不典型抑郁在中国综合医院门诊抑郁发作患者中的效度研究  

The validation of atypical depression among Chinese outpatients with depressive episodes in general hospital

作　　者：甘照宇[1] 钟智勇[1] 王继辉[1] 韩洪瀛[1] 

机构地区：[1]中山大学附属第三医院精神科,广州510630

出　　处：《中华行为医学与脑科学杂志》2013年第9期820-823,共4页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：广东省科技计划项目（20128031800357）

摘　　要：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％VS26．0％）、食欲增加（22．7％VS15．4％）、体质量增加（24．1％VS14．6％）、灌铅样麻痹（56．6％vs47．2％）以及对人际拒绝敏感（66．7％VS34．2％）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。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 cun＇ent depressive episode,then comparison of clinical characteristics including age of onset, gender proportion, seasonality, comorbidity of anxiety disorder, bipolar property, psychotic features, number of de- pressive 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 unipo- lar 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 hkely seen in atypical depression （20.0% vs 9.1% , P〈 0.05 ） , but no difference was found in other clinical features between atypical and nonatyp- ical depression. Except mood reactivity, atypical symptoms including oversleeping（45.5% vs 26.0% ） , overeating （ 22.7% vs 15. d% ） ,weight gain（24.1% vs 14.6% ） ,leaden paralysis（56.6% vs 47.2% ） ,interpersonal rejec- tion 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.

关 键 词：不典型抑郁 效度 

分 类 号：R749.4[医药卫生—神经病学与精神病学]