Popovic Dina, Vieta Eduard, Azorin Jean-Michel, Angst Jules, Bowden Charles L, Mosolov Sergey, Young Allan H, Perugi Giulio
Barcelona Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
Hôpital Sainte-Marguerite, Marseille, France.
Bipolar Disord. 2015 Nov;17(7):795-803. doi: 10.1111/bdi.12338. Epub 2015 Sep 29.
The Bipolar Disorders: Improving Diagnosis, Guidance, and Education (BRIDGE-II-Mix) study aimed to estimate the frequency of mixed states in patients with a major depressive episode (MDE) according to different definitions and to compare their clinical validity, looking into specific features such as suicidality.
A total of 2,811 subjects were enrolled in this multicenter cross-sectional study. Psychiatric symptoms, and sociodemographic and clinical variables were collected. The analysis compared the characteristics of patients with MDE with (MDE-SA group) and without (MDE-NSA) a history of suicide attempts.
The history of suicide attempts was registered in 628 patients (22.34%). In the MDE-SA group, women (72.5%, p = 0.028), (hypo)mania in first-degree relatives (20.5%, p < 0.0001), psychotic features (15.1%, p < 0.0001), and atypical features (9.2%, p = 0.009) were more prevalent. MDE-SA patients' previous responses to treatment with antidepressants included more (hypo)manic switches [odds ratio (OR) = 1.97, 95% confidence interval (CI): 1.58-2.44, p < 0.0001], treatment resistance (OR = 2.07, 95% CI: 1.72-2.49, p < 0.0001), mood lability (OR = 1.98, 95% CI: 1.65-2.39, p < 0.0001), and irritability (OR = 1.80, 95% CI: 1.48-2.17, p < 0.0001). Multivariate analysis evidenced that risky behavior, psychomotor agitation and impulsivity, and borderline personality and substance use disorders were the variables most frequently associated with previous suicide attempts. In the MDE-SA group, 75 patients (11.9%) fulfilled Diagnostic and Statistical Manual (DSM)-5 criteria for MDE with mixed features, and 250 patients (39.8%) fulfilled research-based diagnostic criteria for a mixed depressive episode.
Important differences between MDE-SA and MDE-NSA patients have emerged. Early identification of symptoms such as risky behavior, psychomotor agitation, and impulsivity in patients with MDE, and treatment of mixed depressive states could represent a major step in suicide prevention.
双相情感障碍：改善诊断、指导与教育（BRIDGE-II-Mix）研究旨在根据不同定义估计重度抑郁发作（MDE）患者中混合状态的发生率，并比较其临床有效性，同时研究自杀倾向等特定特征。
本多中心横断面研究共纳入2811名受试者。收集了精神症状、社会人口统计学和临床变量。分析比较了有自杀未遂史（MDE-SA组）和无自杀未遂史（MDE-NSA）的MDE患者的特征。
628名患者（22.34%）有自杀未遂史。在MDE-SA组中，女性（72.5%，p = 0.028）、一级亲属中有（轻）躁狂发作（20.5%，p < 0.0001）、精神病性特征（15.1%，p < 0.0001）和非典型特征（9.2%，p = 0.009）更为常见。MDE-SA患者既往对抗抑郁药治疗的反应包括更多的（轻）躁狂转换[比值比（OR）= 1.97，95%置信区间（CI）：1.58 - 2.44，p < 0.0001]、治疗抵抗（OR = 2.07，95% CI：1.72 - 2.49，p < 0.0001）、情绪不稳定（OR = 1.98，95% CI：1.65 - 2.39，p < 0.0001）和易激惹（OR = 1.80，95% CI：1.48 - 2.17，p < 0.0001）。多变量分析表明，危险行为、精神运动性激越和冲动性以及边缘型人格和物质使用障碍是与既往自杀未遂最常相关的变量。在MDE-SA组中，75名患者（11.9%）符合《精神疾病诊断与统计手册》（DSM）-5中伴有混合特征的MDE标准，250名患者（39.8%）符合基于研究的混合抑郁发作诊断标准。
MDE-SA组和MDE-NSA组患者之间出现了重要差异。早期识别MDE患者的危险行为、精神运动性激越和冲动性等症状，并治疗混合抑郁状态可能是预防自杀的重要一步。
