Winokur G, Coryell W, Keller M, Endicott J, Leon A
National Institute of Mental Health Collaborative Program on the Psychobiology of Depression--Clinical Studies, Bethesda, Md, USA.
Arch Gen Psychiatry. 1995 May;52(5):367-73. doi: 10.1001/archpsyc.1995.03950170041006.
To determine whether bipolar I illness is autonomous or part of a multifactorial continuum with unipolar depression. In this study, we compare familial bipolar I illness and depression among three groups: probands with bipolar I disorder; probands with primary unipolar disorder; and controls. We also examine a continuum of severity between psychotic and nonpsychotic patients with bipolar I disorder. Considerable data suggest that bipolar I illness is distinct from unipolar illness as regards epidemiology, familial psychiatric illness, course, response to treatment, and biologic findings.
Probands were separated into bipolar I and primary unipolar depressive groups. Personally interviewed family members of these patients were compared on variables of bipolar illness or schizoaffective mania and unipolar or schizoaffective depression. A personally examined control group was compared with the relatives of the two proband groups. Similar analyses were performed using data obtained by a systematic family history method. For the same familial variables, psychotic and nonpsychotic manic probands were compared.
Familial mania is more frequent in families of patients with bipolar disease than in controls or in families of patients with primary unipolar disorder. The latter two groups did not differ in amount of mania. Unipolar depressive illness or schizoaffective depression was higher in families of probands with bipolar and unipolar disorder than in controls. Probands with bipolar disease separated into those who had psychotic symptoms (including schizoaffective mania) and no psychotic symptoms did not differ from each other in risk for familial mania or depression.
Bipolar I illness is a separate illness from primary unipolar illness because of an increase in familial mania. Patients with primary unipolar disease and controls show the same amount of familial mania. Lack of an increase in familial illness according to the severity of bipolar disease is against an affective continuum.
确定双相I型障碍是独立的疾病，还是与单相抑郁同属多因素连续谱的一部分。在本研究中，我们比较了三组人群中的家族性双相I型障碍和抑郁症：双相I型障碍先证者；原发性单相障碍先证者；以及对照组。我们还研究了双相I型障碍的精神病性和非精神病性患者之间的严重程度连续谱。大量数据表明，双相I型障碍在流行病学、家族性精神疾病、病程、治疗反应和生物学发现方面与单相疾病不同。
将先证者分为双相I型和原发性单相抑郁组。对这些患者接受个人访谈的家庭成员，就双相疾病或分裂情感性躁狂以及单相或分裂情感性抑郁的变量进行比较。将经过个人检查的对照组与两个先证者组的亲属进行比较。使用通过系统家族史方法获得的数据进行类似分析。对于相同的家族变量，比较了精神病性和非精神病性躁狂先证者。
双相情感障碍患者家族中的家族性躁狂比对照组或原发性单相障碍患者家族中更常见。后两组在躁狂发作数量上没有差异。双相和单相障碍先证者家族中的单相抑郁障碍或分裂情感性抑郁高于对照组。患有双相情感障碍的先证者分为有精神病性症状（包括分裂情感性躁狂）和无精神病性症状的两组，在家族性躁狂或抑郁风险方面彼此没有差异。
由于家族性躁狂增加，双相I型障碍是一种与原发性单相疾病不同的疾病。原发性单相疾病患者和对照组的家族性躁狂数量相同。根据双相情感障碍的严重程度，家族性疾病没有增加，这与情感连续谱不符。
