复发性抑郁患者的强迫症状及个性因素

目的探讨强迫症状对复发性抑郁障碍患者的影响以及复发性抑郁障碍患者个性因素分析。方法采用症状自评量表(SCL-90),结合临床,对56例复发性抑郁障碍患者进行评定;采用艾森克人格问卷(EPQ)对伴有强迫症状的复发性抑郁障碍患者42例与不伴强迫症状的复发性抑郁障碍患者14例进行对照研究。结果75%的患者伴有强迫症状,伴有强迫与无强迫患者相比EPQ的E分较低和N分较高,差异有显著性(P<0.01)。结论强迫症状是复发性抑郁障碍的一个重要的危险因素,人格因素中内向和神经质与强迫症状有关。     

250例单相抑郁与双相抑郁患者临床特征的对照研究

目的探讨双相抑郁与单相抑郁人口学、病程、临床特征和人格等方面的异同点,提高对双相抑郁的诊断识别率。方法符合CCMD-3双相抑郁和单相抑郁诊断标准的患者72例和178例,进行一般情况、SCL-90、HAMD、MMPI评定。结果双相抑郁与单相抑郁比较,首发年龄和住院年龄小,未婚多,学历高、脑力劳动者多;SCL-90和HAMD评定差异少;MMPI的Pd、Ma量表分高,L、Si量表分低。结论难以从临床症状上区别单、双相抑郁,MMPI可能是鉴别单、双相抑郁的有效工具。     

心理社会因素在重性抑郁障碍中的作用

为探讨心理社会因素在重性抑郁障碍中的作用。采用抑郁自评量表(SDS)、汉密尔顿抑郁量表(HAMD)、艾森克人格问卷(EPQ)、生活事件量表(LES)、特质应对方式量表(TCSQ)和社会支持问卷(SSS)对114例重性抑郁障碍患者进行测试,同时选取97名健康志愿者进行对照研究。结果显示:①重性抑郁障碍患者组的EPQ-精神质(P),神经质(N)分高于健康对照组,内外向(E)分低于健康对照组,差异有统计学意义(P<0.05)。②重性抑郁障碍患者经历的负性生活事件高于健康对照组,差异有统计学意义(P<0.01)。③患者组消极应对分高于健康对照组,积极应对分明显低于健康对照组,差异有统计学意义(P<0.01)。④重性抑郁障碍患者组在社会支持总分,主观支持与利用度均低于健康对照组(P<0.01)。重性抑郁障碍患者的人格特征及负性生活事件,应对方式,社会支持在其发病过程中起着重要作用。     

单相抑郁与双相抑郁的临床及神经影像差异

单相抑郁(unipolar disorder)和双相障碍（bipolar disorder, BD）的共同特征是抑郁发作,首发为抑郁的BD常误诊为单相抑郁。因此,寻找两种疾病间的临床表现及生物标记差异或将有助于临床诊断。本文回顾了两种疾病的临床及大脑神经影像结构和功能的相关研究,发现在临床上,双相抑郁有相对更低的起病年龄,更常伴有精神病性特征及家族病史等特征。而神经影像方面的研究则显示,双相抑郁患者在灰质、白质及皮层下区域中均显示了更严重的脑结构变化。功能上,两者间的差异主要集中于前额叶与边缘系统如杏仁核、纹状体及丘脑等脑区。这些发现为日后临床的诊断提供了一定的支持。     

抑郁障碍患者人格特征与自杀风险研究

目的探讨抑郁障碍患者的人格特征及其与自杀风险的关系。方法对183例抑郁障碍患者进行艾森克个性问卷及汉密顿抑郁量表测查，对其结果进行分析。结果①抑郁障碍患者较正常对照组P、N、E分比较具有统计学差异（P〈0．05）；②病例组抑郁障碍患者艾森克问卷中P、N、E各因子与汉密顿关于自杀的因子用方差分析比较没有相关性（P〉0．05），把自杀因子变为有无自杀观念进行独立样本t检验，结果有无自杀与P、N、E各因子比较也没有显著性差异（P〉0．05）。结论①抑郁障碍患者的人格特征突出表现为神经质更明显，情绪更不稳定，更内向；②抑郁障碍患者的人格特征与其自杀风险关系不明显。     

