School of Psychiatry, University of New South Wales, Sydney, Australia.
School of Psychiatry, University of New South Wales, Sydney, Australia.
J Affect Disord. 2020 Dec 1;277:225-231. doi: 10.1016/j.jad.2020.08.014. Epub 2020 Aug 14.
It is unclear whether the bipolar disorders (i.e. BP-I/BP-II) differ dimensionally or categorically. This study sought to clarify this issue.
We recruited 165 patients, of which 69 and 96 had clinician-assigned diagnoses of BP-I and BP-II respectively. Their psychiatrists completed a data sheet seeking information on clinical variables about each patient, while the patients completed a different data sheet and scored a questionnaire assessing the prevalence and severity of 96 candidate manic/hypomanic symptoms.
We conducted a series of analyses examining a set (and two sub-sets) of fifteen symptoms that were significantly more likely to be reported by the clinically diagnosed BP-I patients. Latent class analyses favoured two-class solutions, while mixture analyses demonstrated bimodality, thus arguing for a BP-I/BP-II categorical distinction. Statistically defined BP-I class members were more likely when manic to have experienced psychotic features and over-valued ideas. They were also more likely to have been hospitalised, and to have been younger when they received their bipolar diagnosis and first experienced a depressive or manic episode.
The lack of agreement between some patients and managing clinicians in judging the presence of psychotic features could have compromised some analyses. It is also unclear whether some symptoms (e.g. grandiosity, noting mystical events) were capturing formal psychotic features or not.
Findings replicate our earlier study in providing evidence to support the modelling of BP-I and BP-II as categorically discrete conditions. This should advance research into aetiological factors and determining optimal (presumably differing) treatments for the two conditions.
双相障碍（即 BP-I/BP-II）在维度上或类别上是否存在差异尚不清楚。本研究旨在澄清这一问题。
我们招募了 165 名患者，其中 69 名和 96 名分别由临床医生诊断为 BP-I 和 BP-II。他们的精神科医生填写了一份数据表，以获取每位患者的临床变量信息，而患者则填写了不同的数据表，并对评估 96 种候选躁狂/轻躁狂症状的患病率和严重程度的问卷进行了评分。
我们进行了一系列分析，检查了一组（和两个子集）十五个症状，这些症状更有可能被临床诊断为 BP-I 的患者报告。潜在类别分析支持两类别解决方案，而混合分析则表明存在双峰性，因此支持 BP-I/BP-II 的分类区别。当处于躁狂状态时，具有统计学定义的 BP-I 类别成员更有可能出现精神病特征和过高的观念。他们也更有可能住院，并且在接受双相诊断和首次经历抑郁或躁狂发作时年龄更小。
一些患者和管理临床医生在判断精神病特征存在方面的意见不一致，可能会影响一些分析。也不清楚某些症状（例如夸大妄想、注意神秘事件）是否捕捉到了正式的精神病特征。
这些发现复制了我们之前的研究，为支持将 BP-I 和 BP-II 建模为分类离散条件提供了证据。这应该会推进对病因因素的研究，并确定两种情况的最佳（可能不同）治疗方法。
