Bipolar II disorder: arguments for and against a distinct diagnostic entity.
Bipolar II disorder: arguments for and against a distinct diagnostic entity.
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DOI：
10.1111/j.1399-5618.2007.00561.x
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发表时间：
2008-02
影响因子：
5.4
通讯作者：
E. Vieta;T. Suppes
中科院分区：
文献类型：
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作者：
E. Vieta;T. Suppes
目的作为对国际双相情感障碍学会（ISBD）的承诺，成立了一个工作组来研究双相情感障碍II的诊断价值。方法工作组成员共同审查所有相关文献（原始文章，评论，信件，书籍章节和大会演讲），其中包括“双相II型障碍”和/或“轻躁狂”作为关键词。结果双相情感障碍II似乎是一个合理有效和可靠的诊断类别，但往往被低估或误诊为单相情感障碍或人格障碍。此外，它在DSM-IV-TR中被正式承认为精神障碍，但在ICD-10中没有，许多临床医生仍然认为它是躁狂抑郁症的一种较轻形式，尽管数据支持高发病率和死亡率。事实上，双相II型可能是最常见的双相表型，尽管目前的诊断界限被认为是相当限制性的，涉及轻躁狂所需的持续时间（4天），排除可能由抗抑郁药和其他物质触发的轻躁狂发作，以及忽视轻躁狂混合状态。双相II障碍的病程以抑郁为主的极性为特征，其治疗仍存在争议且缺乏循证依据。结论双相II型障碍作为心境障碍中的一个独立类别得到支持，但其定义和界限需要在DSM-V和ICD-11中得到更大的澄清。
OBJECTIVE As a commitment to the International Society for Bipolar Disorders (ISBD), a Task Force was developed to investigate the diagnostic value of bipolar II disorder. METHODS Task Force members worked jointly reviewing all relevant literature (original articles, reviews, letters, book chapters and congress presentations) that included 'bipolar II disorder' and/or 'hypomania' as key words. RESULTS Bipolar II disorder appears to be a reasonably valid and reliable diagnostic category yet often underdiagnosed or misdiagnosed as unipolar disorder or personality disorder. Moreover, it is officially recognized as a mental disorder in DSM-IV-TR but not in ICD-10, and many clinicians still regard it as a milder form of manic-depressive illness, despite data supporting high morbidity and mortality rates. In fact, bipolar II may be the most prevalent bipolar phenotype, although current diagnostic boundaries are seen as quite restrictive concerning the required duration for hypomania (4 days), the exclusion of hypomanic episodes potentially triggered by antidepressants and other substances, and the negligence of hypomanic mixed states. The course of bipolar II disorder is characterized by depressive predominant polarity, and its treatment is still controversial and poorly evidence-based. CONCLUSIONS Bipolar II disorder is supported as a distinct category within mood disorders, but the definition and boundaries deserve a greater clarification in the DSM-V and ICD-11.