Bipolar II with and without cyclothymic temperament: "dark" and "sunny" expressions of soft bipolarity
Bipolar II with and without cyclothymic temperament: "dark" and "sunny" expressions of soft bipolarity
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DOI：
10.1016/s0165-0327(02)00320-8
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发表时间：
2003-01-01
影响因子：
6.6
通讯作者：
Allilaire, JF
中科院分区：
文献类型：
--
作者：
Akiskal, HS;Hantouche, EG;Allilaire, JF
背景资料：在本报告中，来自法国国家多站点EPIDEP研究，我们专注于双相II（BP-II）的特点，划分的基础上循环性气质（CT）。在我们的配套文章中（Hanovich等人，2003年，这一问题），我们发现，这种气质在其自我评价的版本显着相关的轻躁狂行为的冒险性质。我们的目的是在目前的分析是进一步测试的假设，这类患者分配到CT的基础上，临床采访，代表了一个更“不稳定”的变种BP-II。研究方法：从537名精神病患者中，493名患者在平均一个月后重新检查;在排除256名DSM-IV MDD和41名有躁狂症病史的患者后，其余196名患者被置于BP-II谱中。越来越多的国际证据表明，与抗抑郁药相关的轻躁狂属于这一范围，这种关联本身并不构成排除的理由。临床医生使用基于Akiskal和Mallya（1987）法语版的半结构化访谈对CT进行评估;由于两份文件不包含关于CT的完整访谈数据（本分析中的关键临床变量），因此我们的分析样本为194例BP-II。社会人口学，心理测量，临床，家族和历史参数进行了比较BP-II细分的CT。心理测量包括自评CT和轻躁狂量表，以及汉密尔顿和罗森塔尔抑郁量表。结果如下：BP-II病例分类分配为CT（n = 74）与未进行CT的病例（it = 120），其特点如下：（1）发病年龄较小（P = 0.005）和寻求帮助的年龄（2）HAM-D评分高于对照组（P = 0.05）（P = 0.03）和Rosenthal（非典型抑郁）量表（3）从发病到识别双相的延迟时间较长（P = 0.007）（P = 0.0002）;（4）精神科合并症的发生率较高（P = 0.04）;（5）轴II上的不同轮廓（即，更多的表演性，被动攻击性和较少的强迫性人格障碍）。抑郁症和双相情感障碍的家族史并没有显着区分两组，但是，慢性情感综合征显着较高的BP-II与CT。最后，循环型BP-II在易激冒险方面的得分显著高于“经典”轻躁狂驱动欣快项目。结论：由循环情感型气质引起的抑郁症即使完全符合轻度躁狂的标准也很可能被误诊为人格障碍。他们的情感障碍（包括双相情感障碍）的高家族负担证实了这些“循环情感性抑郁症”的双相性质。我们的数据支持将其作为BP-II的一种更“不稳定”的变体，我们在别处称之为“BP-II 1/2“。这些患者最好被描述为更典型的“阳光”BP-II表型的“黑暗”表达。再加上我们的同伴论文（Hanjiang et al，2003，本期）的数据，目前的研究结果表明，在重性抑郁症患者中筛查循环性心境障碍是检测双相亚型的一种可行方法，否则可能被误认为是一种不稳定的人格障碍。总的来说，我们的研究结果支持最近的国际共识，有利于诊断循环型和双相II型障碍的不稳定和边缘型人格障碍时，这两组疾病的标准同时满足。(C)2002 Elsevier Science B. V.保留所有权利。
Background: In the present report deriving from the French national multi-site EPIDEP study, we focus on the characteristics of Bipolar II (BP-II), divided on the basis of cyclothymic temperament (CT). In our companion article (Hantouche et al., 2003, this issue), we found that this temperament in its self-rated version correlated significantly with hypomanic behavior of a risk-taking nature. Our aim in the present analyses is to further test the hypothesis that such patients-assigned to CT on the basis of clinical interview-represent a more "unstable" variant of BP-II. Methods: From a total major depressive population of 537 psychiatric patients, 493 were re-exarnined on average a month later; after excluding 256 DSM-IV MDD and 41 with history of mania, the remaining 196 were placed in the BP-II spectrum. As mounting international evidence indicates that hypomania associated with antidepressants belongs to this spectrum, such association per se did not constitute a ground for exclusion. CT was assessed by clinicians using a semi-structured interview based on Akiskal and Mallya (1987) in its French version; as two files did not contain full interview data on CT, the critical clinical variable in the present analyses, this left us with an analysis sample of 194 BP-II. Socio-demographic, psychometric, clinical, familial and historical parameters were compared between BP-II subdivided by CT. Psychometric measures included self-rated CT and hypomania scales, as well as Hamilton and Rosenthal scales for depression. Results: BP-II cases categorically assigned to CT (n = 74) versus those without CT (it = 120), were differentiated as follows: (1) younger age at onset (P = 0.005) and age at seeking help (P = 0.05); (2) higher scores on HAM-D (P = 0.03) and Rosenthal (atypical depressive) scale (P = 0.007); (3) longer delay between onset of illness and recognition of bipolarity (P = 0.0002); (4) higher rate of psychiatric comorbidity (P = 0.04); (5) different profiles on axis II (i.e., more histrionic, passive-aggressive and less obsessive-compulsive personality disorders). Family history for depressive and bipolar disorders did not significantly distinguish the two groups; however, chronic affective syndromes were significantly higher in BP-II with CT. Finally, cyclothymic BP-II scored significantly much higher on irritable-risk-taking than "classic" driven-euphoric items of hypomania. Conclusion: Depressions arising from a cyclothymic temperament-even when meeting full criteria for hypomania-are likely to be misdiagnosed as personality disorders. Their high familial load for affective disorders (including that for bipolar disorder) validate the bipolar nature of these "cyclothymic depressions." Our data support their inclusion as a more "unstable" variant of BP-II, which we have elsewhere termed "BP-II 1/2." These patients can best be characterized as the "darker" expression of the more prototypical "sunny" BP-II phenotype. Coupled with the data from our companion paper (Hantouche et al, 2003, this issue), the present findings indicate that screening for cyclothymia in major depressive patients represents a viable approach for detecting a bipolar subtype that could otherwise be mistaken for an erratic personality disorder. Overall, our findings support recent international consensus in favoring the diagnosis of cyclothymic and bipolar II disorders over erratic and borderline personality disorders when criteria for both sets of disorders are concurrently met. (C) 2002 Elsevier Science B.V. All rights reserved.