From the VA Palo Alto Health Care System, Palo Alto, and the Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, Calif.; the Department of Psychiatry, University of Texas Health Science Center, San Antonio; the Department of Psychiatry, UCLA, Los Angeles; the Department of Psychiatry, Mayo Clinic, Rochester, Minn.; the Lindner Center of HOPE, University of Cincinnati, Mason, Ohio; University Medical Center Groningen, University of Groningen, the Netherlands; the Altrecht Institute for Mental Health Care, Utrecht, and VU University Medical Centre Amsterdam, VU University Amsterdam, the Netherlands; the Biological Psychiatry Branch, NIMH, Bethesda, Md.; the Department of Psychiatry and Psychotherapy, Paracelsus Medical University, and Christian Doppler Klinik, Salzburg, Austria; and the School of Medicine and Health Sciences, George Washington University, Washington, D.C.
Am J Psychiatry. 2016 Oct 1;173(10):1015-1023. doi: 10.1176/appi.ajp.2016.15091119. Epub 2016 Apr 15.
DSM-5 introduced the "with mixed features" specifier for major depressive episodes. The authors assessed the prevalence and phenomenology of mixed depression among bipolar disorder patients and qualitatively compared a range of diagnostic thresholds for mixed depression.
In a naturalistic study, 907 adult outpatients with bipolar disorder participating in the Stanley Foundation Bipolar Network were followed longitudinally across 14,310 visits from 1995 to 2002. The Inventory of Depressive Symptomatology-Clinician-Rated Version (IDS-C) and the Young Mania Rating Scale (YMRS) were administered at each visit.
Mixed depression, defined as an IDS-C score ≥15 and a YMRS score >2 and <12 at the same visit, was observed in 2,139 visits (14.9% of total visits, and 43.5% of visits with depression) by 584 patients (64.4% of all patients). Women were significantly more likely than men to experience subthreshold hypomania during visits with depression (40.7% compared with 34.4%). Patients with one or more mixed depression visits had more symptomatic visits and fewer euthymic visits compared with those with no mixed depression visits. DSM-5-based definitions of mixed depression (ranging from narrower definitions requiring ≥3 nonoverlapping YMRS items concurrent with an IDS-C score ≥15, to broader definitions requiring ≥2 nonoverlapping YMRS items) yielded lower mixed depression prevalence rates (6.3% and 10.8% of visits, respectively) but were found to have similar relationships to gender and longitudinal symptom severity.
Among outpatients with bipolar disorder, concurrent hypomanic symptoms observed during visits with depression were common, particularly in women. The DSM-5 diagnostic criteria for depression with mixed features may yield inadequate sensitivity to detect patients with mixed depression.
DSM-5 为重度抑郁发作引入了“伴有混合特征”的特征。作者评估了双相情感障碍患者中混合性抑郁的患病率和表现，并从质的角度比较了混合性抑郁的一系列诊断阈值。
在一项自然主义研究中，1995 年至 2002 年期间，来自斯坦利基金会双相情感障碍网络的 907 名成年门诊双相情感障碍患者参与了 14310 次随访。每次就诊时都进行了抑郁症状学评定量表-临床医生评定版（IDS-C）和 Young 躁狂评定量表（YMRS）的评定。
混合性抑郁定义为同一就诊时 IDS-C 评分≥15 分和 YMRS 评分＞2 分且＜12 分，在 584 名患者（所有患者的 64.4%）的 2139 次就诊（总就诊次数的 14.9%，和有抑郁就诊次数的 43.5%）中观察到。女性在有抑郁就诊时出现亚临床轻躁狂的可能性明显高于男性（40.7%比 34.4%）。与无混合性抑郁就诊的患者相比，有一次或多次混合性抑郁就诊的患者有更多的症状就诊次数和更少的缓解就诊次数。基于 DSM-5 的混合性抑郁定义（从需要≥3 个不重叠的 YMRS 项目同时伴有 IDS-C 评分≥15 的较窄定义，到需要≥2 个不重叠的 YMRS 项目的较宽定义）产生了较低的混合性抑郁患病率（分别为就诊次数的 6.3%和 10.8%），但与性别和纵向症状严重程度的关系相似。
在门诊双相情感障碍患者中，抑郁就诊期间观察到的共病轻躁狂症状较为常见，尤其是在女性中。DSM-5 诊断标准中伴有混合特征的抑郁可能无法充分检测出混合性抑郁患者。
