Terziivanova Petya D, Haralanov Svetlozar H
First Psychiatric Clinic, St Naum University Hospital of Neurology and Psychiatry, Medical University, Sofia, Bulgaria
Folia Med (Plovdiv). 2014 Oct-Dec;56(4):282-8. doi: 10.1515/folmed-2015-0009.
Previous studies have suggested that the two opposite poles of psychomotor disturbances in unipolar depression (UD) - retardation and agitation - require different treatment strategies as the psychomotor overactivation requires an augmentation of the antidepressant therapy with mood stabilizers and/or atypical antipsychotics.
The aim of the present study was to objectively identify and measure the psycho-motor disturbances in UD using differentiation between activity and reactivity.
An equilibriometric movement pattern analysis system that allows differentiation between psychomotor activity and reactivity was applied in 58 unipolar depressive patients and 76 healthy controls.
Compared to controls, the patients as a group were significantly slower in their psychomotor reactivity. However, the subsequent subgrouping according to the direction of deviation of their objective psychomotor parameters revealed a disinhibition of psychomotor activity and/or reactivity in about one half of them. Such a contradictory combination of clinically manifested depressive mood and subclinically detected manic-like psychomotor overactivation might be regarded as belonging to the bipolar spectrum, since it was admitted that manic psychomotor disinhibition in unipolar depressive patients uncovers a latent bipolarity.
Not only prototypical depressive inhibition, but also prototypical manic-like disinhibition may underlie clinically manifested UD. Since the combination between depressive mood and psychomotor overactivation multiplies the suicidal risk, we may presume that the timely detection of this combination at a subclinical level would contribute to an earlier and more effective suicidal prevention by an objectively-guided optimization of pharmacological treatment.
先前的研究表明，单相抑郁症（UD）中精神运动障碍的两个相反极点——迟缓与激越——需要不同的治疗策略，因为精神运动过度激活需要用心境稳定剂和/或非典型抗精神病药物增强抗抑郁治疗。
本研究的目的是通过区分活动和反应性来客观识别和测量UD中的精神运动障碍。
将一种能够区分精神运动活动和反应性的平衡运动模式分析系统应用于58例单相抑郁患者和76例健康对照者。
与对照组相比，患者组的精神运动反应明显较慢。然而，根据其客观精神运动参数的偏离方向进行后续亚组分析发现，其中约一半患者存在精神运动活动和/或反应性的去抑制。这种临床表现为抑郁情绪与亚临床检测到的类躁狂精神运动过度激活的矛盾组合可能被视为属于双相谱系，因为人们承认单相抑郁患者中的躁狂精神运动去抑制揭示了潜在的双相性。
不仅典型的抑郁性抑制，而且典型的类躁狂性去抑制可能是临床表现为UD的基础。由于抑郁情绪与精神运动过度激活的组合会增加自杀风险，我们可以推测，在亚临床水平及时发现这种组合将有助于通过客观指导的药物治疗优化实现更早、更有效的自杀预防。
