ICD-10与DSM-5诊断双相障碍混合状态的临床表型分析  

Analysis of clinical phenotypes of bipolar disorder with mixed states diagnosed using ICD-10 and DSM-5

作　　者：李旸[1] 周佳[1] 汪作为[2] 朱云程 徐贵云[3] 潘苗[4] 陈致宇[5] 李文飞[6] 焦志安[7] 李名立[8] 张勇[9] 陈景旭[10] 陈修哲[11] 李娜[12] 孙静[13] 张建[14] 胡少华[15] 伍海姗[16] 甘照宇[17] 秦研 王育梅[19] 马燕桃[20] 王小平[16] 李晓虹[1] 方贻儒[21] Li Yang;Zhou Jia;Wang Zuowei;Zhu Yuncheng;Xu Guiyun;Pan Miao;Chen Zhiyu;Li Wenfei;Jiao Zhian;Li Mingli;Zhang Yong;Chen Jingxu;Chen Xiuzhe;Li Na;Sun Jing;Zhang Jian;Hu Shaohua;Wu Haishan;Gan Zhaoyu;Qin Yan;Wang Yumei;Ma Yantao;Wang Xiaoping;Li Xiaohong;Fang Yiru(Beijing Anding Hospital,Capital Medical University,Beijing 100088,China;Shanghai Hongkou Mental Health Center,Shanghai 200081,China;The Affiliated Brain Hospital of Guangzhou Medical University,Guangzhou 510370,China;The Second Affiliated Hospital of Xinxiang Medical University,Xinxiang 453002,China;Hangzhou Seventh People′s Hospital,Hangzhou 310063,China;Anhui Mental Health Center,Hefei 230022,China;Shandong Provincial Hospital,Jinan 250021,China;West China Hospital Sichuan University,Chengdu 610044,China;Tianjin Anding Hospital,Tianjin 300222,China;Beijing Huilongguan Hospital,Beijing 102208,China;Shandong Mental Health Center,Jinan 250014,China;The First Affiliated Hospital of Kunming Medical College,Kunming 650032,China;Nanjing Brain Hospital,Nanjing 210024,China;Shenzhen Kangning Hospital,Shenzhen 518020,China;The First Affiliated Hospital Zhejiang University School of Medicine,Hangzhou 310003,China;The Second Xiangya Hospital of Central South University,Changsha 410012,China;The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Dalian Seventh People′s Hospital,Dalian 116086,China;The First Hospital of Hebei Medical University,Shijiazhuang 050030,China;Peking University Institute of Mental Health,Beijing 100191,China;Shanghai Mental Health Centre,School of Medicine,Shanghai Jiao Tong University,Shanghai 200030,China)

机构地区：[1]首都医科大学附属北京安定医院,北京100088 [2]上海市虹口区精神卫生中心,上海200081 [3]广州医科大学附属脑科医院,广州510370 [4]新乡医学院第二附属医院,新乡453002 [5]杭州市第七人民医院,杭州310063 [6]安徽省精神卫生中心,合肥230022 [7]山东省立医院,济南250021 [8]四川大学华西医院,成都610044 [9]天津市安定医院,天津300222 [10]北京回龙观医院,北京102208 [11]山东省精神卫生中心,济南250014 [12]昆明医科大学第一附属医院,昆明650032 [13]南京医科大学附属脑科医院,南京210024 [14]深圳市康宁医院,深圳518020 [15]浙江大学医学院附属第一医院,杭州310003 [16]中南大学湘雅二医院,长沙410012 [17]中山大学附属第三医院,广州510630 [18]大连市第七人民医院,大连116086 [19]河北医科大学第一医院,石家庄050030 [20]北京大学第六医院,北京100191 [21]上海交通大学医学院附属精神卫生中心,上海200030

出　　处：《中华精神科杂志》2023年第4期267-275,共9页Chinese Journal of Psychiatry

基　　金：上海市精神心理疾病临床医学研究中心(19MC1911100);上海市医学重点专科建设计划(ZK2019A06)

摘　　要：目的分析双相障碍混合状态的ICD-10与DSM-5诊断标准的检出率及症状学差异。方法基于中国双相躁狂临床路径调研一期(2012年)、二期(2021年)数据库,分别纳入符合ICD-10和DSM-5诊断标准的双相障碍患者,描述一般人口学资料、临床特征,以及双相障碍伴或不伴混合状态患者的症状学表型,采用卡方检验比较一、二期伴或不伴混合状态的双相障碍的检出率及症状学表现。结果双相障碍混合状态检出率方面,二期采用DSM-5诊断标准较一期采用ICD-10诊断标准的检出率[18.79%(199/1059)与6.78%(199/2934)]高,差异有统计学意义(χ^(2)=125.05,P<0.001);分别比较ICD-10与DSM-5诊断标准的伴与不伴混合状态的双相障碍患者的症状学差异,结果显示双相障碍混合状态的患者多项症状学发生频率更高。结论双相障碍混合状态的DSM-5诊断标准的检出率高于ICD-10,并且双相障碍混合状态的临床表型因不同诊断标准存在显著差异。ObjectiveThis study investigates the difference in the detection rate and symptomatology between ICD-10 and DSM-5 diagnostic criteria for bipolar disorder with mixed states.MethodsBased on the PhaseⅠ(2012)and PhaseⅡ(2021)databases of National Bipolar Mania Pathway Survey(BIPAS),patients with bipolar disorder were included.General demographic data,clinical characteristics,symptomatic phenotypes,and mixed characteristics were retrieved.The detection rates and symptomatic performances of patients with or without mixed states in PhaseⅠandⅡwere compared using the chi-square test.ResultsFor patients with mixed states,the detection rate during PhaseⅡ(2021)using DSM-5(18.79%,199/1059)criteria was significantly higher than that during PhaseⅠ(2012)using ICD-10(6.78%,199/2934;χ^(2)=125.05,P<0.001).Whether using ICD-10 or DSM-5 criteria,patients with mixed states had a significantly higher frequency of multiple symptomatic manifestations.ConclusionThe DSM-5 diagnostic criteria generate a high detection rate for bipolar disorder with mixed states.The clinical phenotypes of bipolar disorder with mixed states vary significantly using different diagnostic tools.

关 键 词：双相情感障碍 诊断标准 混合发作 混合特征 

分 类 号：R749.4[医药卫生—神经病学与精神病学]