Takeshima Minoru, Oka Takashi
J Clinic, 3-30-10 Sainen, Kanazawa City, 920-0024, Japan; Department of Psychiatry, Kouseiren Takaoka Hospital, 5-10 Eiraku-cyou, Takaoka City, 933-8555, Japan.
J Clinic, 3-30-10 Sainen, Kanazawa City, 920-0024, Japan.
Compr Psychiatry. 2016 Apr;66:71-8. doi: 10.1016/j.comppsych.2016.01.001. Epub 2016 Jan 12.
Difficult-to-treat major depressive disorder (MDD-DT), which involves antidepressant refractoriness or antidepressant-related adverse psychiatric effects, is bipolar in nature; therefore, it may share common temperamental features with bipolar disorder. To examine this hypothesis, affective temperament was compared between MDD-DT, easy-to-treat major depressive disorder (MDD-ET), and bipolar disorder.
Affective temperament was measured in 320 patients (69, 56, and 195 with MDD-ET, MDD-DT, and bipolar disorder, respectively) using the self-rated questionnaire version of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-A), with between-group differences examined using multiple logistic regression analysis controlling for confounders. Optimal cut-off points for TEMPS-A scores to discriminate between diagnostic groups were determined using receiver-operating characteristic analysis.
Of the five temperamental domains, the mode for cyclothymic temperament score was highest, followed by those of bipolar disorder, MDD-DT, and MDD-ET. The cyclothymic temperament score discriminated significantly between bipolar disorder and MDD-DT (odds ratio [OR]: 1.12, 95% confidence interval [CI]: 1.04-1.20, p=0.0022), MDD-DT and MDD-ET (OR: 1.15, 95% CI: 1.01-1.31, p=0.0334), and bipolar and major depressive disorders (OR: 1.17, 95% CI: 1.07-1.28, p=0.0003). Optimal cut-off points for the cyclothymic temperament scores to discriminate between bipolar disorder and major depressive disorder and MDD-DT and MDD-ET were 9 (sensitivity: 64.6%, specificity: 76.0%) and 6 (66.1%, 62.3%), respectively.
MDD-DT has a quantitatively stronger bipolar temperamental feature, cyclothymic temperament, relative to that of MDD-ET. Cut-off points determined in this study could be clinically helpful. Because of our study design, longitudinal changes in temperamental scores during treatment cannot be fully excluded.
难治性重度抑郁症（MDD - DT），涉及抗抑郁药难治性或与抗抑郁药相关的不良精神效应，本质上具有双相性；因此，它可能与双相情感障碍具有共同的气质特征。为检验这一假设，对MDD - DT、易治性重度抑郁症（MDD - ET）和双相情感障碍患者的情感气质进行了比较。
使用孟菲斯、比萨、巴黎和圣地亚哥气质评估（TEMPS - A）的自评问卷版本，对320例患者（分别为69例MDD - ET、56例MDD - DT和195例双相情感障碍患者）进行情感气质测量，并使用多因素逻辑回归分析控制混杂因素来检验组间差异。使用受试者工作特征分析确定TEMPS - A分数区分诊断组的最佳截断点。
在五个气质领域中，环性心境气质得分的众数最高，其次是双相情感障碍、MDD - DT和MDD - ET。环性心境气质得分在双相情感障碍与MDD - DT之间（优势比[OR]：1.12，95%置信区间[CI]：1.04 - 1.20，p = 0.0022）、MDD - DT与MDD - ET之间（OR：1.15，95% CI：1.01 - 1.31，p = 0.0334）以及双相情感障碍与重度抑郁症之间（OR：1.17，95% CI：1.07 - 1.28，p = 0.0003）有显著差异。区分双相情感障碍与重度抑郁症以及MDD - DT与MDD - ET的环性心境气质得分的最佳截断点分别为9（敏感性：64.6%，特异性：76.0%）和6（66.1%，62.3%）。
相对于MDD - ET，MDD - DT具有更强的双相气质特征，即环性心境气质。本研究确定的截断点可能在临床上有帮助。由于我们的研究设计，无法完全排除治疗期间气质得分的纵向变化。
