中华行为医学与脑科学杂志
中華行為醫學與腦科學雜誌
중화행위의학여뇌과학잡지
CHINESE JOURNAL OF BEHAVIORAL MEDICINE AND BRAIN SCIENCE
2013年
9期
820-823
,共4页
甘照宇%钟智勇%王继辉%韩洪瀛
甘照宇%鐘智勇%王繼輝%韓洪瀛
감조우%종지용%왕계휘%한홍영
不典型抑郁%效度
不典型抑鬱%效度
불전형억욱%효도
Atypical depression%Validation
目的 评价不典型抑郁在中国综合医院抑郁发作患者中的效度,并考察不典型抑郁症状对鉴别单、双相抑郁的临床意义.方法 利用自编的临床特征调查问卷对276例抑郁障碍患者进行临床结构式访谈,比较不典型抑郁与其相对应的非不典型抑郁在发病年龄、性别、季节性、焦虑障碍共病、双相属性、精神病性特征、抑郁发作次数、最长的抑郁发作时程等临床特征上的差异,继而比较不典型抑郁症状在单、双相抑郁中的分布情况.结果 DSM-Ⅳ-TR所定义的不典型抑郁,在所有抑郁发作患者中的比例为23.9％.与非不典型抑郁比较,不典型抑郁患者精神病性特征更常见(20.0％ vs9.1％,P＜0.05),但在其他临床特征上两者无统计学差异(P＞0.05).除情绪高反应性外,睡眠增多(45.5％ vs 26.0％)、食欲增加(22.7％ vs 15.4％)、体质量增加(24.1％ vs 14.6％)、灌铅样麻痹(56.6％ vs 47.2％)以及对人际拒绝敏感(66.7％ vs 34.2％)在双相抑郁患者中的发生率较在单相抑郁患者中高,其中睡眠增多与对人际关系敏感具有统计学差异(P＜0.05).伴有情绪高反应性的抑郁发作患者未发现在其他临床特征上有别于没伴有情绪高反应性的患者(P＞0.05).情绪高反应性以及灌铅样麻痹与其他诊断症状之间无明显相关(P＞0.05).结论 不典型抑郁或许是一个有用的概念,但其诊断标准的效度在中国人群中仍有待进一步研究.
目的 評價不典型抑鬱在中國綜閤醫院抑鬱髮作患者中的效度,併攷察不典型抑鬱癥狀對鑒彆單、雙相抑鬱的臨床意義.方法 利用自編的臨床特徵調查問捲對276例抑鬱障礙患者進行臨床結構式訪談,比較不典型抑鬱與其相對應的非不典型抑鬱在髮病年齡、性彆、季節性、焦慮障礙共病、雙相屬性、精神病性特徵、抑鬱髮作次數、最長的抑鬱髮作時程等臨床特徵上的差異,繼而比較不典型抑鬱癥狀在單、雙相抑鬱中的分佈情況.結果 DSM-Ⅳ-TR所定義的不典型抑鬱,在所有抑鬱髮作患者中的比例為23.9％.與非不典型抑鬱比較,不典型抑鬱患者精神病性特徵更常見(20.0％ vs9.1％,P＜0.05),但在其他臨床特徵上兩者無統計學差異(P＞0.05).除情緒高反應性外,睡眠增多(45.5％ vs 26.0％)、食欲增加(22.7％ vs 15.4％)、體質量增加(24.1％ vs 14.6％)、灌鉛樣痳痺(56.6％ vs 47.2％)以及對人際拒絕敏感(66.7％ vs 34.2％)在雙相抑鬱患者中的髮生率較在單相抑鬱患者中高,其中睡眠增多與對人際關繫敏感具有統計學差異(P＜0.05).伴有情緒高反應性的抑鬱髮作患者未髮現在其他臨床特徵上有彆于沒伴有情緒高反應性的患者(P＞0.05).情緒高反應性以及灌鉛樣痳痺與其他診斷癥狀之間無明顯相關(P＞0.05).結論 不典型抑鬱或許是一箇有用的概唸,但其診斷標準的效度在中國人群中仍有待進一步研究.
목적 평개불전형억욱재중국종합의원억욱발작환자중적효도,병고찰불전형억욱증상대감별단、쌍상억욱적림상의의.방법 이용자편적림상특정조사문권대276례억욱장애환자진행림상결구식방담,비교불전형억욱여기상대응적비불전형억욱재발병년령、성별、계절성、초필장애공병、쌍상속성、정신병성특정、억욱발작차수、최장적억욱발작시정등림상특정상적차이,계이비교불전형억욱증상재단、쌍상억욱중적분포정황.결과 DSM-Ⅳ-TR소정의적불전형억욱,재소유억욱발작환자중적비례위23.9％.여비불전형억욱비교,불전형억욱환자정신병성특정경상견(20.0％ vs9.1％,P＜0.05),단재기타림상특정상량자무통계학차이(P＞0.05).제정서고반응성외,수면증다(45.5％ vs 26.0％)、식욕증가(22.7％ vs 15.4％)、체질량증가(24.1％ vs 14.6％)、관연양마비(56.6％ vs 47.2％)이급대인제거절민감(66.7％ vs 34.2％)재쌍상억욱환자중적발생솔교재단상억욱환자중고,기중수면증다여대인제관계민감구유통계학차이(P＜0.05).반유정서고반응성적억욱발작환자미발현재기타림상특정상유별우몰반유정서고반응성적환자(P＞0.05).정서고반응성이급관연양마비여기타진단증상지간무명현상관(P＞0.05).결론 불전형억욱혹허시일개유용적개념,단기진단표준적효도재중국인군중잉유대진일보연구.
Objective to evaluate the validation of "atypical depression" among Chinese outpatients with depressive episodes and explore the role of atypical depressive symptoms in distinguishing bipolar depression from unipolar depression.Methods Structural clinical interviews with self-compiled questionnaires were performed on 276 outpatients with current depressive episode,then comparison of clinical characteristics including age of onset,gender proportion,seasonality,comorbidity of anxiety disorder,bipolar property,psychotic features,number of depressive episodes,and maximum duration of depressive episode were conducted between atypical (defined by DSM-Ⅳ-TR) and nonatypical depression.then the rate of atypical depressive symptoms were compared between unipolar depression and bipolar depression.Results The proportion of atypical depression among all the participants was 23.9％.Compared to nonatypical depression,psychotic features were more likely seen in atypical depression (20.0％ vs 9.1％,P＜0.05),but no difference was found in other clinical features between atypical and nonatypical depression.Except mood reactivity,atypical symptoms including oversleeping(45.5％ vs 26.0％),overeating (22.7％ vs 15.4％),weight gain(24.1％ vs 14.6％),leaden paralysis (56.6％ vs 47.2％),interpersonal rejection sensitivity(66.7％ vs 34.2％) were more likely to occur in bipolar depression than in unipolar depression,the difference was statistically significant for oversleeping and interpersonal rejection sensitivity (P ＜ 0.05).Patients with mood reactivity differed little from those without mood reactivity in other clinical features.No association was found between mood reactivity,leaden paralysis and other criteria symptoms of atypical depression.Conclusion-Atypical depression might be a useful concept,but its diagnostic criteria needs further validation among Chinese population.
