摘要
目的 分析精神专科医院就诊的抑郁障碍和双相Ⅱ型抑郁患者精神障碍共病状况及其对抑郁发作类型的影响.方法 采用MINI中文版对符合美国精神障碍诊断与统计手册第4版修订版中抑郁障碍或双相Ⅱ型抑郁诊断标准的患者共病情况进行评估和比较,使用二分类Logisitc回归分析共病对抑郁发作类型的影响.结果 共入组833例患者,其中708例为抑郁障碍患者（抑郁障碍组）,125例为双相Ⅱ型抑郁患者（双相Ⅱ型抑郁组）.双相Ⅱ型抑郁和抑郁障碍的精神障碍共病比例分别为68.0％（70/125）和53.1％（277/708）,差异有统计学意义（x2=9.534,P=0.002）.前者共病场所恐惧症（无惊恐发作史）[26.4％（33/125）与8.1％（57/708）,x2=31.118,P=0.000]、社交焦虑障碍[21.6％（27/125）与11.4％（81/708）,x2=9.718,P=0.002]、精神病性症状[11.2％ （14/125）与2.4％ （17/708）,x2=22.957,P=0.000]和进食障碍[3.2％（4/125）与0.7％（5/708）,P=0.033]的构成比例显著高于后者.共病场所恐惧症（OR=3.332,95％ CI 1.970～ 5.635,P=0.000）或精神病性症状（OR=3.432,95％ CI 1.543～7.632,P=0.002）,复发性抑郁（OR=2.457,95％ CI 1.625～ 3.714,P=0.000）及自杀未遂史（OR=1.764,95％CI1.045～ 2.975,P=0.033）是双相Ⅱ型抑郁的影响因素.结论 抑郁障碍和双相Ⅱ型抑郁的精神障碍共病均较常见,对共病的全面评估及共病模式差异的识别或有助于抑郁发作类型的鉴别.
Objective This report aimed at exploring magnitude of psychiatric comorbidities of patients with major depressive disorder （MDD） or bipolar Ⅱ depression.Comorbidity patterns between MDD and bipolar Ⅱ depression were compared and the association of clinical presentation with the two types of depressive episodes were analyzed.Methods A cross-sectional survey was conducted on a total of 833 patients that met the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition Text Revision criteria for MDD or bipolar Ⅱ depression with current major depressive episodes who were seeking help in a psychiatric hospital were enrolled.Endorsement of comorbid psychiatric disorders were based on the MINI-International Neuropsychiatric Interview （Chinese version）.Psychiatric comorbidities were compared between the two groups and the binary logistic model was developed to estimate association of endorsement of psychiatric comorbidities with the two types of depressive episodes.Results Up to 68.0% （70/125） of participants with bipolar Ⅱ depression and 53.1% （277/708） of participants with MDD adopted at least one psychiatric comorbidity （x2=9.534,P=0.002）.Significant difference of presence of agoraphobia （without panic attack） （26.4% （33/125） vs.8.1% （57/708）,x2=31.118,P=0.000）,social anxiety disorder （21.6% （27/125） vs.11.4% （81/708）,x2=9.718,P=0.002）,psychosis （11.2% （14/125） vs.2.4% （17/708）,x2=22.957,P=0.000） and eating disorders （3.2% （4/125）vs.0.7% （5/708）,P=0.033） were detected between the two groups.Comorbid agoraphobia （OR=3.332,95% CI 1.970-5.635,P=0.000） or psychosis （OR=3.432,95% CI 1.543-7.632,P=0.002）,and endorsement of recurrent depression （OR=2.457,95% CI 1.625-3.714,P=0.000） or attempted suicides （OR=1.764,95% CI 1.045-2.975,P=0.033） was associated with bipolar Ⅱ depression.Conclusions MDD and bipolar Ⅱ depression differed in comorbidity patterns although psychiatric comorbidities are both commonly seen in the two conditions.A comprehensive assessment on comorbidity pattern and recognition of differential clinical presentations of bipolar Ⅱ depression versus MDD may be helpful to guide clinicians to more accurate diagnoses.
出处
《中华精神科杂志》
CAS
CSCD
北大核心
2015年第5期266-270,共5页
Chinese Journal of Psychiatry
基金
“十二五”国家科技支撑项目（2012BAI01B04）
上海市科学技术委员会医学（西医）引导类项日（134119b0400）
国家自然科学基金重大研究计划（91232719）
国家临床重点专科建设项目（卫生部医政司2011-873）
关键词
抑郁症
双相情感障碍
共病现象
Depressive disorder
Bipolar disorder
Comorbidity
