Comparing The Clinical And Psychopathological Characteristics Of Bipolar Depressive Disorder And Major Depressive Disorder

BackgroundMood disorder is a group of mental disorders with a significant and lasting mood or emotional change as the main feature.As the clinical manifestations of bipolar disorder complex,severity ranging from the course of the cycle and more clinical manifestations of depressive disorder,so that the diagnosis is difficult,misdiagnosis rate as high as 70%.Domestic and foreign studies have shown that bipolar disorder is most likely to be misdiagnosed as unipolar depressive disorder,especially when the patient occurs at the onset of depression,or in the depression when the performance of subthreshold hypomania symptoms.At present,there is no more objective indicators of the current clinical between unipolar and bipolar depressive disorder in the diagnosis of patients,based on biochemistry,genetics,neuroimaging and other aspects of the study.Its reliability depends on the specific performance of the patient and the clinical skills and clinical experience of the clinician.In order to screening of manic or hypomanic symptoms,Chinese version Mood Disorder Scale(C-MDQ)and Chinese version 32-item Hypomania Checklist(C-HCL-32)has been compiled.Objective?Inorer to explore the value of MDQ and HCL-32 in patients with unipolar and bipolar depressive disorder,and compare the clinical and psychopathological characteristics of patients with unipolar and bipolar disorder,we evaluate a series of scales.?Comparing the clinical and psychopathological characteristics of bipolar depressive disorder and major depressive disorder to improve the recognition rate of bipolar disorder.to provide the basis for distinguish bipolar depressive disorder from unipolar depressive disorder,and improving the recognition of bipolar disorder.? To investigate the effect of C-MDQ and C-HCL-32 on evaluating mixed features in patients with depressive episodes of unipolar and bipolar depression.Methods? All patients from inpatients and outpatients with unipolar depressive disorder(n=262 cases)or bipolar depressive disorder(n=204)were diagnosed according to Diagnostic and Statistical Manual of Mental Disorder,Fourth Edition(DSM-?)using The Mini-International Neuropsychiatric Interview,(M.I.N.I.).? Clinical features were evaluated by 17-Item Hamilton Depression Scale(HAMD-17),Hamilton Anxiety Scale(HAMA),the Brief Psychiatric Rating Scale(BPRS),Young Mania Rating Scale(YMRS),Epworth sleepiness scale(ESS),the patient health questionnaire(PHQ-15).At the same time,previous mania or hypomania symptoms were evaluated with Chinese version of MDQ(C-MDQ)and Chinese version of HCL-32(C-HCL-32),then mania or hypomania symptoms of current depressive episode were assessed C-MDQ and C-HCL-32 again respectively.? According to the results of C-MDQ and C-HCL-32,we analyzed the internal consistency reliability,positive response rate and receiver operating characteristic curves(ROC curve).To compare the clinical and psychopathological characteristics of patients with single phase and bipolar depressive disorder.? Comparing the clinical and psychopathological characteristics of bipolar depressive disorder and major depressive disorder.Results?C-MDQ:a.C-MDQ scores of bipolar depression group,bipolar I group and bipolar II group were higher than the unipolar depression group(P<0.01).b.Factor analysis showed that C-MDQ cannot form factors.c.Internal consistency reliability(Cronbach's alpha)of C-MDQ is 0.75.d.Positive rate of C-MDQ was from 20.0%to 79.0%in bipolar depression.e.the ROC curve method,C-MDQ distinguishes between unipolar depression and double phase depression(sensitivity 0.78,specificity 0.89),bipolar ? depression(sensitivity 0.81,specificity 0.89)and bipolar ? depression(sensitivity 0.74,specificity 0.89)the optimal cut-off points are 6 points(sensitivity 0.78,specificity 0.89).?C-HCL:a.C-HCL-32 scores of bipolar ? depression group,depression group and bipolar? depression group were higher than unipolar depression group(P<0.01);b.C-HCL-32 factor analysis showed that 2 factors were better(Eigen values were 2.74 and 1.59,the cumulative contribution rate was 33.27%),namely "active mood rising" and "irritable";c.Internal consistency reliability(Cronbach's alpha)of C-HCL-32 is 0.78d.Bipolar depression group HCL-32 positive rate was 11.8%(answer to drink more)?82.4%(ideas,more high)e.ROC curve method,HCL-32 respectively distinction of unipolar depression and bipolar depression(sensitivity 0.87,specificity 0.82),bipolar ? depression(sensitivity 0.89,specificity 0.82)and bipolar ? depression(sensitivity 0.84,specificity 0.82)the optimal cut-off points are 6 points.? clinical and psychopathological characteristicsa.Compared with patients with unipolar depressive disorder,patients with bipolar depressive disorder are earlier onset age,family history of higher suicide higher risk,and delay work and interest,somatic anxiety(gastrointestinal symptoms),more psychotic symptoms(P<0.05);b.patients with unipolar depressive disorder are more female,daytime sleepiness and wake up early,more somatic anxiety(cardiovascular and respiratory system symptoms)(P<0.05).c.Functional somatic discomfort is common both unipolar and bipolar depressive disorder.Pain symptoms of patients with bipolar depressive disorder are more seriousness than patients of unipolar depressive disorder(P<0.05),such a stomach,chest pain and limb or joint pain.? applications of C-MDQ and C-HCL-32a.C-MDQ and C-HCL-32 can effectively identify patients with manic and hypomanic symptoms.b.Total scores of mixed features of patients of unipolar depressive disorder are lower than bipolar depressive disorder and bipolar ? depressive disorder evaluating by C-MDQ(P<0.05).c.Total scores of mixed features of patients of unipolar depressive disorder are lower than both bipolar ? and ? depressive disorder evaluating by C-HCL-32(P<0.05).There is no significant difference of mixed teatures between bipolar ? and ?depressive disorder(P>0.05).Conclusions?Regard 6 and 14 as cut off value of C-MDQ and C-HCL-3 2 respectively helps to distinguish between unipolar and bipolar depressive disorder.In order to improve sensitivity,we recommended with a cut-off score of 13 when distinguish unipolar depressive disorder and bipolar ? disorder with C-HCL-32.Conclusion,C-MDQ and C-HCL-32 have good validity and reliability,and can be used for screening of manic or hypomanic symptoms in clinical practice.?Clinical and psychopathological Characteristics are different between unipolar depressive disorder and bipolar depressive disorder.Such as,patients with unipolar depressive disorder were more women,somatic anxiety(cardiovascular and respiratory symptoms),wake up early and excessive sleepiness at daytime.Patients with bipolar depressive disorder were earlier age of onset,family history and suicide higher risk,and delayed work and interests,somatic anxiety(gastrointestinal symptoms),more psychotic symptoms,more pain symptoms more obvious(such as stomach pain,chest pain and limb or joint pain etc.).? Mixed features of patients with bipolar depressive disorder when its depressive episode is more obvious than patients with unipolar depression.Evaluating mixed features with C-MDQ and C-HCL-32 are helpful to distinguish between unipolar and bipolar depressive disorder.C-HCL-32 is helpful to distinguish unipolar and bipolar ? depressive disorder.