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

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.