본문 바로가기
KERD
논문KCI 등재

양극성 장애의 새로운 개념:혼재성 상태를 중심으로

Emerging Concepts of Bipolar Disorder:Focus on Mixed States

0

조회

0

다운로드

2

인용

0

참고문헌

키워드

주제분류정신과학

초록

An admixture of affective symptoms of opposite polarity in bipolar disorders has very important clinical implications just beyond the diagnostic classification of diseases. In this respect, there are several clinical problems with the very strict concepts of bipolar mixed state according to the DSM-IV and ICD-10. First, many cases in which affective symptoms of opposite polarity are combined without fully satisfying the criteria for one or the other type of episode have been seen in clinical situations. Second, mixed symptomatology of opposite polarity frequently represents the first expression of a bipolar disorder. Third, unipolar depressives with intra-episodic expansive symptoms may not adequately respond to antidepressant drugs, which can be causative in treatment resistance or lead to cycling. Mixed state does not represent a mere combination of depressive and manic symptomatology, but a complex process of temperamental disposition and affective process. Trait factors such as hyperthymic and depressive temperaments, when opposite to the polarity of superimposed affective episodes, might underlie the affective instability of bipolar mixed states. Affective instability appears to be the clinical expression of the neurophysiological dysregulation believed to underlie bipolar disorders. Mixed state might be considered the most eloquent expression of this dysregulation. In conclusion, the concepts of bipolar mixed state will be needed to be broader than what is included in DSM-IV and ICD-10. (J Korean Neuropsychiatr Assoc 2008;47(2):119-125)

Abstract

An admixture of affective symptoms of opposite polarity in bipolar disorders has very important clinical implications just beyond the diagnostic classification of diseases. In this respect, there are several clinical problems with the very strict concepts of bipolar mixed state according to the DSM-IV and ICD-10. First, many cases in which affective symptoms of opposite polarity are combined without fully satisfying the criteria for one or the other type of episode have been seen in clinical situations. Second, mixed symptomatology of opposite polarity frequently represents the first expression of a bipolar disorder. Third, unipolar depressives with intra-episodic expansive symptoms may not adequately respond to antidepressant drugs, which can be causative in treatment resistance or lead to cycling. Mixed state does not represent a mere combination of depressive and manic symptomatology, but a complex process of temperamental disposition and affective process. Trait factors such as hyperthymic and depressive temperaments, when opposite to the polarity of superimposed affective episodes, might underlie the affective instability of bipolar mixed states. Affective instability appears to be the clinical expression of the neurophysiological dysregulation believed to underlie bipolar disorders. Mixed state might be considered the most eloquent expression of this dysregulation. In conclusion, the concepts of bipolar mixed state will be needed to be broader than what is included in DSM-IV and ICD-10. (J Korean Neuropsychiatr Assoc 2008;47(2):119-125)

참고문헌 (49)

