Arathimos Ryan, Fabbri Chiara, Vassos Evangelos, Davis Katrina A S, Pain Oliver, Gillett Alexandra, Coleman Jonathan R I, Hanscombe Ken, Hagenaars Saskia, Jermy Bradley, Corbett Anne, Ballard Clive, Aarsland Dag, Creese Byron, Lewis Cathryn M
Br J Psychiatry. 2022 Feb 23;220(6):1-2. doi: 10.1192/bjp.2022.4.
Mood disorders are characterised by pronounced symptom heterogeneity, which presents a substantial challenge both to clinical practice and research. Identification of subgroups of individuals with homogeneous symptom profiles that cut across current diagnostic categories could provide insights in to the transdiagnostic relevance of individual symptoms, which current categorical diagnostic systems cannot impart.
To identify groups of people with homogeneous clinical characteristics using symptoms of manic and/or irritable mood and explore differences between groups in diagnoses, functional outcomes. and genetic liability.
We used latent class analysis (LCA) on eight binary self-reported symptoms of manic and irritable mood in UK Biobank and PROTECT studies to investigate how individuals formed latent subgroups. We tested associations between the latent classes and diagnoses of psychiatric disorders, sociodemographic characteristics, and polygenic risk scores (PRS).
Five latent classes were derived in UK Biobank. (N=42,183) and were replicated in the independent PROTECT cohort (N=4,445), including ‘minimally affected’, ‘inactive restless’, active restless’, ‘focused creative’, and ‘extensively affected’ individuals. These classes differed in disorder risk, PRS, and functional outcomes. One class that experienced disruptive episodes of mostly irritable mood was largely comprised of cases of depression/anxiety, and a class of individuals with increased confidence/creativity reported comparatively lower disruptiveness and functional impairment.
Findings suggest that data-driven investigations of psychopathological symptoms that include sub-diagnostic threshold conditions, can complement research of clinical diagnoses. Improved classification systems of psychopathology could investigate a weighted approach to symptoms, towards a more dimensional classification of mood disorders. 245/250
情绪障碍的特点是症状高度异质性,这给临床实践和研究都带来了巨大挑战。识别具有跨越当前诊断类别的同质症状特征的个体亚组,可为个体症状的跨诊断相关性提供见解,而这是当前的分类诊断系统无法提供的。
使用躁狂和/或易激惹情绪症状识别具有同质临床特征的人群组,并探讨各组在诊断、功能结局和遗传易感性方面的差异。
我们在英国生物银行和PROTECT研究中,对八种自我报告的躁狂和易激惹情绪的二元症状进行了潜在类别分析(LCA),以研究个体如何形成潜在亚组。我们测试了潜在类别与精神疾病诊断、社会人口学特征和多基因风险评分(PRS)之间的关联。
在英国生物银行(N = 42,183)中得出了五个潜在类别,并在独立的PROTECT队列(N = 4,445)中得到了重复,包括“受影响最小的”、“不活跃烦躁的”、“活跃烦躁的”、“专注有创造力的”和“受广泛影响的”个体。这些类别在疾病风险、PRS和功能结局方面存在差异。一个主要经历以易激惹情绪为主的破坏性发作的类别主要由抑郁/焦虑病例组成,而一类自信心/创造力增强的个体报告的破坏性和功能损害相对较低。
研究结果表明,对包括亚诊断阈值情况在内的精神病理症状进行数据驱动的调查,可以补充临床诊断的研究。改进的精神病理学分类系统可以研究一种针对症状的加权方法,朝着更具维度的情绪障碍分类发展。245/250