양극성 장애에서 1형과 2형 환자 간의 임상 양상 비교
Differences in Clinical Manifestations between Bipolar I and Bipolar II Disorders in Korean Population
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참고문헌
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초록
본 연구는 1형 양극성 장애 환자와 2형 양극성 장애 환 자에서 직접 면담을 통해 광범위한 증상 및 질병 경과를 평가하여 비교하였다. 그 결과, 2형 양극성 장애는 1형 양 극성 장애에 비해 우울 삽화의 재발이 더 잦았고, 급속 순환 형과 계절적 주기성을 보이는 비율도 더 높았다. 두 군은 또한 (경)조증 삽화 및 우울 삽화에서 나타나는 증상 양상 에 있어서도 차이를 보였다. 이러한 결과는 향후 원인론적, 치료적 접근에 있어서 1형과 2형 양극성 장애를 독립된 대 상으로 접근하는 것이 타당할 수 있음을 시사해 주었다.
Abstract
Objectives Whether bipolar II disorder (BP-II) is simply a milder form of bipolar I disorder (BP-I) or a valid diagnostic category that could be separated from BP-I, is an issue still under consideration. Investigations exploring differential clinical and biological features of the two conditions are needed to resolve the controversies. This study aimed to obtain a comprehensive view of differences in clinical course and symptoms characteristics between BP-I and BP-II. Methods 44 BP-I and 26 BP-II patients were assessed using the Diagnostic Interview for Genetic Studies (DIGS), Korean version. Demographic data, age at onset, number of (hypo) manic/ depressive episodes, the duration of illness, polarity at onset, seasonality, rapid cycling, atypical depression and symptom profiles of each episode were evaluated. Results BP-II patients experienced depressive episodes more frequently than BP-I patients after illness onset (U=240.5, p=0.008). More BP-II patients showed seasonality (34.9% vs. 61.5%) and a rapid cycling course (4.5% vs. 18.2%). When comparing symptom profiles of manic/hypomanic episodes, irritable mood, decreased sleep need, inattention, reckless behavior, arrogant/provocative attitude and frequent outbursts of anger were less encountered in BP-II patients. In depressive episodes, leaden paralysis and psychomotor agitation were more frequently observed in BP-II patients. There was no significant difference between the two groups in psychotic symptoms of depressive episode. Conclusion BP-I and BP-II disorders showed differences in clinical courses and symptom profiles. BP-II disorder seems to be less severe than BP-I disorder with regard to the intensity of manic symptoms, but more severe with respect to frequencies of depressive episodes. These results provide additional evidence supporting the distinction of BP-I and BP-II as separate diagnos-tic categories that might have different genetic profiles and/or biological mechanisms.
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