Diagnosing bipolar disorder and the effect of antidepressants: A naturalistic study
Diagnosing bipolar disorder and the effect of antidepressants: A naturalistic study
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DOI：
10.4088/jcp.v61n1013
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发表时间：
2000-10-01
影响因子：
5.3
通讯作者：
Goodwin, FK
中科院分区：
文献类型：
--
作者：
Ghaemi, SN;Boiman, EE;Goodwin, FK
目的：探讨双相情感障碍在临床诊断中的准确性，评价抗抑郁药物对双相情感障碍病程的影响。方法：对1年来门诊就诊的情感性精神障碍患者(85例双相或单相)进行分析。过去的诊断和治疗信息通过患者报告和系统的精神病史获得。双相情感障碍的诊断基于DSM-IV标准，采用基于SCID的访谈。结果：37%的患者在首次躁狂/躁狂发作后第一次看心理健康专家时被误诊为单相抑郁。与情绪稳定剂相比，抗抑郁药的使用更早、更频繁，其中23%的未选择样本经历了新的或恶化的快速循环过程，这可归因于抗抑郁药的使用。结论：这些结果表明双相情感障碍往往被误诊为单相抑郁障碍，抗抑郁药物似乎与双相情感障碍的恶化有关。然而，这项自然主义的试验是不受控制的，需要更多的对照研究来证实或驳斥这些发现。
Objectives: To determine if bipolar disorder is accurately diagnosed in clinical practice and to assess the effects of antidepressants on the course of bipolar illness.Method: Charts of outpatients with affective disorder diagnoses seen in an outpatient clinic during 1 year (N = 85 with bipolar or unipolar disorders) were reviewed. Past diagnostic and treatment information was obtained by patient report and systematic psychiatric history. Bipolar diagnosis was based on DSM-IV criteria using a SCID-based interview.Results: Bipolar disorder was found to be misdiagnosed as unipolar depression in 37% of patients who first see a mental health professional after their first manic/hypomanic episode. Antidepressants were used earlier and more frequently than mood stabilizers, and 23% of this unselected sample experienced a new or worsening rapid-cycling course attributable to antidepressant use.Conclusion: These results suggest that bipolar disorder tends be misdiagnosed as unipolar major depressive disorder and that antidepressants seem to be associated with a worsened course of bipolar illness. However, this naturalistic trial was uncontrolled, and more controlled research is required to confirm or refute these findings.