Ferentinos Panagiotis, Fountoulakis Konstantinos N, Lewis Cathryn M, Porichi Evgenia, Dikeos Dimitris, Papageorgiou Charalambos, Douzenis Athanassios
2nd Department of Psychiatry, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece; Institute of Psychiatry, Psychology & Neuroscience, Social, Genetic and Development Psychiatry Center, London, United Kingdom.
3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Greece.
Compr Psychiatry. 2017 Aug;77:89-99. doi: 10.1016/j.comppsych.2017.06.007. Epub 2017 Jun 16.
The literature on DSM-5's 'Major Depressive Disorder with lifetime mixed features' (MDD-MF) is limited. This study investigated MDD-MF's potential inclusion into a bipolar spectrum.
We recruited 287 patients with Bipolar I disorder (BD-I), BD-II, MDD-MF or 'MDD without lifetime mixed features' (MDD-noMF); most (N=280) were stabilized for at least one year on medication. Sixteen validators (clinical features, psychiatric family history, temperament, stabilizing treatment) were compared across groups and subjected to trend analyses. Two discriminant function analyses (DFA; primary and secondary), excluding or including, respectively, treatment-related predictors, explored latent dimensions maximizing between-group discrimination; mahalanobis distances between group 'centroids' were calculated.
Eleven validators differed significantly across groups; nine varied monotonically along a bipolar diathesis gradient with significant linear trends; two peaked at MDD-MF and displayed significant quadratic trends. In the primary DFA, apart from a classic bipolarity dimension, correlating with hospitalizations, early age at onset, lifetime psychosis and lower anxious temperament scores, on which groups ranked along a bipolar propensity gradient, a second dimension was also significant, peaking at BD-II and MDD-MF (challenging the classic bipolar ranking), which correlated with lifetime psychiatric comorbidities, suicidality, lower lifetime psychosis rates, female gender, higher cyclothymic and lower depressive temperament scores; MDD-MF was equipoised amidst BD-II and MDD-noMF. After including treatment-related predictors (secondary DFA), discrimination improved overall but BD-II and MDD-MF were closest than any other pair, suggesting similar treatment patterns for these two groups at this naturalistic setting.
To our knowledge, this is the first time a two-dimensional bipolar spectrum based on classic external validators is proposed, fitting the data better than a unidimensional model. Additional predictors are warranted to improve BD-II/MDD-MF discrimination.
关于《精神疾病诊断与统计手册》第五版（DSM - 5）中“伴有终生混合特征的重度抑郁症”（MDD - MF）的文献有限。本研究调查了MDD - MF纳入双相谱系的可能性。
我们招募了287名患有双相I型障碍（BD - I）、双相II型障碍（BD - II）、MDD - MF或“无终生混合特征的重度抑郁症”（MDD - noMF）的患者；大多数（N = 280）患者已通过药物治疗稳定至少一年。对16项验证指标（临床特征、精神科家族史、气质、稳定治疗）进行组间比较并进行趋势分析。进行了两项判别函数分析（DFA；主要和次要分析），分别排除或纳入与治疗相关的预测因素，探索能使组间差异最大化的潜在维度；计算了组“质心”之间的马氏距离。
11项验证指标在组间存在显著差异；9项指标沿着双相素质梯度呈单调变化且具有显著线性趋势；2项指标在MDD - MF时达到峰值并呈现显著二次趋势。在主要DFA中，除了一个与住院、发病年龄早、终生精神病和较低焦虑气质得分相关的经典双相维度外，各组在此维度上沿双相倾向梯度排列，还有一个第二维度也很显著，在BD - II和MDD - MF时达到峰值（挑战了经典双相排列），该维度与终生精神科共病、自杀倾向、较低的终生精神病发生率、女性、较高的环性心境气质和较低的抑郁气质得分相关；MDD - MF在BD - II和MDD - noMF之间处于平衡状态。纳入与治疗相关的预测因素后（次要DFA），总体判别能力有所提高，但BD - II和MDD - MF比其他任何一对组更接近，表明在这种自然环境下这两组的治疗模式相似。
据我们所知，这是首次基于经典外部验证指标提出二维双相谱系，比一维模型更能拟合数据。需要更多预测因素以改善BD - II/MDD - MF的判别。
