Berk Michael, Corrales Asier, Trisno Roth, Dodd Seetal, Yatham Lakshmi N, Vieta Eduard, McIntyre Roger S, Suppes Trisha, Agustini Bruno
Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Barwon Health, Geelong, VIC, Australia.
Mental Health, Drugs and Alcohol Service, Barwon Health, Geelong, VIC, Australia.
World Psychiatry. 2025 Jun;24(2):175-189. doi: 10.1002/wps.21300.
Bipolar II disorder (BD-II) is currently identified by both the DSM-5 and ICD-11 as a distinct subtype of bipolar disorder, defined by at least one depressive episode and at least one hypomanic episode, with no history of mania. Despite its prevalence and impact, the literature on BD-II remains relatively sparse. This paper provides a comprehensive overview of the available research and current debate on the disorder, including its diagnostic criteria, clinical presentations, comorbidities, epidemiology, risk factors, and treatment strategies. Patients with BD-II often present with recurrent depressive episodes, which outnumber hypomanic episodes by a ratio of 39:1. The condition is therefore often misdiagnosed as major depressive disorder and treated with antidepressant monotherapy, which may worsen its prognosis. The recognition of BD-II is further complicated by the overlap of its symptoms with other disorders, in particular borderline personality disorder. Although BD-II is often perceived as a less severe form of bipolar disorder, evidence suggests significant functional and cognitive impairment, accompanied by an elevated risk of suicidal behavior, including a rate of completed suicide at least equivalent to that observed in bipolar I disorder (BD-I). Psychiatric comorbidities, in particular anxiety and substance use disorders, are common. The disorder is associated with a high prevalence of numerous physical comorbidities, with a particularly high risk of comorbid cardiovascular diseases. Various genetic and environmental risk factors have been identified. Inflammation, circadian rhythm dysregulation and mitochondrial dysfunction are being studied as potential pathophysiological mechanisms. Current treatment guidelines, often extrapolated from BD-I and depression research, may not fully address the unique aspects of BD-II. Nevertheless, substantial evidence supports the value of some pharmacological treatments - primarily mood stabilizers and atypical antipsychotics - augmented by psychoeducation, cognitive behavioral or interpersonal and social rhythm therapy, and lifestyle interventions. Further research on BD-II should be a priority, in order to refine diagnostic criteria, identify potentially modifiable risk factors, and develop targeted interventions.
双相II型障碍（BD-II）目前在《精神疾病诊断与统计手册》第5版（DSM-5）和《国际疾病分类》第11版（ICD-11）中均被认定为双相情感障碍的一种独特亚型，其定义为至少有一次抑郁发作和至少一次轻躁狂发作，且无躁狂发作史。尽管其患病率和影响较大，但关于BD-II的文献仍然相对较少。本文全面概述了关于该疾病的现有研究和当前争论，包括其诊断标准、临床表现、共病情况、流行病学、危险因素和治疗策略。BD-II患者常出现反复的抑郁发作，抑郁发作与轻躁狂发作的比例为39:1。因此，该疾病常被误诊为重度抑郁症，并采用抗抑郁药单一疗法进行治疗，这可能会使其预后恶化。BD-II症状与其他疾病，特别是边缘型人格障碍的症状重叠，这使得对BD-II的识别更加复杂。尽管BD-II通常被认为是双相情感障碍的一种不太严重的形式，但有证据表明其存在显著的功能和认知损害，并伴有自杀行为风险升高，包括自杀完成率至少与双相I型障碍（BD-I）相当。精神科共病，尤其是焦虑和物质使用障碍很常见。该疾病与多种躯体共病的高患病率相关，尤其是合并心血管疾病的风险特别高。已经确定了各种遗传和环境危险因素。炎症、昼夜节律失调和线粒体功能障碍正在作为潜在的病理生理机制进行研究。当前的治疗指南通常是从BD-I和抑郁症研究中推断出来的，可能无法完全解决BD-II的独特问题。然而，大量证据支持一些药物治疗的价值——主要是心境稳定剂和非典型抗精神病药物——辅以心理教育、认知行为或人际与社会节律治疗以及生活方式干预。对BD-II的进一步研究应作为优先事项，以便完善诊断标准、识别潜在的可改变危险因素并制定针对性的干预措施。
