Hantouche E G, Akiskal H S
International Mood Center, UCSD, La Jolla 92093-0603, USA.
Encephale. 1997 Jan;23 Spec No 1:27-34.
The authors argue from an "adult" perspective, that clinically ascertained affective dysregulations are prevalent in the prebipolar history. This hypothesis is based: 1) on early age of onset; 2) gender ratio; 3) high propensity to mood switching under antidepressant treatment; 4) high rate of recurrence; 5) family affective loading and; 6) the frequent superposition of major episodes on affective temperamental dysregulation (prominence of mood lability and explosive anger: indicators of mixed states). The authors submit that affective temperaments (cyclothymic, hyperthymic and dysthymic) represent putative developmental pathways to bipolarity. A french version of the semi-structured interview and self-assessment of affective temperaments had been constructed by the authors. The french version of these psychometric tools is presented in this chapter. The authors hoped that current knowledge and new research in the domain of affective temperaments will encourage clinicians to further understanding the manic-depressive illness and to make early detection of different clinical expressions of bipolarity. More clinical sophistication is needed to go beyond the classical "diagnostic" instruments and artificial classifications (as in DSM IV) and to delineate the psycho-biological pathways to bipolarity.
作者从“成人”视角出发，认为临床上确定的情感调节障碍在双相情感障碍前期病史中很常见。这一假设基于以下几点：1）发病年龄早；2）性别比例；3）抗抑郁治疗下情绪转换的高倾向；4）高复发率；5）家族情感负荷；6）主要发作频繁叠加于情感气质性调节障碍（情绪易变性和爆发性愤怒突出：混合状态的指标）。作者认为情感气质（环性心境、轻躁狂和恶劣心境）代表了双相情感障碍可能的发展途径。作者构建了法语版的情感气质半结构化访谈和自我评估。本章展示了这些心理测量工具的法语版本。作者希望情感气质领域的现有知识和新研究将鼓励临床医生进一步了解躁郁症，并早期发现双相情感障碍的不同临床表现。需要更高的临床精细度来超越经典的“诊断”工具和人为分类（如《精神疾病诊断与统计手册》第四版），并描绘出双相情感障碍的心理生物学途径。
