주요우울장애 환자에서 기분장애 질문지를 이용한 양극성 스펙트럼장애 선별에 관한 연구
The Association Study between Mood Disorder Questionnaire and Bipolar Spectrum Disorder in Major Depressive Disorder
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초록
본 연구는 임상에서 양극성 장애를 진단받은 과거력이 없는 주요우울장애 환자들에서의 양극성 스펙트럼장애 빈도를알아보고, 이러한 환자들의 양극성을 시사하는 임상양상들에대해 조사하고자 하였다. 또한 K-MDQ와 양극성 스펙트럼장애와의 관련성과 실제 임상 현장에서 선별도구로서의 유용성을 확인해 보고자 하였다. 그 결과, 주요우울장애 환자들 중 약35.7%의 높은 비율에서 양극성 스펙트럼장애로 분류되었고, 양극성을 시사하는 임상양상들은 양극성 스펙트럼장애로 분류되지 않은 주요우울장애 환자와 유의한 차이를 보임을 알수 있었다. 또한 K-MDQ의 시행을 통해 양극성 스펙트럼장애를 임상에서 유용하게 선별하여 양극성 스펙트럼장애 환자를보다 빠르고 정확하게 진단내리는데 도움이 될 것이다. 이러한 양극성 스펙트럼장애 환자들에 대한 임상적인 접근과 치료결과에 대한 연구가 부족한 실정으로 추후 더욱 많은 연구가이뤄져야 할 것으로 생각한다.
Abstract
Objectives This study was performed to evaluate the frequency of bipolar spectrum disorder (BSD) among patients who have been diagnosed with major depressive disorder. In addition, authors assessed the practical usefulness of the Mood Disorder Questionnaire (MDQ) to investigate the frequency of bipolar spectrum disorder in major depressive disorder. Methods The participants were 70 depressive patients who have never been diagnosed with bipolar disorders. The subjects were interviewed for diagnosis using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision criteria and the Mini-International Neuropsychiatric Interview to exclude bipolar disorders from the subjects. BSD criteria (as defined by Ghaemi, et al. 2002), and Korean version of the Mood Disorder Questionnaire (K-MDQ) was used to investigate their bipolarity. Data were collected including family history of affective disorder, number of previous depressive episode, age of onset, history of suicide attempt, comorbid psychiatric illness, and drug and alcohol use. Results Among 70 subjects, 25 patients (35.7%) were classified as having bipolar spectrum disorder on BSD criteria, while other 45 patients (64.3%) as unipolar depression. Among the 25 patients who meet the BSD criteria, 24 patients (34.3%) scored more than 7 and only 1 patient (1.4%) scored less than 6 on K-MDQ. Among the 45 patients who don’t meet BSD criteria, 40 patients (57.1%) scored less than 6 and only 5 patients (7.1%) scored more than 7 on K-MDQ. Early age of onset, recurrent depressive episode, brief depressive episode, bipolar family history, history of suicide attempt, antidepressant induced hypomania, hyperthymic temperament, atypical depressive symptom, psychotic depressive symptom, and antidepressant “wear off” were found to be highly related with MDQ positive subjects and BSD subjects among the depressive subjects. Conclusion The result of this study demonstrates the high frequency of BSD in depressive patients who have never been diagnosed with bipolar disorders. Some BSD criteria can be used to differentiate BSD subjects from the subjects with major depressive disorder. Also these results indicate that K-MDQ is useful for screening of bipolar spectrum disorder.
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