重视双相障碍混合状态的临床复杂性

Focus on the complexity of bipolar mixed states in clinical practice

本文目的是对双相障碍混合状态的概念演变、流行病学、临床特征与当前生物学治疗证据等进行述评,以强调双相混合状态的临床复杂性及目前基于《国际疾病分类(第10版)》(ICD-10)临床诊疗的特点。根据狭义的ICD-10“混合发作”定义,临床常见的伴“相反”相阈下症状的混合状态常被忽略。未来需重视基于《精神障碍诊断与统计手册(第5版)》(DSM-5)等广义的混合状态定义进一步临床研究,以进行科学的治疗,改善患者预后。

The purpose of this paper is to review the evolution of the concept,prevalence,clinical correlates,and current evidence for biological treatments of bipolar mixed states,emphasize the illness complexities of bipolar mixed states while highlighting the gaps in clinical treatment and research using International Classification of Diseases,tenth edition(ICD-10)criteria.Narrowly defined ICD-10 mixed episodes ignores subthreshold symptoms of the opposite pole common with patients.Further clinical studies specifically designed to enroll the full range of mixed states are needed to promote appropriate treatment options and improve clinical outcomes.