卫校学生抑郁障碍与应激及人格特征相关分析

目的 了解卫校学生抑郁障碍发病情况,并探讨其与应激性生活事件和人格特征的相关性.方法 按年级分层整群抽取保定市卫校学生620名,进行一般状况问卷并施测自编DSM-Ⅳ抑郁障碍自评量表、Zung抑郁自评量表(SDS)、青少年生活事件量表(ADLSC)、艾森克人格问卷(EPQ).结果 卫校学生样本中轻度抑郁障碍者94名,占所有受试者的15.53%;重度抑郁症者11名,占所有受试者的1.82%;抑郁障碍总检出率为17.35%.卫校学生抑郁障碍程度与生活事件量表总分及艾森克人格问卷得分呈显著相关.人际关系和神经质是影响抑郁的最重要因素.结论 较多卫校学生存在抑郁障碍,且抑郁的发生与应激及人格特征有关,建议对卫校学生有针对性开展心理健康教育.     

不育症女性患者焦虑、抑郁与个性特征关系的对照研究

目的：探讨不育妇女焦虑、抑郁与个性特征的关系.方法：采用艾森克个性问卷（EPQ）,抑郁自评量表（SDS）和特质焦虑问卷（STAI）对170名不育妇女进行问卷调查,同时选择正常育龄妇女88名作对照.结果：不育症妇女状态焦虑分与特质焦虑分明显高于对照组（P＜0.01）,不育症妇女SDS总分高于对照组（P＜0.01）,不育症妇女EPQ的N得分高于对照组（P＜0.01）.结论：不育症妇女存在焦虑、抑郁情绪及高神经质的人格特点.     

重性抑郁症共病焦虑障碍的应对方式、社会支持和人格特征研究

目的:了解重性抑郁症共病焦虑障碍的应对方式、社会支持和人格特征。方法:采用社会支持评定量表(SSRS)、特质应对方式问卷(TCSQ)和艾森克人格问卷(EPQ),对共病焦虑障碍的重性抑郁症与非共病焦虑障碍的重性抑郁症患者进行评估。结果:共病组的社会支持总分、主观支持分、客观支持分显著高于抑郁组(P<0.05),对支持的利用度与抑郁组无显著性差异;共病组的消极应对方式分显著高于抑郁组(P<0.01),在积极应对方式上两组无显著差异。两组患者EPQ各维度评分之间均无显著性差异(P>0.05)。结论:与非共病患者相比,共病焦虑障碍的重性抑郁症患者社会支持较高、应对方式更为消极,未发现共病者与非共病者在人格方面的差异。     

新乡市大学生抑郁与人格特征的相关研究

目的了解新乡市大学生的抑郁情绪的流行状况,并探讨人格特征与抑郁的相关性。方法采用流调中心抑郁量表和艾森克人格问卷对新乡市的1039名大学生进行调查。结果①新乡市大学生总的抑郁情绪检出率为83.8%;不同性别的大学生抑郁状况(t=2.158,P<0.05)有显著性差异,不同生源地的大学生抑郁状况无显著差异(t=-1.414,P>0.05);②艾森克人格问卷中,情绪性、精神质对抑郁具有正预测作用,内外向、掩饰性对抑郁具有负预测作用。结论新乡市大学生抑郁心理症状检出率较高,大学生的抑郁与其人格中的诸多因素显著相关。     

