İki uçlu depresyonda doğru tanı koymak: Tek uçlu ve iki uçlu depresyon ayrımı

İki uçlu bozukluklu hastalara sıklıkla tekrar edici major depresyon tanısı konulmaktadır. Major depresif tanısı koymadan önce klinisyenler mutlaka ayırıcı tanıda çok önemli olan mani veya hipomani öyküsü sorgulamalıdır. İki uçlu depresyonda daha fazla mizaçta oynaklık ,daha fazla motor retardasyon ve hipersomni mevcuttur. Erken başlangıç, depresif atakların daha sık olması, iki uçlu bozukluğa ait aile öyküsü tanıda iki uçlu bozukluk lehinedir. İki uçlu bozukluklu hastalarda mizaç belirtileri hem işlevsellikte bozulma hem de yeti kaybı ile daha fazla ilişkilidir. Yeti kaybının ilişkisi manik belirtilerden ziyade depresif belirtilerle ilişkilidir. Yanlış tanı hastanın uygun tedavi almaması ile sonuçlanırken hastalığın gidişinde de olumsuz etkisi vardır. Bu yazıda bir olgu örneği çerçevesinde iki uçlu ve tek uçlu depresyon ayırıcı tanısı üzerinde durulmaktadır.

Anahtar Kelimeler:

tek uçlu depresyon, iki uçlu depresyon, yanlış tanı, mani, hipomani

True diagnoses in bipolar depression: differentiation between unipolar and bipolar depression

Bipolar disoder can be difficult to diagnose and is often misdiagnosed as recurrent major depressive disorder While diagnosing major depressive episode clinicians should be checking for a history of mania or hypomania, which is indicative of bipolar disorder rather than major depressive disorder. Bipolar depression is associated with more mood lability, more motor retardation, and hypersomnia. Early age of onset, a high frequency of depressive episodes, bipolar family history are suggestive of bipolar disorder rather than major depression. Severity of mood symptoms are strongly associated with functional impairment and disability among bipolar patients. The association of Level of disablity is much stronger with depressive symptoms than symptoms of mania. Misdiagnose can result with inappropriate treatment which has a detrimental effect on the course of the illness. The differential diagnosis of bipolar disorder will be reviewed with a case sample with this article.

Keywords:

unipolar depression, bipolar depression, misdiagnosis, mania, hypomania,

PDF

___

Roy-Byrne P, Post RM, Uhde TW, Porcu T, Davis D.The longitudinal course of recurrent affective illness: life chart data from research patients at the NIMH. Acta Psychiatr Scand Suppl. 1985;317:1-34
Hirschfeld RM, Lewis L, Vornik LA. Perceptions and impact of bipolar disorder: how far have we really come? results of the National Depressive and Manic-Depressive Association 2000 survey of individuals with bipolar disorder. J Clin Psychiatry. 2003;64:161–174.
Ghaemi SN, Boiman EE, Goodwin FK. Diagnosing bipolar disorder and the effect of antidepressants: a naturalistic study. J Clin Psychia¬try. 2000;61:804-8.
Mizuna DJ, Kemp DE, McIntyre DS.Differentiating bipolar disorders from major depressive disorders: Treatment Implications. Annual Clin Psych 2007 ;19:305-12.
Judd LL, Akiskal HS, Schettler PJ, Endicott J, Maser J, Solomon DA, Leon AC, Rice JA, Keller MB. The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry. 2002;59(6):530–7.
Judd LL, Akiskal HS, Schettler PJ, Coryell W, Endicott J, Maser JD, Solomon DA, Leon AC, Keller MB. A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Arch Gen Psychiatry. 2003;60:261–9.
Akiskal HS, Walker P, Puzantian VR, King D, Rosenthal TL, Dranon M. Bipolar outcome in the course of depressive illness: phenomenologic, familial, and pharmacologic predictors. J Affect Disord. 1983;5:115–28. Othmer E, Desouza CM, Penick EC, Nickel EJ, Hunter EE, Othmer SC, Powell BJ, Hall SB. Indicators of mania in depressed outpatients: a retrospective analysis of data from the Kansas 1500 study. J Clin Psychiatry. 2007;68:47–51.