Nakamura Kimiya, Iga Junichi, Matsumoto Naoki, Ohmori Tetsuro
Department of Psychiatry,Course of Integrated Brain Sciences,University of Tokushima School of Medicine,TokushimaJapan.
Acta Neuropsychiatr. 2015 Apr;27(2):113-8. doi: 10.1017/neu.2014.42. Epub 2014 Dec 22.
Severe depression may be a risk factor for diagnostic conversion into bipolar disorder (BD), and psychotic depression (PD) has been consistently associated with BD. The aims of the present study were to investigate the stability of the diagnosis of severe depression and the differences between PD and non-psychotic severe depression (non-PD), as well as to assess the effectiveness of electroconvulsive therapy (ECT).
Patients who were hospitalised for severe depression (diagnosed according to ICD-10) both with and without psychotic symptoms (n=89; mean age=55.6 years, SD=13.9) from 2001 to 2010 were retrospectively assessed.
By the 75th month of follow-up assessments, 11(12.4%) patients had developed BD. Among these 11 converters, nine had developed BD within 1 year after admission. Only sub-threshold hypomanic symptoms were significantly related to developing BD. The number of depressive episodes and history of physical diseases were significantly increased in non-PD compared with PD patients, whereas ECT was significantly increased in PD compared with non-PD patients. There was a significant association between length of stay at the hospital and the number of days between admission and ECT.
Sub-threshold hypomanic symptoms may represent a prodrome of BD or an indicator of an already manifest phenotype, especially in older patients, which suggests cautious use of antidepressants. In severe depression, non-PD may often occur secondary to physical diseases and patients may experience increased recurrences compared with PD patients, which may be a more 'primary' disorder and often requires ECT treatments. ECT is effective for severe depression regardless of the presence of any psychotic feature; the earlier ECT is introduced, the better the expected treatment outcome.
重度抑郁症可能是诊断转换为双相情感障碍（BD）的一个风险因素，而伴有精神病性症状的抑郁症（PD）一直与双相情感障碍相关。本研究的目的是调查重度抑郁症诊断的稳定性、PD与非精神病性重度抑郁症（非PD）之间的差异，以及评估电休克治疗（ECT）的有效性。
对2001年至2010年因重度抑郁症（根据ICD - 10诊断）住院的有和没有精神病性症状的患者（n = 89；平均年龄 = 55.6岁，标准差 = 13.9）进行回顾性评估。
到随访评估的第75个月时，11名（12.4%）患者发展为双相情感障碍。在这11名转换者中，9名在入院后1年内发展为双相情感障碍。只有阈下轻躁狂症状与发展为双相情感障碍显著相关。与PD患者相比，非PD患者的抑郁发作次数和躯体疾病史显著增加，而与非PD患者相比，PD患者接受ECT的比例显著增加。住院时间与入院至ECT之间的天数存在显著关联。
阈下轻躁狂症状可能代表双相情感障碍的前驱症状或已显现表型的一个指标，尤其是在老年患者中，这提示谨慎使用抗抑郁药。在重度抑郁症中，非PD可能常继发于躯体疾病，与PD患者相比，患者可能经历更多复发，这可能是一种更“原发性”的疾病，且常需要ECT治疗。ECT对重度抑郁症有效，无论是否存在任何精神病性特征；ECT引入越早，预期治疗效果越好。