医学毕业生抑郁状态及其影响因素分析

目的探讨应届医学毕业生抑郁的发生率及影响因素,为心理健康教育工作提供依据。方法以213名应届医学毕业生为实验组,189名非毕业生为对照组,采用抑郁自评量表（SDS）、艾森克成人个性问卷（EPQ）、社会支持评定量表（SSRS）、简易应对方式问卷（SCSQ）、成人Nowicki-Strickland内—外控制量表（ANSIE）等工具进行调查。结果①实验组抑郁症状阳性检出率为44.6%,与对照组比较（22.2%）有显著差异（P〈0.01）;②实验组EPQ中P分和N分高于对照组;③社会支持量表实验组的客观支持、支持利用度明显低于对照组;④实验组外控心理倾向者较多,采用积极应对方式者较少。逐步回归分析表明：神经质个性、控制感倾向和应对方式是影响医学毕业生抑郁情绪的主要因素。结论部分应届医学毕业生存在明显的抑郁情绪。     

Temperament and personality in bipolar II disorder

BackgroundThere is limited research examining temperament and personality in bipolar II disorder. We sought to determine any over-represented temperament and personality features in bipolar II disorder compared to other affective groups.MethodScores on a self-report measure of temperament and personality were examined in a sample of 443 participants diagnosed with unipolar, bipolar I and bipolar II disorder.ResultsAfter controlling for age, gender, age of depression onset and current depression severity, those with bipolar II disorder were characterized by higher irritability, anxious worrying, self-criticism and interpersonal sensitivity scores, and with lower social avoidance scores compared to unipolar participants. No differences were found between bipolar sub-types on any temperament and personality sub-scales.Limitations included the lack of a control group, a relatively small sample of bipolar I participants, and with the cross-sectional design disallowing conclusions regarding premorbid personality traits as opposed to illness 'scarring' effects.ConclusionsFurther research should seek to clarify whether certain temperament and personality styles are over-represented in bipolar II disorder. Any over-represented characteristics may assist with diagnostic differentiation from phenomenologically similar conditions and lead to more appropriate clinical management.     

Borderline personality disorder characteristics in young adults with recurrent mood disorders: a comparison of bipolar and unipolar depression

BACKGROUND: In young adults it can be difficult to differentiate between an early bipolar illness and borderline personality disorder. There are considerable areas of clinical overlap between cyclothymic temperament, bipolar-spectrum disorders and borderline characteristics. The aim of this study was to measure borderline characteristics in young adults during an index depressive episode and to compare three diagnostic groups: DSM-IV bipolar affective disorder (BPAD); bipolar spectrum disorder (BSD); and DSM-IV recurrent major depressive disorder (MDD). METHODS: Eighty-seven young adults with a current episode of major depression and at least one previous episode of depression were recruited from consecutive referrals to a psychiatric clinic. Diagnoses were based on the Structured Clinical Interview for DSM-IV (SCID-1) and recently proposed structured diagnostic criteria for BSD. All patients also completed the borderline questions from the screening questionnaire of the International Personality Disorders Examination (IPDE). RESULTS: Diagnostically, the cohort of 87 patients divided into three groups: 14 with BPAD; 27 with BSD; and 46 with MDD. None of the subjects fulfilled DSM-IV or ICD-10 diagnostic criteria for personality disorder and all three groups were well matched in terms of age, gender distribution, ethnicity, socioeconomic and educational status, age at onset of illness, and severity of index depressive episode. Both of the bipolar-depressed groups reported significantly higher median levels of borderline characteristics than the MDD group (p<0.0001). Three of the borderline characteristics emerged as potentially useful in differentiating bipolar depression from unipolar depression: 'I've never threatened suicide or injured myself on purpose' (sensitivity=0.93; positive predictive value [PPV]=56.7); 'I have tantrums or angry outbursts' (sensitivity 0.66; PPV=65.6%); and 'Giving in to some of my urges gets me into trouble' (sensitivity=0.76; PPV=59.6%). LIMITATIONS: All of the subjects were recruited from a university health service clinic and as such are unlikely to be representative of patients from more diverse socio-economic backgrounds. No structured diagnostic assessment of personality disorder was administered. The diagnostic criteria for BSD are not yet fully validated. CONCLUSIONS: Young adults with bipolar depression exhibit significantly higher levels of borderline personality pathology than those with unipolar depression. Those borderline screening questions that reflect cyclothymic characteristics or depressive mixed states may be of practical use to clinicians in helping to differentiate between bipolar depression and unipolar depression in young adults.     

