Treatment-induced manic switch in the course of unipolar depression can predict bipolarity: Cluster analysis based evidence
Treatment-induced manic switch in the course of unipolar depression can predict bipolarity: Cluster analysis based evidence
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DOI：
10.1016/j.jad.2011.06.019
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发表时间：
2011-11-01
影响因子：
6.6
通讯作者：
Tunca, Zeliha
中科院分区：
文献类型：
--
作者：
Dumlu, Kemal;Orhon, Zahide;Tunca, Zeliha
背景：抗抑郁药可诱导抑郁症患者的躁狂转换。DSM IV不将治疗诱导的躁狂视为双相情感障碍。本研究的目的是评估是否有治疗诱发躁狂病史的单相抑郁症患者的临床特征与双相情感障碍患者相似。方法：本研究包括217例连续的DSM-IV心境障碍患者，诊断为：I型双相情感障碍（BP-I，n = 58）或II型（BP-II，n = 18）首次发作为抑郁症，复发性（单相）重度抑郁障碍伴抗抑郁药治疗诱导的躁狂病史（转换者= stir）; n = 61）和无此类事件（rUD; n = 80）。首先，使用方差和卡方分析比较各组的临床特征和病程说明。四组之间差异显著的变量被纳入两步聚类分析，以探索所有诊断中自然发生的亚组。随后，研究了自然发生的集群与预定义的DSM-IV诊断之间的关系。结果：两步集群分析揭示了两个不同的自然发生的群组。较高的抑郁发作的严重程度，较高的发病率，较高的住院次数和自杀企图，在一个集群中，转换者（77%），双相I型，（94.8%）和II（83.3%）患者聚集在一起。这项研究的结果证实，治疗引起的躁狂症是一种临床现象，属于-双相性精神障碍是双相性精神障碍的一种，而不是一种偶然的治疗并发症，在未来的分类系统中，它应该被归类为“双相性精神障碍”。(C)2011爱思唯尔有限公司版权所有。
Background: Antidepressants are known to induce manic switch in patients with depression. Treatment-induced mania is not considered as bipolar disorder in DSM IV. The aim of this study was to assess whether clinical characteristics of patients with unipolar depression with a history of treatment-induced mania were similar to those of patients with bipolar disorder.Method: The study included 217 consecutive patients with DSM-IV mood disorders, diagnosed as: bipolar disorder type I (BP-I, n = 58) or type II (BP-II, n = 18) whose first episodes were depression, recurrent (unipolar) major depressive disorder with a history of antidepressant treatment-induced mania (switchers = stir); n = 61) and without such an event (rUD; n = 80). First, the groups were compared with regard to clinical features and course specifiers using variance and chi-square analysis. Variables that differed significantly between the four groups were included in two-step cluster analysis to explore naturally occurring subgroups in all diagnoses. Subsequently, the relationship between the naturally occurring clusters and pre-defined DSM-IV diagnoses were investigated.Results: Two-step cluster analysis revealed two different naturally occurring groups. Higher severity of depressive episodes, with higher rate of melancholic features, higher number of hospitalization and suicide attempts were represented in one cluster where switchers (77%), bipolar I (94.8%) and II (83.3%) patients clustered together.Conclusion: The findings of this study confirm that treatment-induced mania is a clinical phenomenon that belongs within-the bipolar spectrum rather than a coincidental treatment complication, and that it should be placed under "bipolar disorders" in future classification systems.Limitations: The study includes the limitations of any naturalistic retrospective study. (C) 2011 Elsevier B.V. All rights reserved.