Hypomania/Mania by DSM-5 definition based on daily smartphone-based patient-reported assessments
Hypomania/Mania by DSM-5 definition based on daily smartphone-based patient-reported assessments
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DOI：
10.1016/j.jad.2020.01.014
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发表时间：
2020-03-01
影响因子：
6.6
通讯作者：
Kessing, Lars Vedel
中科院分区：
文献类型：
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作者：
Faurholt-Jepsen, Maria;Christensen, Ellen Margrethe;Kessing, Lars Vedel
简介：DSM-5引入了情绪高涨/易怒和活动/精力增加作为诊断(低)躁狂的同等和必要的标准A症状。这些变化的影响尚不清楚。这项研究的目的是使用现实生活中基于智能手机的患者报告的情绪、易怒和活动性的测量方法，调查在ICD-10和DSM-IV诊断为BD的患者中，在活动增加的情况下和不同情况下情绪高涨/易怒的患病率的差异，以及这些之间的关联。方法：结合两个RCT的数据，调查基于智能手机的治疗对BD患者的效果。BD患者(N=117)通过基于智能手机的系统在6至9个月内每天评估情绪、易怒和活动水平。这项研究的分析是基于先前发表的数据的探索性事后分析。结果：在随访期内，患者报告情绪高涨的时间为8.0%，易怒的时间为28.4%，活动增加的时间为20.6%。在连续四天(低躁狂发作的持续时间标准)中，共同出现的情绪高涨/易怒情绪和活动的比例为0.12%，而没有同时出现活动增加的高涨/易怒情绪的情况下，这一比例为24%。在考虑个体间和个体内差异的线性混合效应模型中，情绪和活动之间存在显著的正相关(B：0.14，95%CI：0.046；0.24，p=0.004)。易怒与活动之间没有关联(p=0.23)。结论：基于现实生活中的日常评估，由于DSM-5的引入，(低)躁狂发作的患病率显著降低，并具有潜在的临床后果。
Introduction: The DSM-5 has introduced elevated/irritable mood and increased activity/ energy as equal and necessary criterion A symptoms for a diagnosis of (hypo)mania. The impact of these changes is poorly elucidated. The aim of the study was to investigate differences in the prevalence of elevated/irritable mood with and without co-occurring increased activity, and the associations between these, in patients with an ICD-10 and DSM-IV diagnosis of BD, using real life daily smartphone-based patient-reported measures of mood, irritability and activity.Methods: Data from two RCTs investigating the effect of smartphone-based treatment in patients with BD were combined. Patients with BD (N = 117) evaluated mood, irritability and activity level daily for six to nine months via a smartphone-based system. Analyses in this study are exploratory post hoc analyses based on previously published data.Results: During the follow-up period, patients reported elevated mood 8.0% of the time, irritability 28.4% of the time and increased activity 20.6% of the time. Co-occurring elevated/irritable mood and activity were prevalent 0.12% of the time for four consecutive days (duration criteria for a hypomanic episode) compared to 24% of the time with elevated/irritable mood without co-occurring increased activity. In linear mixed effect models accommodating for inter-individual and intra-individual variation, there was a statistically significant positive association between mood and activity (B: 0.14, 95% CI: 0.046; 0.24, p = 0.004). There was no association between irritability and activity (p = 0.23).Conclusion: Based on real life daily assessments, the prevalence of (hypo)manic episodes is substantial reduced as a result of the introduction of DSM-5 and with potentially clinical consequences.