Reliability and validity of TEMPS-A in a Japanese non-clinical population: application to unipolar and bipolar depressives

BACKGROUND: In Japan, TEMPS-A has gathered much attention, because Kraepelin's concepts on "fundamental states" of mood disorder and temperaments have been widely respected. METHOD: TEMPS-A was translated into Japanese (and after the approval of the English back translation by H.S.A.), it was administered to 1391 non-clinical subjects, and 29 unipolar and 30 bipolar patients in remission. Of the non-clinical sample, 426 were readministered the instrument again in 1 month. A control group matched for gender and age was drawn from the non-clinical sample. RESULTS: Regarding test-retest reliability, Spearman's coefficients for depressive, cyclothymic, hyperthymic, irritable and anxious temperaments were 0.79, 0.84, 0.87, 0.81 and 0.87, respectively; regarding internal consistency, Cronbach's alpha coefficients were 0.69, 0.84, 0.79, 0.83 and 0.87, respectively. The unipolar and bipolar groups showed significantly higher depressive, cyclothymic and anxious temperament scores than the control group. Curiously, the bipolar group showed significantly lower hyperthymic score than the control group; irritable temperament scores showed no significant differences. Depressive, cyclothymic, irritable and anxious temperament scores showed significant correlations with each other. Between the unipolar and bipolar groups, there was little difference regarding the temperament scores. Also the inter-temperament correlations showed the same pattern in the unipolar and bipolar groups. LIMITATION: The clinically well cohort was 70% male. CONCLUSION: TEMPS-A showed a high reliability and validity (internal consistency) in a Japanese non-clinical sample. By and large, the hypothesized five temperament structure was upheld. Depressive, cyclothymic and anxious temperaments showed concurrent validity with mood disorder. Irritable temperament may represent a subtype of depressive, cyclothymic or anxious temperaments. There may be a temperamental commonality between unipolar and bipolar disorders. TEMPS-A will open new possibilities for international research on mood disorder and personality traits.     

Clonazepam augmentation of antidepressants: does it distinguish unipolar from bipolar depression?

BACKGROUND: The authors compared the effect of clonazepam supplement treatment on unipolar depression and bipolar depression. METHODS: A total of 38 protracted depression patients with unipolar depression (n = 19) or bipolar depression (n = 19) were treated with 3.0 mg clonazepam for 4 weeks. RESULTS: In the unipolar depression group, 84.2% of the subjects fulfilled the response criteria (at least an 80% reduction in their HDRS score). However, in the bipolar depression group, only 10.5% of them fulfilled these criteria. CONCLUSIONS: The difference in responses between the two groups supposes that the underlying abnormality in unipolar depression is not the same as that in bipolar depression. This trial also supposed that clonazepam can play active role in the treatment of protracted depression in patients with unipolar depression. LIMITATIONS: This finding was made in an open study, and the effect on clonazepam alone was not established.     

The premorbid personality of patients with different subtypes of an affective illness. Statistical analysis of blind assignment of case history data to clinical diagnoses

On the basis of case history data, the assumption that there exists an association between the 'manic type' of personality and a predominantly manic course of an affective illness, and between the 'melancholic type' of personality and a unipolar depressive course of the illness was examined. Premorbid data were extracted from 42 case records, 10 of 'unipolar' manic subjects (the ratio of manic to depressive episodes greater than or equal to 4:1), 11 of typical bipolar I patients, 11 of bipolar II patients, and 10 of unipolar endogenous depressives. A rater (J.P.), blind to diagnosis and selection procedure, assigned case notes to personality types. Differences were predicted in terms of personality type between the two unipolar groups, the two bipolar groups and, due to the higher number of cases, also between the combined groups of 'unipolar' manic and bipolar I patients on the one hand, and unipolar depressive and bipolar II patients on the other. According to the Fisher test these predictions were fulfilled. Furthermore, in agreement with our hypotheses on the relationship between premorbid personality and course of the disease, the ratio of assignments to 'manic type' and 'melancholic type' decreased from 'unipolar' mania, to bipolar I and bipolar II disorders, and to unipolar depression.     

