The duration of hypomania in bipolar-II disorder in private practice: methodology and validation
The duration of hypomania in bipolar-II disorder in private practice: methodology and validation
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DOI：
10.1016/j.jad.2004.04.006
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发表时间：
2006-12-01
影响因子：
6.6
通讯作者：
Akiskal, Hagop
中科院分区：
文献类型：
--
作者：
Benazzi, Franco;Akiskal, Hagop
背景：DSM-IV 4 天最短轻躁狂持续时间没有证据支持。流行病学数据表明，社区中普遍存在短暂的轻躁狂。我们试图找出私人诊所中短期（2-3 天）与长期（>= 4 天）轻躁狂的相对患病率。方法：采用经作者修改的 DSM-IV 结构化临床访谈对 206 名双相 II 型 (BP-II) 抑郁症门诊患者（B 组）和 140 名缓解 BP-II 患者（R 组）进行评估。在诸如发病年龄早、抑郁复发、非典型特征说明、抑郁混合状态和双相家族史等双相验证器上比较了短期和长期轻躁狂的 BP-II。此外，为了确定伴有短暂轻躁狂的抑郁症患者的双相状态，我们纳入了一个由 178 名重度抑郁症 (MDD) 患者组成的对照组，在抑郁时进行评估。结果：27-30% 的轻躁狂（取决于评估是在患者抑郁还是缓解时发生）持续 2-3 天； 72% 持续时间不到 4 周。除了非典型特征说明符之外，具有短躁狂的 BP-II 与具有较长轻躁狂的 BP-II 在双极验证器上没有显着差异。此外，与较长的轻躁狂对应物一样，较短的 BP-II 在所有双相指标上均与对照 MDD 组显着不同。 局限性：未研究短于两天的轻躁狂。单一访谈者和对轻躁狂持续时间的回顾性评估。结论：由于 BP-II 患者在临床上几乎从未出现过轻躁狂发作，因此对这些发作持续时间的回顾性评估在临床上是不可避免的。大多数轻躁狂持续两天到几周。与较长的轻躁狂相比，较短的 BP-IT 女性、合并症和非典型特征的比例显着更高，但在关键的双相情感障碍验证器上无法区分。此外，这些验证器，包括双相情感障碍家族史，可以将具有短暂轻躁狂的 BP-II 与 MDD 组区分开来。保守的 4 天阈值会将三分之一的 BP-II 错误分类为 MDD。这种错误分类对抑郁症和双相情感障碍的治疗和结果以及临床研究方法具有相关影响。 (c) 2004 Elsevier B.V. 保留所有权利。
Background: DSM-IV 4-day minimum hypomania duration is not evidence-based. Epidemiologic data suggest that briefer hypomanias are prevalent in the community. We sought to find out the relative prevalence of short (2-3 days) versus long (>= 4 days) hypomanias in private practice.Methods: 206 bipolar-II (BP-II) depressed outpatients (group B) and a group of 140 remitted BP-II (group R) were assessed with the DSM-IV Structured Clinical Interview, as modified by the authors. BP-II with short vs. longer hypomania were compared on such bipolar validators as early age at onset, depressive recurrence, atypical feature specifier, depressive mixed state and bipolar family history. In addition, to ascertain the bipolar status of depressed patients with brief hypomanias, we included a comparison group of 178 major depressive disorder (MDD) patients assessed when depressed.Results: 27-30% of hypomanias (depending on whether assessment occurred when patients were depressed or in remission) had 2-3-day duration; 72% lasted less than 4 weeks. Except for the atypical feature specifier, BP-II with short vs. BP-II with longer hypomania were not significantly different on bipolar validators. Moreover, BP-II with short, like its longer hypomanic counterpart, was significantly different from the comparison MDD group on all bipolar indicators.Limitations: Hypomanias shorter than two days were not studied. Single interviewer and retrospective evaluation of duration of hypomania.Conclusions: As BP-II patients almost never present clinically in a hypomanic episode, the retrospective assessment of the duration of these episodes is clinically unavoidable. Most hypomanias last from 2 days to a few weeks. BP-IT with shorter vs. longer hypomanias had significantly higher rates of females, comorbidity and atypical features, but were otherwise indistinguishable on crucial bipolar validators. Furthermore, such validators, including bipolar family history, robustly distinguished BP-II with short hypomanias from the MDD group. The conservative 4-day threshold would misclassify one out of three BP-II as MDD. Such misclassification has relevant implications for treatment and outcome, as well as clinical research methodology for depressive and bipolar disorders. (c) 2004 Elsevier B.V. All rights reserved.