Atypical depression: a variant of bipolar II or a bridge between unipolar and bipolar II?
Atypical depression: a variant of bipolar II or a bridge between unipolar and bipolar II?
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DOI：
10.1016/j.jad.2004.05.004
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发表时间：
2005-02-01
影响因子：
6.6
通讯作者：
Benazzi, F
中科院分区：
文献类型：
--
作者：
Akiskal, HS;Benazzi, F
背景：虽然越来越多的数据链非典型抑郁症（AD）的双相频谱，争议的重叠程度比比皆是。特别的是，哥伦比亚大学的研究小组率先提供了非典型抑郁症的操作清晰度和药理学特异性的数据，尽管如此，他们始终避免研究其与双相情感障碍II （BP-II）的区别有效性。因此，我们在BP-II和单极（UP）重度抑郁症（MDD）的大型临床样本中对这种联系进行了全面验证。方法：对连续348例BP-II型和254例重度抑郁发作（MDE）的MDD门诊患者进行非精神药物性访谈，采用改良的DSM-IV结构化临床访谈、结构化家族史筛查和轻躁狂访谈指南。我们使用DSM-IV标准来描述“非典型特征”。抑郁混合状态定义为MDE期间>= 3个同时出现的轻躁症状和体征。双相情感障碍确诊者为发病年龄、抑郁高复发率、抑郁混合状态和双相情感障碍家族史（I型和II型）。单变量和多变量逻辑回归用于检验关联和控制混杂变量。结果：BP-II和MDD合并病例AD发生率为43.0%。AD患者BP-II的发生率明显高于非AD患者。AD与所有双相情感障碍患者显著相关，其中家族史最为显著。MDE期间非典型症状的数量与双相家族史负荷之间存在剂量-反应关系。在控制BP-II的混杂效应后，双相家族史与非典型症状数量之间的关联仍然显著。双相情感障碍家族史与铅性麻痹和嗜睡的非典型症状密切相关。结论：这些结果证实了AD与双相情感障碍患者在精神病理和家族基础上的紧密联系。从实用的角度来看，AD最好被视为BP-I的变体。临床医生面对表现为非典型特征的MDE患者应强烈考虑BP-II诊断。在更假设的情况下，非典型性或与之相关的一些特征可能作为UP和BP-II之间的病理性桥梁。(c) 2004 Elsevier B.V.版权所有
Background: Although increasing data link atypical depression (AD) to the bipolar spectrum, controversies abound about the extent of the overlap. In particular, the Columbia group, which has pioneered in providing data on operational clarity and pharmacological specificity of atypical depressions, has nonetheless consistently avoided studying its discriminatory validity from bipolar II (BP-II). Accordingly, we undertook a full scale validation of such a link in a large clinical sample of BP-II and unipolar (UP) major depressive disorder (MDD).Methods: Consecutive 348 BP-II and 254 MDD outpatients presenting with major depressive episodes (MDE) were interviewed off psychoactive drugs with a modified Structured Clinical Interview for DSM-IV, the structured Family History Screen and the Hypomania Interview Guide. We used the DSM-IV criteria for "atypical features" specifier. Depressive mixed state was defined as >= 3 concurrent hypomanic signs and symptoms during MDE. Bipolar validators were age at onset, high depressive recurrence, depressive mixed state and bipolar family history (types I and II). Univariate and multivariate logistic regression were used to examine associations and control for confounding variables.Results: Frequency of AD was 43.0% in the combined BP-II and MDD sample. AD, versus non-AD, had significantly higher rates of BP-II. AD was significantly associated with all bipolar validators, among which family history was the most robust. A dose-response relationship was found between number of atypical symptoms during MDE and bipolar family history loading. The association between bipolar family history and number of atypical symptoms remained significant after controlling for the confounding effect of BP-II. Bipolar family history was strongly associated with the atypical symptoms of leaden paralysis and hypersomnia.Conclusion: These results confirm a strong link between AD and bipolar validators along psychopathologic and familial grounds. From a practical standpoint, AD is best viewed as a variant of BP-I. Clinicians confronted with MDE patients presenting with atypical features should strongly consider a BP-II diagnosis. In a more hypothetical vein, atypicality or some associated features thereof-might serve as a nosologic bridge between UP and BP-II. (c) 2004 Elsevier B.V. All rights reserved.