米氮平联用碳酸锂治疗双相抑郁的疗效分析

目的：评价米氮平联用碳酸锂治疗双相抑郁的疗效及其安全性。方法：将符合CCMD-3(中国精神障碍分类第三版)双相抑郁诊断标准的66例门诊或住院病人随机分为2组，每组33例，分别服用米氮平联用碳酸锂，或丙米嗪联用碳酸锂。试验时间为6周，以HAMD(汉密尔顿抑郁问卷)和CGI(临床总体印象问卷)评估两组的疗效，以TESS(治疗中出现的不良反应量表)评定安全性。结果：两组疗效差异无显著性，米氮平组的不良反应发生率明显低于丙米嗪组，差异有显著性。结论：米氮平治疗双相抑郁起效快，疗效肯定，副作用小，依从性好，联用锂盐能较好提高双相抑郁的缓解率，降低转躁率。     

Exploring aspects of DSM-IV interpersonal sensitivity in bipolar II

BACKGROUND: The aim of the study was to find the prevalence of interpersonal rejection sensitivity (IRS) (a personality trait in DSM-IV) in bipolar II and unipolar depression. METHODS: 557 consecutive unipolar and bipolar II outpatients, presenting for depression treatment, were interviewed with the DSM-IV Structured Clinical Interview and the Global Assessment of Functioning Scale. DSM-IV atypical features criteria (which include IRS) were followed. RESULTS: IRS was significantly more common in bipolar II than in unipolar patients (37.8% vs. 20.5%, odds ratio 2.3, P=0.0000). Sensitivity and specificity for bipolar II diagnosis were 37.8% and 79.4%. CONCLUSIONS: IRS personality trait seems to be more common in bipolar II than in unipolar depression. LIMITATIONS: reliability of bipolar II diagnosis, non-blind, cross-sectional assessment, single interviewer.     

Distinct seasonality of depressive episodes differentiates unipolar depressive patients with and without depressive mixed states

BACKGROUND: The bipolar nature of unipolar depression with depressive mixed states (DMX) needs further validation studies. The seasonality of depressive episodes is indicated to be different between unipolar and bipolar depressions. We therefore explored the seasonal pattern of depressive episodes in unipolar depressive patients with DMX. METHODS: The subjects were 958 consecutive depressive inpatients for a 6-year period. For defining DMX, previously validated operational criteria were used (2 or more of 8 manic or mania-related symptoms: flight of idea, logorrhea, aggression, excessive social contact, increased drive, irritability, racing thoughts, and distractibility). Onsets of the index depressive episodes during each of the 12 calendar months were summed up over the 6-year for bipolar depressive patients (N = 95), and unipolar depressive patients with (N = 77) and without DMX (N = 786) separately. An appropriate statistic was used for testing seasonality. RESULTS: A significant seasonal variation with a large peak in spring was recognized in unipolar depression without DMX, while both bipolar depression and unipolar depression with DMX had a significant fall peak. The monthly distribution of depressive episodes was significantly different between unipolar depression without DMX and other 2 diagnostic categories. Similar results were obtained in separate analyses for each gender. LIMITATIONS: Further replication study using an epidemiological or outpatient sample is needed. Bipolar I and II patients were combined due to a small number of bipolar II patients in this sample. CONCLUSION: Unipolar depression with DMX has a seasonal pattern similar to bipolar depression. The finding provides further evidence of the bipolar nature of unipolar depression with DMX.