我们认为这种情况更适合归入DSM-5的双相情感障碍章节。我们还认为,抑郁障碍与双相情感障碍边界的这种模糊是重度抑郁障碍诊断中评分者间信度较低的一个原因。