Bipolar disorder diagnosis: challenges and future directions.
Bipolar disorder diagnosis: challenges and future directions.
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DOI：
10.1016/s0140-6736(13)60989-7
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发表时间：
2013-05-11
期刊：
影响因子：
--
通讯作者：
Kupfer DJ
中科院分区：
文献类型：
--
作者：
Phillips ML;Kupfer DJ
双相情感障碍指的是一组情感障碍，这些障碍的共同特征是抑郁和躁狂或躁狂发作。这些障碍包括：I型双相障碍(抑郁和躁狂发作：这种障碍可以在一次躁狂发作的基础上被诊断)；II型双相障碍(抑郁和轻躁发作)；循环胸腺障碍(不符合抑郁发作标准的轻躁和抑郁症状)；以及未另行规定的双相障碍(抑郁和类似轻躁狂症状，不符合上述任何障碍的诊断标准)。II型双相情感障碍尤其难以准确诊断，因为这种障碍很难与抑郁症患者中的复发性单相抑郁(复发性抑郁发作)相区分。识别代表双相障碍和单相抑郁之间不同的病理生理过程的客观生物标记物，既可以为双相障碍的诊断提供信息，也可以为新的个性化治疗的开发提供生物靶点。神经成像研究可以帮助识别区分双相情感障碍和单相抑郁的生物标志物，但在检测这些障碍之间的明确边界方面的问题表明，它们可能更好地代表为情感障碍的连续体。神经成像和模式识别方法的创新组合可以识别神经结构和功能的个别模式，从而准确地确定患者在行为量表上的位置。最终，一种综合的方法，通过使用不同的尺度进行几种生物测量，可以产生生物标记物(生物签名)的模式，以帮助确定个性化的生物靶标和所有情感障碍的新治疗方法。
Bipolar disorder refers to a group of affective disorders, which together are characterised by depressive and manic or hypomanic episodes. These disorders include: bipolar disorder type I (depressive and manic episodes: this disorder can be diagnosed on the basis of one manic episode); bipolar disorder type II (depressive and hypomanic episodes); cyclothymic disorder (hypomanic and depressive symptoms that do not meet criteria for depressive episodes); and bipolar disorder not otherwise specified (depressive and hypomanic-like symptoms that do not meet the diagnostic criteria for any of the aforementioned disorders). Bipolar disorder type II is especially difficult to diagnose accurately because of the difficulty in differentiation of this disorder from recurrent unipolar depression (recurrent depressive episodes) in depressed patients. The identification of objective biomarkers that represent pathophysiologic processes that differ between bipolar disorder and unipolar depression can both inform bipolar disorder diagnosis and provide biological targets for the development of new and personalised treatments. Neuroimaging studies could help the identification of biomarkers that differentiate bipolar disorder from unipolar depression, but the problem in detection of a clear boundary between these disorders suggests that they might be better represented as a continuum of affective disorders. Innovative combinations of neuroimaging and pattern recognition approaches can identify individual patterns of neural structure and function that accurately ascertain where a patient might lie on a behavioural scale. Ultimately, an integrative approach, with several biological measurements using different scales, could yield patterns of biomarkers (biosignatures) to help identify biological targets for personalised and new treatments for all affective disorders.