Department of Mental Health, ASST Nord Milano, Italy; Department of Medicine and Surgery, University of Milano Bicocca, Italy.
Department of Medicine and Surgery, University of Milano Bicocca, Italy.
J Affect Disord. 2020 Nov 1;276:234-240. doi: 10.1016/j.jad.2020.07.035. Epub 2020 Jul 16.
Systematic data on clinical correlates of mixed features in bipolar disorder are not available, so far. We conducted a systematic review and meta-analysis estimating the association between DSM-5 mixed features and candidate characteristics in depressive and manic/hypomanic episodes.
We included observational studies indexed in the main electronic databases. The association between DSM-5 mixed features and relevant correlates was estimated using odds ratio (OR) and standardized mean difference (SMD) with 95% confidence intervals (CIs), for categorical and continuous variables, respectively. Analyses were based on random effects models.
Eight studies were included, involving 3070 individuals (1495 with a major depressive episode and 1575 with hypo/manic episode). No clinical characteristics were associated with mixed features in subjects with a depressive episode. Among subjects with a manic/hypomanic episode, those with mixed features were more likely to have a history of suicide attempts (OR: 2.37; 95%CI: 1.42 to 3.94; I=39.7%), co-occurring anxiety disorders (OR: 2.67; 95%CI: 1.28 to 5.57; I=0%), and a rapid cycling course (OR=4.23; 95%CI: 1.29 to 13.81; I=0%), with less severe manic symptoms (SMD=-0.40; 95%CI: -0.65 to -0.16; I=0%).
(1) the heterogeneity of methods across studies and the inconsistency of findings; (2) the limited amount of data on correlates of DSM-5 mixed features; (3) the possible influence of publication bias.
Findings of this meta-analysis show that mixed features among individuals with a manic/hypomanic episode may identify a special clinical population, characterized not only by depressive symptoms, but also by anxiety, rapid cycling, and suicidality.
目前尚无关于双相情感障碍混合特征的临床相关性的系统数据。我们进行了一项系统评价和荟萃分析，以评估 DSM-5 混合特征与抑郁和躁狂/轻躁狂发作中候选特征之间的关系。
我们纳入了主要电子数据库中索引的观察性研究。使用比值比（OR）和标准化均数差（SMD）及其 95%置信区间（CI），分别估计 DSM-5 混合特征与相关特征之间的关联，用于分类和连续变量。分析基于随机效应模型。
纳入了 8 项研究，涉及 3070 人（1495 人患有重性抑郁发作，1575 人患有轻躁狂/躁狂发作）。在重性抑郁发作患者中，没有临床特征与混合特征相关。在轻躁狂/躁狂发作患者中，具有混合特征的患者更有可能有自杀企图史（OR：2.37；95%CI：1.42 至 3.94；I=39.7%）、共病焦虑障碍（OR：2.67；95%CI：1.28 至 5.57；I=0%）和快速循环病程（OR=4.23；95%CI：1.29 至 13.81；I=0%），且躁狂症状较轻（SMD=-0.40；95%CI：-0.65 至 -0.16；I=0%）。
（1）研究之间方法的异质性和结果的不一致性；（2）DSM-5 混合特征相关因素的数据有限；（3）可能存在发表偏倚的影响。
本荟萃分析的结果表明，躁狂/轻躁狂发作患者的混合特征可能识别出一种特殊的临床人群，其特征不仅是抑郁症状，还包括焦虑、快速循环和自杀倾向。
