Bartoli Francesco, Cavaleri Daniele, Callovini Tommaso, Palpella Dario, Piacenti Susanna, Crocamo Cristina, Carrà Giuseppe
School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
J Psychosom Res. 2025 Jan;188:111990. doi: 10.1016/j.jpsychores.2024.111990. Epub 2024 Nov 18.
Evidence on the clinical and metabolic characterization of mixed features (MFs) in bipolar disorder (BD) is limited. We performed a cross-sectional study analyzing clinical and metabolic correlates of MFs in people with bipolar depression or mania/hypomania.
We included people with BD consecutively admitted for inpatient treatment from May 2020 to July 2023 as part of the Northern Milan Area Cohort (NOMIAC) project. The SCID-5 was used to confirm the diagnosis and assess DSM-5 specifiers. Young Mania Rating Scale and Montgomery-Åsberg Depression Rating Scale were used to measure symptom severity. Information on socio-demographic, clinical, and metabolic conditions - including obesity, diabetes, hypertension, dyslipidemia, and hypothyroidism - were collected. Multiple logistic regression models were used to compare clinical and metabolic correlates between subjects with and without DSM-5 MFs.
We included 163 inpatients with BD (111 admitted for a manic/hypomanic episode and 52 for a major depressive episode), 39 of whom with MFs. The overall logistic regression model showed that MFs were associated with anxious distress (z = 2.44; p = 0.015) and obesity (z = 2.39; p = 0.017), also being less frequent among moderately/markedly ill people as compared with those borderline/mildly ill (z = -2.71; p = 0.007). Additional analyses corroborated the association between MFs and these characteristics in people with a depressive episode, though not in those with mania/hypomania.
Notwithstanding some limitations, our study provides additional insight into the characterization of individuals with MFs, highlighting that anxious distress and symptom severity, along with obesity, may represent core features helpful for the assessment and management of MFs in BD.
双相情感障碍（BD）中混合特征（MFs）的临床和代谢特征方面的证据有限。我们进行了一项横断面研究，分析双相抑郁或躁狂/轻躁狂患者中MFs的临床和代谢相关性。
作为北米兰地区队列（NOMIAC）项目的一部分，我们纳入了2020年5月至2023年7月连续入院接受住院治疗的BD患者。使用《精神障碍诊断与统计手册》第5版临床定式检查问卷（SCID-5）来确诊并评估DSM-5的诊断说明符。使用杨氏躁狂评定量表和蒙哥马利-阿斯伯格抑郁评定量表来测量症状严重程度。收集了社会人口统计学、临床和代谢状况的信息，包括肥胖、糖尿病、高血压、血脂异常和甲状腺功能减退。使用多元逻辑回归模型比较有和没有DSM-5 MFs的受试者之间的临床和代谢相关性。
我们纳入了163例BD住院患者（111例因躁狂/轻躁狂发作入院，52例因重度抑郁发作入院），其中39例有MFs。总体逻辑回归模型显示，MFs与焦虑痛苦（z = 2.44；p = 0.015）和肥胖（z = 2.39；p = 0.017）相关，与病情为中度/重度的患者相比，在病情为边缘性/轻度的患者中出现频率更低（z = -2.71；p = 0.007）。进一步分析证实了MFs与抑郁发作患者这些特征之间的关联，但在躁狂/轻躁狂发作患者中未得到证实。
尽管存在一些局限性，我们的研究为MFs个体的特征提供了更多见解，强调焦虑痛苦、症状严重程度以及肥胖可能是有助于评估和管理BD中MFs的核心特征。
