From Braulio A. Moyano Neuropsychiatric Hospital, Buenos Aires, Argentina (Dr. Hernandorena); Department of Psychiatry, Queen's University (Drs. Hernandorena and Vázquez); Harvard Medical School, Boston, MA (Drs. Baldessarini and Tondo); McLean Hospital, Belmont, MA (Drs. Baldessarini, Tondo, and Vázquez); Lucio Bini Mood Disorder Centers, Cagliari and Rome, Italy (Dr. Tondo).
Harv Rev Psychiatry. 2023;31(4):173-182. doi: 10.1097/HRP.0000000000000371.
LEARNING OBJECTIVES AFTER PARTICIPATING IN THIS CME ACTIVITY, THE PSYCHIATRIST SHOULD BE BETTER ABLE TO: • Analyze and compare the different bipolar disorder (BD) types.• Identify markers that distinguish BD types and explain how the DSM-IV defines the disorder.
Since the status of type II bipolar disorder (BD2) as a separate and distinct form of bipolar disorder (BD) remains controversial, we reviewed studies that directly compare BD2 to type I bipolar disorder (BD1). Systematic literature searching yielded 36 reports with head-to-head comparisons involving 52,631 BD1 and 37,363 BD2 patients (total N = 89,994) observed for 14.6 years, regarding 21 factors (with 12 reports/factor). BD2 subjects had significantly more additional psychiatric diagnoses, depressions/year, rapid cycling, family psychiatric history, female sex, and antidepressant treatment, but less treatment with lithium or antipsychotics, fewer hospitalizations or psychotic features, and lower unemployment rates than BD1 subjects. However, the diagnostic groups did not differ significantly in education, onset age, marital status, [hypo]manias/year, risk of suicide attempts, substance use disorders, medical comorbidities, or access to psychotherapy. Heterogeneity in reported comparisons of BD2 and BD1 limits the firmness of some observations, but study findings indicate that the BD types differ substantially by several descriptive and clinical measures and that BD2 remains diagnostically stable over many years. We conclude that BD2 requires better clinical recognition and significantly more research aimed at optimizing its treatment.
参与本次 CME 活动后，精神科医生应能够：
分析和比较不同的双相情感障碍 (BD) 类型。
确定区分 BD 类型的标志物，并解释 DSM-IV 如何定义该疾病。
由于 II 型双相情感障碍 (BD2) 是否作为一种独立的双相情感障碍 (BD) 形式仍存在争议，我们回顾了直接比较 BD2 与 I 型双相情感障碍 (BD1) 的研究。系统的文献搜索产生了 36 份报告，涉及 52631 名 BD1 和 37363 名 BD2 患者（总计 N = 89994）的 14.6 年随访，涉及 21 个因素（12 个报告/因素）。BD2 患者有更多的其他精神科诊断、抑郁/年、快速循环、家族精神病史、女性、抗抑郁治疗，但锂或抗精神病药物治疗较少、住院或精神病特征较少、失业率较低与 BD1 患者相比。然而，诊断组在教育、发病年龄、婚姻状况、[轻躁狂]躁狂/年、自杀企图风险、物质使用障碍、共病医学、或接受心理治疗方面无显著差异。BD2 和 BD1 报告比较的异质性限制了一些观察结果的确定性，但研究结果表明，BD 类型在几个描述性和临床指标上存在显著差异，并且 BD2 在多年内保持诊断稳定。我们得出结论，BD2 需要更好的临床识别，并进行更多旨在优化其治疗的研究。
