【摘要】 背景双相障碍常未被识别或被误诊为单相抑郁。明确未被识别或被误诊的双相障碍者的临床特征有助于减少错误分类。目的调查门诊抑郁症患者中未被识别的双相障碍者的比例,并分析未被识别的双相障碍者的临床特征。方法使用32项轻躁狂症状清单(Hypomania Checklist-32,HCL-32)、心境障碍问卷(Mood Disorder Questionnaire,MDQ)和简明国际神经精神访谈(Mini International Neuropsychiatric Interview,MINI)对目前被诊断为抑郁症的100例门诊患者进行调查。对被重新诊断为双相障碍与仍然被诊断为抑郁症的患者的临床特征进行比较分析。结果共有29例(29%)抑郁症门诊患者被诊断为双相障碍;其中双相Ⅰ型6例,双相Ⅱ型23例。与未更改诊断的抑郁症者相比,被重新诊断为双相障碍者年龄轻、起病早、发病次数多、受教育程度高,多为复发性抑郁且多伴精神病性症状。多因素Logistic回归分析显示年龄(OR=0.55,95%CI=0.34~0.89)和精神病性症状(OR=9.12,95%CI=1.56~53.26)是双相障碍的独立危险因素。结论在门诊抑郁症患者中未被识别的双相障碍比例较高,尤其是双相Ⅱ型。与单相抑郁相比,诊断为抑郁症而为未被识别的双相障碍者年龄轻,更可能伴有精神病性症状。更多还原

【Abstract】 Background:Bipolar disorders are often unrecognized or misdiagnosed as unipolar depression.Determining the clinical features associated with unrecognized or misdiagnosed bipolar disorder should help decrease the rates of misclassification.Objective:Estimate the prevalence of unrecognized bipolar disorders among outpatients with major depressive disorder and analyze the clinical characteristics of patients with unrecognized bipolar disorder.Method:100 outpatients with a current diagnosis of major depressive disorder were administered the Hypomania Checklist-32(HCL-32),the Mood Disorder Questionnaire(MDQ)and the Mini International Neuropsychiatric Interview(MINI).The characteristics of patients who were re-diagnosed as bipolar disorder were compared to those whose diagnosis did not change.Results:Twenty nine(29%)of the outpatients were diagnosed with bipolar disorder;6 as Bipolar I and 23 as Bipolar II.Compared to those whose diagnosis did not change,those re-diagnosed as bipolar were younger,had an earlier age of onset,had more episodes,had a higher level of education and were more likely to have concurrent psychotic symptoms.Multivariate logistic regression analysis showed that age(OR=0.55,95% CI=0.34-0.89)and concurrent psychotic symptoms(OR=9.12,CI=1.56-53.26)were independent risk factors of bipolar disorder.Conclusion:A substantial proportion of outpatients diagnosed with major depressive disorder have unrecognized bipolar disorders,particularly bipolar II disorder.Compared to patients with unipolar depression,patients with a diagnosis of depression who have unrecognized bipolar disorders are younger and are more likely to have experienced psychotic symptoms.更多还原