Swann A C, Stokes P E, Secunda S K, Maas J W, Bowden C L, Berman N, Koslow S H
Department of Psychiatry, University of Texas Medical School, Houston 77225.
Biol Psychiatry. 1994 May 15;35(10):803-13. doi: 10.1016/0006-3223(94)91143-6.
The existence of mixed affective states challenges the idea of specific biological abnormalities in depression and mania. We compared biogenic amines and hypothalamic-pituitary-adrenocortical (HPA) function in mixed manic (n = 8), pure manic (n = 11), agitated bipolar depressed (n = 20), and nonagitated bipolar depressed (n = 27) inpatients (Research Diagnostic Criteria). Mixed manics met Research Diagnostic Criteria for primary manic episodes and also met criteria for major depressive episodes except for duration. The norepinephrine metabolite methoxyhydroxy phenthylene glycol (MHPG) was higher in cerebrospinal fluid from mixed manic than from agitated depressed patients, consistent with differences previously reported between the overall samples of depressed and manic patients. Similarly, patients in a mixed state had higher urinary excretion of norepinephrine (NE) and elevated output of NE relative to its metabolites. HPA activity was similar in mixed manic and agitated depressed patients. These data suggest that mixed manics combine certain biological abnormalities considered to be characteristic of mania and of depression.
混合情感状态的存在对抑郁症和躁狂症中特定生物学异常的观点提出了挑战。我们比较了混合躁狂（n = 8）、单纯躁狂（n = 11）、激越性双相抑郁（n = 20）和非激越性双相抑郁（n = 27）住院患者（研究诊断标准）的生物胺和下丘脑 - 垂体 - 肾上腺皮质（HPA）功能。混合躁狂患者符合原发性躁狂发作的研究诊断标准，除持续时间外也符合重度抑郁发作的标准。混合躁狂患者脑脊液中的去甲肾上腺素代谢产物甲氧基羟基苯乙二醇（MHPG）高于激越性抑郁患者，这与先前报道的抑郁和躁狂患者总体样本之间的差异一致。同样，处于混合状态的患者去甲肾上腺素（NE）的尿排泄量较高，且相对于其代谢产物，NE的输出量增加。混合躁狂患者和激越性抑郁患者的HPA活性相似。这些数据表明，混合躁狂患者兼具某些被认为是躁狂症和抑郁症特征的生物学异常。
