Systematic clinical methodology for validating bipolar-II disorder:: data in mid-stream from a French national multi-site study (EPIDEP)
Systematic clinical methodology for validating bipolar-II disorder:: data in mid-stream from a French national multi-site study (EPIDEP)
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DOI：
10.1016/s0165-0327(98)00112-8
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发表时间：
1998-09-01
影响因子：
6.6
通讯作者：
Châtenet-Duchêne, L
中科院分区：
文献类型：
--
作者：
Hantouche, EG;Akiskal, HS;Châtenet-Duchêne, L
工作背景：本文介绍了一项法国多中心研究（EPIDEP）的方法学和临床数据，该研究正在对DSM-IV重性抑郁发作（MDE）患者的全国样本进行研究。EPIDEP的目的是证明由执业临床医生验证软双相情感障碍谱的可行性。在本报告中，我们重点关注双极II（BP-II）。方法：EPIDEP涉及在15个地点培训48名法国精神病医生;根据DSM-IV和Akiskal的标准制定一项共同协议（软双极性），以及从Angst的工作修改的标准（轻躁狂量表）、Ahearn-Carroll双相量表、HAM-D和Rosenthal非典型抑郁量表;情感气质评价的半结构式访谈（基于Akiskal-Mallya），自评循环性心境量表（Akiskal），家族史（研究诊断标准）;和前瞻性随访。结果：目前为止，在急性期研究的250例（共537例）MDE患者的结果。BP-II障碍的发生率在初始评估时为22%，通过系统评估几乎翻了一番（40%）。正如通过统一标准选择MDE所预期的那样，BP-II与单极之间的组间比较显示，大多数社会人口统计学参数、临床表现和抑郁的总体强度无差异。尽管如此一致，关键特征显着区分BP-II从单极：年轻的年龄在第一次抑郁症发作，更高的频率自杀的想法和嗜睡在指数发作，更高的分数轻躁狂检查表和循环性和易激惹的气质，和较高的转换率在目前的治疗。88%的病例被临床医生分配为循环性心境气质（自我评定循环性心境的10/21项截止），被认为是BP-II。临床医生和患者对这种气质的评价在高度显著水平上相关（r = 0.73; p
Background: This paper presents the methodology and clinical data in mid-stream from a French multi-center study (EPIDEP) in progress on a national sample of patients with DSM-IV major depressive episode (MDE). The aim of EPIDEP is to show the feasibility of validating the spectrum of soft bipolar disorders by practising clinicians. In this report, we focus on bipolar II (BP-II). Method: EPIDEP involves training 48 French psychiatrists in 15 sites; construction of a common protocol based on the criteria of DSM-IV and Akiskal (Soft Bipolarity), as well as criteria modified from the work of Angst (Hypomania Checklist), the Ahearn-Carroll Bipolarity Scale, HAM-D and Rosenthal Atypical Depression Scale; Semi-Structured Interview for Evaluation of Affective Temperaments (based on Akiskal-Mallya), self-rated Cyclothymia Scale (Akiskal), family history (Research Diagnostic Criteria); and prospective follow-up. Results: Results are presented on 250 (of the 537) MDE patients studied thus far during the acute phase. The rate of BP-II disorder which was 22% at initial evaluation, nearly doubled (40%) by systematic evaluation. As expected from the selection of MDE by uniform criteria, inter-group comparison between BP-II vs unipolar showed no differences on the majority of socio-demographic parameters, clinical presentation and global intensity of depression. Despite such uniformity, key characteristics significantly differentiated BP-II from unipolar: younger age at onset of first depression, higher frequency of suicidal thoughts and hypersomnia during index episode, higher scores on Hypomania Checklist and cyclothymic and irritable temperaments, and higher switching rate under current treatment. Eighty-eight percent of cases assigned to cyclothymic temperament by clinicians (with a cut-off of 10/21 items on self-rated cyclothymia) were recognized as BP-II. Evaluation of this temperament by clinician and patient correlated at a highly significant level (r = 0.73; p