Dunner D L, Tay L K
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle.
Compr Psychiatry. 1993 Sep-Oct;34(5):303-7. doi: 10.1016/0010-440x(93)90015-v.
Records of patients who had been systematically evaluated at the Center for Anxiety and Depression were reviewed. Included in this report are records of patients who had a diagnosis of bipolar II or unipolar affective disorder as determined by one of the authors and who also underwent a Structured Clinical Interview for DSM-III (SCID). A second study was undertaken with L.K.T. observing the clinical interview of D.L.D. and both clinicians making a diagnosis for the patient. There was reasonable diagnostic agreement between D.L.D. and the SCID for diagnosis of bipolar II disorder. Twelve of 34 patients clinically diagnosed as bipolar II were diagnosed by the SCID as unipolar. These 12 patients failed to demonstrate clinical factors, which could help explain the diagnostic difference between SCID and the clinical diagnosis. There was excellent agreement on 34 patients as to the presence or absence of hypomania, comparing two clinicians. The SCID interview underestimates the diagnosis of hypomania, a condition that can be diagnosed reliably by clinicians trained to make this diagnosis. This finding has some implications for DSM-IV, where there is a proposal for inclusion of bipolar II disorder as a parallel entity with bipolar disorder.
对在焦虑与抑郁中心接受过系统评估的患者记录进行了回顾。本报告纳入了由其中一位作者确诊为双相II型或单相情感障碍且还接受过《精神疾病诊断与统计手册》第三版（DSM-III）结构化临床访谈（SCID）的患者记录。另一项研究由L.K.T.进行，观察D.L.D.的临床访谈，两位临床医生都对患者进行诊断。在双相II型障碍的诊断上，D.L.D.与SCID之间存在合理的诊断一致性。临床诊断为双相II型的34例患者中，有12例被SCID诊断为单相。这12例患者未表现出有助于解释SCID与临床诊断之间诊断差异的临床因素。比较两位临床医生，在34例患者是否存在轻躁狂方面存在高度一致性。SCID访谈低估了轻躁狂的诊断，而经过诊断培训的临床医生能够可靠地诊断这种情况。这一发现对《精神疾病诊断与统计手册》第四版（DSM-IV）有一定影响，其中提议将双相II型障碍作为双相障碍的平行实体纳入。
