Strategies to reduce misdiagnosis of bipolar depression
Strategies to reduce misdiagnosis of bipolar depression
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DOI：
10.1176/appi.ps.52.1.51
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发表时间：
2001-01-01
影响因子：
3.8
通讯作者：
Bowden, CL
中科院分区：
文献类型：
--
作者：
Bowden, CL
过去十年的研究表明，双相情感障碍的患病率与重度抑郁症相似。作者讨论了双相情感障碍诊断的复杂性，特别是在区分双相情感障碍和单相抑郁症方面。双相抑郁症与更多的情绪不稳定、更多的运动迟缓和更长的睡眠时间有关。发病年龄早，抑郁发作频率高，患病时间较长，发病时间相对较急或症状减轻，提示双相情感障碍，而不是重度抑郁症。由于DSM-IV标准要求双相情感障碍的诊断需要有躁狂或轻躁发作，因此许多患者最初被诊断和治疗为重度抑郁症。单独用抗抑郁药治疗双相情感障碍是无效的，并且可能加重轻躁、躁狂或循环。临床医生在抗抑郁治疗过程中警惕任何双极性发展的迹象是很重要的，特别是在首发重度抑郁症患者中。
Research over the past decade indicates that the prevalence of bipolar disorder is similar to that of major depression. The author discusses complexities in the diagnosis of bipolar disorder, especially in distinguishing bipolar from unipolar depression. Bipolar depression is associated with more mood lability, more motor retardation, and greater time spent sleeping. Early age of onset, a high frequency of depressive episodes, a greater percentage of time ill, and a relatively acute onset or offset of symptoms are suggestive of bipolar disorder rather than major depression. Because DSM-IV criteria require a manic or hypomanic episode for a diagnosis of bipolar disorder, many patients are initially diagnosed and treated as having major depression. Treatment of bipolar disorder with antidepressants alone is not efficacious and may exacerbate hypomania, mania, or cycling. It is important that clinicians be alert to any hint of bipolarity developing in the course of antidepressant therapy especially among patients with first-episode major depression.