Mood episodes and mood disorders: patterns of incidence and conversion in the first three decades of life
Mood episodes and mood disorders: patterns of incidence and conversion in the first three decades of life
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DOI：
10.1111/j.1399-5618.2009.00738.x
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发表时间：
2009-09-01
影响因子：
5.4
通讯作者：
Pfennig, Andrea
中科院分区：
文献类型：
--
作者：
Beesdo, Katja;Hoefler, Michael;Pfennig, Andrea
目的：关于社区青少年和年轻人的情绪发作模式以及从单相情感障碍到双相情感障碍的转化率，仍然存在重大问题。我们通过检查前瞻性纵向社区研究的数据来解决这些问题，以（i）确定生命前三十年情绪发作和疾病的累积发生率； (ii) 确定有轻躁狂/躁狂发作史的个体首次出现抑郁症的风险，反之亦然；方法：使用慕尼黑综合国际诊断访谈，经过临床培训的访谈员评估了 3,021 名社区受试者（基线年龄 14-24 岁，第三次随访年龄 21-34 岁）的情绪发作和精神障碍。结果：估计 33 岁时躁狂的累计发病率为 2.9%，轻躁狂为 4.0%，重度躁狂为 29.4%抑郁，19.0% 为轻度抑郁发作；总体而言，26.0% 患有单相重性抑郁，4.0% 患有双相抑郁，1.5% 患有单相躁狂，3.6% 患有单相轻躁狂（无重度抑郁）。总体而言，分别有 0.6% 和 1.8% 的人患有单相躁狂或轻躁狂，甚至没有轻微抑郁的迹象。总共 3.6% 的初始单相重性抑郁病例随后发展为（轻）躁狂，其中青少年发病抑郁症的发生率特别高（< 17 岁：9%）。总共 49.6% 的最初单相躁狂病例随后发展为重度抑郁症，75.6% 为重度或轻度抑郁症。虽然双相情感障碍病例比单相抑郁病例有更多不良的临床和病程抑郁特征以及更高的治疗率，但双相情感障碍的躁狂特征与单相躁狂病例没有显着差异。结论：单相和双相情感障碍在青春期和成年早期的发病率比之前想象的要高，而这个时期医疗保健系统的识别率和干预率都相当低。在最初的单相抑郁症中“转变”为双相情感障碍是有限的，但在最初的单相躁狂中很常见。其余的单相躁狂病例在临床和病程特征方面似乎很重要，因此需要更多的研究关注来复制这些发现。
Objectives:Significant questions remain regarding both the incidence patterns of mood episodes in adolescents and young adults from the community and the conversion rate from unipolar to bipolar disorders. We addressed these issues by examining data from a prospective longitudinal community study to (i) determine the cumulative incidence of mood episodes and disorders in the first three decades of life; (ii) determine the risk for first onset of depression among individuals with a previous history of hypomanic/manic episodes and vice versa; and (iii) determine the clinical and treatment characteristics of these subjects.Methods:Using the Munich-Composite International Diagnostic Interview, clinically trained interviewers assessed mood episodes and mental disorders in 3,021 community subjects (aged 14-24 at baseline and 21-34 at third follow-up).Results:The estimated cumulative incidence at age 33 was 2.9% for manic, 4.0% for hypomanic, 29.4% for major depressive, and 19.0% for minor depressive episodes; overall, 26.0% had unipolar major depression, 4.0% bipolar depression, 1.5% unipolar mania, and 3.6% unipolar hypomania (no major depression). Overall, 0.6% and 1.8% had unipolar mania or hypomania, respectively, without indication for even minor depression. A total of 3.6% of the initial unipolar major depression cases subsequently developed (hypo)mania, with particularly high rates in adolescent onset depression (< 17 years: 9%). A total of 49.6% of the initial unipolar mania cases subsequently developed major depression and 75.6% major or minor depression. While bipolar cases had more adverse clinical and course depression characteristics and higher treatment rates than unipolar depressed cases, bipolar cases did not significantly differ in mania characteristics from unipolar mania cases.Conclusions:Unipolar and bipolar mood disorders are more frequent than previously thought in adolescence and young adulthood, a time period when both the recognition and the intervention rates by the healthcare system are rather low. 'Conversion' to bipolar disorder is limited in initial unipolar depression, but common in initial unipolar mania. The remaining unipolar mania cases appear to be significant in terms of clinical and course characteristics and thus require more research attention to replicate these findings.