  1. Marneros A, "Expanding the group of bipolar disorders", J Affect Disord, 62, pp.39~44 (2001)
  2. Angst J, "Bipolarity from ancient to modern times: conception, birth and rebirth", J Affect Disord, 67, pp.3~19 (2001)
  3. Dunner DL, "Heritable factors in the severity of affective illness", Biol Psychiatry, 11, pp.31~42 (1976)
  4. Akiskal HS, "The evolving bipolar spectrum. Prototypes I, II, III, and IV", Psychiatr Clin North Am, 22, pp.517~534 (1999)
  5. McElroy SL, "Clinical and research implications of the diagnosis of dysphoric or mixed mania or hypomania", Am J Psychiatry, 149, pp.1633~1644 (1992)
  6. Pope HG Jr, "Diagnosis in schizophrenia and manicdepressive illness: a reassessment of the specificity of ‘schizophrenic’ symptoms in the light of current research", Arch Gen Psychiatry, 35, pp.811~828 (1978)
  7. Akiskal HS, "Psychotic forms of depression and mania", Psychiatr Clin North Am, 2, pp.419~439 (1979)
  8. Khantzian EJ, "The self-medication hypothesis of substance use disorders: a reconsideration and recent applications", Harv Rev Psychiatry, 4, pp.231~244 (1997)
  9. Salloum IM, "Impact of substance abuse on the course and treatment of bipolar disorder", Bipolar Disord, 2, pp.269~280 (2000)
  10. Young LT, "Anxious and nonanxious bipolar disorder", J Affect Disord, 29, pp.49~52 (1993)
  11. Perugi G, "Depressive comorbidity of panic, social phobic, and obsessive- compulsive disorders re-examined: is there a bipolar II connection?", J Psychiatr Res, 33, pp.53~61 (1999)
  12. Kraepelin E, "Psychiatrie. 4th ed", pp.366~367 (1893), J A Barth
  13. Kraepelin E, "Psychiatrie, 5th ed", pp.634~ (1896), J A Barth
  14. Kraepelin E, "Psychiatrie, 6th ed", pp.394~399 (1899), J A Barth
  15. Kraepelin E, "Psychiatrie, Ein Lehrbuch für Studierende und Ärzte., vol 3 , Part 2", pp.1284~1303 (1913), J A Barth
  16. Koukopoulos A, "Agitated depression as a mixed state and the problem of melancholia", Psychiatr Clin North Am, 22, pp.547~564 (1999)
  17. Weygandt W, "Über die Mischzustände des manisch-depressiven Irreseins", pp.5~ (1899), J F Lehmann
  18. Berner P, "Diagnostic Criteria for Functional Psychoses. 2nd ed" (1993), Cambridge University Press
  19. American Psychiatric Association, "Diagnostic and Statistical Manual of Mental Disorders. 3rd ed-revised", pp.225~226 (1987), American Psychiatric Association
  20. American Psychiatric Association, "Diagnostic and Statistical Manual of Mental Disorders. 4th ed", pp.333~335 (1994), American Psychiatric Association
  21. Post RM, "Cocaine, kindling, and psychosis", Am J Psychiatry, 133, pp.627~634 (1976)
  22. Himmelhoch JM, "Mixed states, manic-depressive illness, and the nature of mood", Psychiatr Clin North Am, 2, pp.449~459 (1979)
  23. World Health Organization, "The ICD-10 Classification of Mental and Behavioral Disorders: Clinical descriptions and diagnostic guidelines", pp.118~119 (1992), World Health Organization
  24. Perugi G, "Clinical subtypes of bipolar mixed states: validating a broader European definition in 143 cases", J Affect Disord, 43, pp.169~180 (1997)
  25. Perugi G, "Polarity of the first episode, clinical characteristics, and course of manic depressive illness: a systematic retrospective investigation of 320 bipolar I patients", Compr Psychiatry, 41, pp.13~18 (2000)
  26. Swann AC, "Depression during mania: Treatment response to lithium or divalproex", Arch Gen Psychiatry, 54, pp.37~42 (1997)
  27. Akiskal HS, "Criteria for the “soft” bipolar spectrum: treatment implications", Psychopharmacol Bull, 23, pp.68~73 (1987)
  28. Koukopoulos A, "Mixed depressive syndrome", Encephale, 18, pp.19~21 (1992)
  29. Murphy DL, "Depression, elation, and lithium carbonate responses in manic patient subgroups", Arch Gen Psychiatry, 31, pp.643~648 (1974)
  30. Post RM, "Dysphoric mania. Clinical and biological correlates", Arch Gen Psychiatry, 46, pp.353~358 (1989)
  31. Bunney WE Jr, "The “switch process” in manic-depressive illness. I. A systematic study of sequential behavioral changes", Arch Gen Psychiatry, 27, pp.295~302 (1972)
  32. Bauer MS, "Testing definitions of dysphoric mania and hypomania: prevalence, clinical characteristics and inter-episode stability", J Affect Disord, 32, pp.201~211 (1994)
  33. McElroy SL, "Differences and similarities in mixed and pure mania", Compr Psychiatry, 36, pp.187~194 (1995)
  34. Akiskal HS, "Gender, temperament, and the clinical picture in dysphoric mixed mania: findings from a French national study (EPIMAN)", J Affect Disord, 50, pp.175~186 (1998)
  35. Perugi G, "Clinical characterization of depressive mixed state in bipolar-I patients: Pisa-San Diego collabortion", J Affect Disord, 67, pp.105~114 (2001)
  36. Berner P, "The Viennese concept of endogenomorphic axial syndromes ; Psychiatry: the State of the Art", pp.113~114 (1983), Plenum Press
  37. Benazzi F, "Depressive mixed states: unipolar and bipolar II", Eur Arch Psychiatry Clin Neurosci, 통권 : 250, pp.249~253 (2000)
  38. Benazzi F, "Delineating bipolar II mixed states in the Ravenna-San Diego collaborative study: the relative prevalence and diagnostic significance of hypomanic features during major depressive episodes", J Affect Disord, 67, pp.115~122 (2001)
  39. Akiskal HS, "Switching from ‘unipolar’ to bipolar II. An 11-year prospective study of clinical and temperamental predictors in 559 patients", Arch Gen Psychiatry, 52, pp.114~123 (1995)
  40. Perugi G, "The high prevalence of “soft” bipolar (II) features in atypical depression", Compr Psychiatry, 39, pp.63~71 (1998)
  41. Akiskal HS, "Family history validation of the bipolar nature of depressive mixed states", J Affect Disord, 73, pp.113~122 (2003)
  42. Akiskal HS, "Cyclothymic temperamental disorders", Psychiatr Clin North Am, 2, pp.527~554 (1979)
  43. Akiskal HS, "The mixed states of bipolar I, II, III", Clin Neuropsychopharm, 15, pp.632~633 (1992)
  44. Dell’Osso L, "The manic -depressive mixed state: familial, temperamental and psychopathologic characteristics in 108 female inpatients", Eur Arch Psychiatry Clin Neurosci, 240, pp.234~239 (1991)
  45. Dell’Osso L, "Psychotic and nonpsychotic mixed states: comparisons with manic and schizoaffective disorders", Eur Arch Psychiatry Clin Neurosci, 243, pp.75~81 (1993)
  46. Perugi G, "The contrasting influence of depressive and hyperthymic temperaments on psychometrically derived manic subtypes", Psychiatr Res, 101, pp.249~258 (2001)
  47. Goodwin FK, "Manic-Depressive Illness", pp.575~595 (1990), Oxford University Press
  48. Strakowski SM, "Suicidality among patients with mixed and manic bipolar disorder", Am J Psychiatry, 153, pp.674~676 (1996)
  49. Goldberg JF, "Portera L. Association of recurrent suicidal ideation with nonremission from acute mixed mania", Am J Psychiatry, 155, pp.1753~1755 (1998)

관련 논문AI추천

이 간행물의 다른 논문 (11건)