Toward a re-definition of subthreshold bipolarity:: epidemiology and proposed criteria for bipolar-II, minor bipolar disorders and hypomania
Toward a re-definition of subthreshold bipolarity:: epidemiology and proposed criteria for bipolar-II, minor bipolar disorders and hypomania
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DOI：
10.1016/s0165-0327(02)00322-1
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发表时间：
2003-01-01
影响因子：
6.6
通讯作者：
Rössler, W
中科院分区：
文献类型：
--
作者：
Angst, J;Gamma, A;Rössler, W
背景：过去十年来，两极格局的界限一直在扩大。使用特征明确的流行病学队列，本文的目标是：(1) 测试 DSM-IV 轻躁狂的诊断标准，(2) 制定和验证双相 II (BP-II) 障碍和轻躁狂较软表达的定义标准，(3) 证明整个软双相谱系的患病率、临床有效性和合并症。方法：使用了从一项针对年轻人的 20 年前瞻性社区队列研究中收集的从正常情绪到病理情绪和过度活动的连续数据。通过家族史、病程和临床特征（包括与抑郁和药物滥用的关系）分析临床有效性。结果：（1）与欣快、烦躁一样，过度活动症状也应纳入轻躁狂的干标准；只要存在七种体征和症状中的三种，发作长度可能不应成为定义轻躁狂的标准，并且功能的改变仍然是严格诊断的必要条件。 (2) 低于该阈值，与重度或轻度抑郁相关的“仅轻躁狂症状”是双相情感障碍的重要指标。 (3) 双相 II 型障碍的广义定义给出的累积患病率为 10.9%，而广义定义的重度抑郁症的累积患病率为 11.4%。确定了一个特殊的轻微双相情感障碍群体（患病率 9.4%），其中 2.0% 患有循环性情感障碍；纯粹的轻躁狂发生率为3.3%。软双相情感障碍的总患病率为 23.7%，与整个抑郁症谱系（包括心境恶劣、轻微和复发性短暂抑郁）的患病率 (24.6%) 相当。局限性：需要具有大量受试者的全国队列来验证本文提出的最软双相亚组的数字组成。结论：轻躁狂的诊断标准需要修订。在其已证明的临床有效性的基础上，提出了更广泛的软双相情感障碍概念，其中近 11% 构成了双相情感障碍本身的谱系，另外 13% 可能代表了介于双相情感障碍和正常之间的双相情感障碍的最软表达。 (C) 2002 Elsevier Science B.V. 保留所有权利。
Background: The boundaries of bipolarity have been expanding over the past decade. Using a well characterized epidemiologic cohort, in this paper our objectives were: (1) to test the diagnostic criteria of DSM-IV hypomania, (2) to develop and validate criteria for the definition of softer expressions of bipolar-II (BP-II) disorder and hypomania, (3) to demonstrate the prevalence, clinical validity and comorbidity of the entire soft bipolar spectrum. Methods: Data on the continuum from normal to pathological mood and overactivity, collected from a 20-year prospective community cohort study Of Young adults, were used. Clinical validity was analysed by family history, course and clinical characteristics, including the association with depression and substance abuse. Results: (1) Just as euphoria and irritability, symptoms of overactivity should be included in the stem criterion of hypomania; episode length should probably not be a criterion for defining hypomania as long as three of seven signs and symptoms are present, and a change in functioning should remain obligatory for a rigorous diagnosis. (2) Below that threshold, 'hypomanic symptoms only' associated with major or mild depression are important indicators of bipolarity. (3) A broad definition of bipolar-II disorder gives a cumulative prevalence rate of 10.9%, compared to 11.4% for broadly defined major depression. A special group of minor bipolar disorder (prevalence 9.4%) was identified, of whom 2.0% were cyclothymic; pure hypomania occurred in 3.3%. The total prevalence of the soft bipolar spectrum was 23.7%, comparable to that (24.6%) for the entire depressive spectrum (including dysthymia, minor and recur-rent brief depression). Limitation: A national cohort with a larger number of subjects is needed to verify the numerical composition of the softest bipolar subgroups proposed herein. Conclusion: The diagnostic criteria of hypomania need revision. On the basis of its demonstrated clinical validity, a broader concept of soft bipolarity is proposed, of which nearly 11% constitutes the spectrum of bipolar disorders proper, and another 13% probably represent the softest expression of bipolarity intermediate between bipolar disorder and normality. (C) 2002 Elsevier Science B.V. All rights reserved.