Oliva Vincenzo, De Prisco Michele, Fico Giovanna, Possidente Chiara, Fortea Lydia, Montejo Laura, Anmella Gerard, Hidalgo-Mazzei Diego, Grande Iria, Murru Andrea, Fornaro Michele, de Bartolomeis Andrea, Dodd Alyson, Fanelli Giuseppe, Fabbri Chiara, Serretti Alessandro, Vieta Eduard, Radua Joaquim
Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain.
Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Barcelona, Spain.
Acta Psychiatr Scand. 2023 Dec;148(6):472-490. doi: 10.1111/acps.13618. Epub 2023 Sep 22.
Emotion dysregulation (ED) is a transdiagnostic construct characterized by difficulties regulating intense emotions. People with bipolar disorder (BD) are more likely to show ED and use maladaptive emotion regulation strategies than adaptive ones. However, little is known about whether ED in BD is a trait or it is rather an epiphenomenon of mood symptoms.
We conducted a systematic review and meta-analysis of the evidence across major literature databases reporting correlations between measures of emotion regulation (overall ED and different emotion regulation strategies) and measures of depressive and (hypo)manic symptoms in BD from inception until April 12th, 2022.
Fourteen studies involving 1371 individuals with BD were included in the qualitative synthesis, of which 11 reported quantitative information and were included in the meta-analysis. ED and maladaptive strategies were significantly higher during periods with more severe mood symptoms, especially depressive ones, while adaptive strategies were lower.
ED significantly correlates with BD symptomatology, and it mainly occurs during mood alterations. ED may be a target for specific psychotherapeutic and pharmacological treatments, according to precision psychiatry. However, further studies are needed, including patients with mood episodes and longitudinal design, to provide more robust evidence and explore the causal direction of the associations.
情绪失调（ED）是一种跨诊断概念，其特征是在调节强烈情绪方面存在困难。双相情感障碍（BD）患者比适应性情绪调节策略更有可能表现出情绪失调并使用适应不良的情绪调节策略。然而，关于双相情感障碍中的情绪失调是一种特质还是仅仅是情绪症状的一种附带现象，目前所知甚少。
我们对主要文献数据库中从开始到2022年4月12日期间报告情绪调节测量指标（总体情绪失调和不同情绪调节策略）与双相情感障碍中抑郁和（轻）躁狂症状测量指标之间相关性的证据进行了系统综述和荟萃分析。
定性综合分析纳入了14项涉及1371名双相情感障碍患者的研究，其中11项报告了定量信息并纳入荟萃分析。在情绪症状更严重的时期，尤其是抑郁症状期，情绪失调和适应不良策略显著更高，而适应性策略则更低。
情绪失调与双相情感障碍症状显著相关，且主要发生在情绪变化期间。根据精准精神病学，情绪失调可能是特定心理治疗和药物治疗的目标。然而，需要进一步研究，包括有情绪发作的患者和纵向设计，以提供更有力的证据并探索这些关联的因果方向。
