Dell'Osso Bernardo, Dobrea Cristina, Cremaschi Laura, Buoli Massimiliano, Miller Shefali, Ketter Terence A, Altamura A Carlo
1Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti,Università degli Studi di Milano,Dipartimento di Salute Mentale,Fondazione IRCCS Ca' Granda,Ospedale Maggiore Policlinico, Milano,Italy.
2Bipolar Disorders Clinic,Stanford Medical School,Stanford University,Stanford,Calfornia,USA.
CNS Spectr. 2017 Aug;22(4):325-332. doi: 10.1017/S1092852915000887. Epub 2016 Feb 24.
Introduction Bipolar disorders (BDs) comprise different variants of chronic, comorbid, and disabling conditions, with relevant suicide and suicide attempt rates. The hypothesis that BD types I (BDI) and II (BDII) represent more and less severe forms of illness, respectively, has been increasingly questioned over recent years, justifying additional investigation to better characterize related sociodemographic and clinical profiles.
A sample of 217 outpatients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)-described BD (141 BDI, 76 BDII), without a current syndromal mood episode, was recruited, and sociodemographic and clinical characteristics of BDI and II patients were compared.
BDII patients had significantly more favorable sociodemographics, in relation to occupational stability, cohabitation, and marital status. However, BDII compared with BDI patients had significantly longer duration of untreated illness, more frequent lifetime anxiety disorders comorbidity, longer most recent episode duration, higher rate of depressive first/most recent episode, and more current antidepressant use. In contrast, BDI compared with BDII patients had significantly more severe illness in terms of earlier age at onset; higher rate of elevated first/most recent episode, lifetime hospitalizations, and involuntary commitments; lower Global Assessment of Functioning score; and more current antipsychotic use. BDI and II patients had similar duration of illness, psychiatric family history, lifetime number of suicide attempts, current subthreshold symptoms, history of stressful life events, and overall psychiatric/medical comorbidity.
BDII compared with BDI patients had more favorable sociodemographic features, but a mixture of specific unfavorable illness characteristics, confirming that BDII is not just a milder form of BD and requires further investigation in the field.
引言 双相情感障碍（BDs）包括慢性、共病且致残状况的不同变体，伴有相关的自杀和自杀未遂率。近年来，I型双相情感障碍（BDI）和II型双相情感障碍（BDII）分别代表病情较轻和较重形式的这一假设受到越来越多的质疑，这使得有必要进行更多研究以更好地描述相关的社会人口学和临床特征。
招募了217名符合《精神障碍诊断与统计手册》第四版修订版（DSM-IV-TR）描述的双相情感障碍门诊患者（141例BDI，76例BDII），目前无综合征性情绪发作，并比较了BDI和BDII患者的社会人口学和临床特征。
BDII患者在职业稳定性、同居和婚姻状况方面的社会人口学特征明显更有利。然而，与BDI患者相比，BDII患者的未治疗疾病持续时间明显更长，终生焦虑症共病更频繁，最近一次发作持续时间更长，抑郁首发/最近一次发作率更高，目前使用抗抑郁药的比例更高。相比之下，与BDII患者相比，BDI患者在发病年龄更早方面病情明显更严重；首发/最近一次发作升高、终生住院和非自愿住院的比例更高；功能总体评估得分更低；目前使用抗精神病药的比例更高。BDI和BDII患者在疾病持续时间、精神科家族史、终生自杀未遂次数、目前阈下症状、应激性生活事件史以及总体精神科/内科共病方面相似。
与BDI患者相比BDII患者具有更有利的社会人口学特征，但也有一些特定的不利疾病特征，这证实了BDII并非只是BD的较轻形式，需要在该领域进一步研究。
