Cvjetković-Bosnjak M
Institut za neurologiju, psihijatriju i mentalno zdravlje, Medicinski fakultet, Novi Sad.
Med Pregl. 1998 Jul-Aug;51(7-8):329-32.
In the last decades affective disorders were divided into unipolar and bipolar and this division has been generally accepted. The bipolar type is manifested by mania or by both mania and depression. On the other hand, unipolar affective disorders are manifested only by depression. In numerous investigations authors have noticed that there are very distinctive differences between these two types of depressive disorders such as: course of illness, personality disorders, sex, family history etc. Nevertheless, in practice it is often very difficult to make the right diagnosis. The bipolar type often starts with a few pure depressive episodes and sometimes mania occurs a few years later so only at that point the psychiatrist can make the right diagnosis and treat the patient correctly.
This investigation comprised 50 patients hospitalized at the Psychiatric Clinic in Novi Sad during 1992-1995. The experimental group consisted of 20 patients with a bipolar affective disorder (according to ICD-X), while the control group consisted of 30 patients with clinical diagnosis of unipolar depression (intensive, without psychiatric features). Both groups of patients were weekly evaluated by Hamilton Depression Rating Scale (HDRS), whereas the initial score for all patients had to be higher than 16.
Patients suffering from unipolar depression were older than patients with bipolar depression and there were more females in this group. There were no differences in demographic characteristics (level of education, migration, etc.), but the experimental group had a greater genetic loading for affective disorders. Unipolar depressive patients had more agitation and they were more anxious than patients with bipolar depression.
The fact that unipolar depressive patients were older than bipolar is similar to most of the results gained in this kind of investigation. On the other hand, we did not find statistical differences in the intensity of disorders, and in the literature these results are contraindicating. Numerous investigators report that bipolar depressives had a stronger genetic loading for affective disorders and our study confirms the same. All these results can help us to make the right diagnosis of unipolar and bipolar affective disorders.
在过去几十年中,情感障碍被分为单相和双相,这种分类已被普遍接受。双相型表现为躁狂发作,或既有躁狂又有抑郁发作。另一方面,单相情感障碍仅表现为抑郁。在众多研究中,作者们注意到这两种类型的抑郁障碍之间存在非常明显的差异,例如:病程、人格障碍、性别、家族史等。然而,在实践中往往很难做出正确的诊断。双相型通常始于几次单纯的抑郁发作,有时几年后才会出现躁狂,所以只有到那时精神科医生才能做出正确的诊断并正确治疗患者。
本研究包括1992年至1995年期间在诺维萨德精神病诊所住院的50名患者。实验组由20名双相情感障碍患者(根据国际疾病分类第十版)组成,而对照组由30名临床诊断为单相抑郁症(重度,无精神症状)的患者组成。两组患者每周都用汉密尔顿抑郁量表(HDRS)进行评估,所有患者的初始评分必须高于16分。
单相抑郁症患者比双相抑郁症患者年龄更大,且该组女性更多。在人口统计学特征(教育程度、移民情况等)方面没有差异,但实验组情感障碍的遗传负荷更大。单相抑郁患者比双相抑郁患者更易激惹且更焦虑。
单相抑郁患者比双相患者年龄更大这一事实与这类研究中获得的大多数结果相似。另一方面,我们在疾病严重程度方面未发现统计学差异,而在文献中这些结果是相互矛盾的。许多研究者报告双相抑郁患者情感障碍的遗传负荷更强,我们的研究也证实了这一点。所有这些结果有助于我们对单相和双相情感障碍做出正确的诊断。