目的 研究青少年重型抑郁障碍(Major Depressive Disorder,MDD)、双相情感障碍(Bipolar Disorder,BD)多病种认知表型的跨诊断聚类分析的实际临床意义.方法 本研究共入组335名受试者:84名BD患者,58名MDD患者,以及193例青少年健康对照;评定受试者汉密尔顿焦虑(Hamilton Anxiety Scale,HAMA-14)及汉密尔顿抑郁(Hamilton Depression Rating Scale,HAMD-24)量表,简明精神病量表(Brief Psychiatry Rating Scale,BPRS)、杨氏躁狂量表(Young mania Rating Scale,YMRS);采用分层聚类检测认知亚型;比较不同亚型间症状严重程度的差异.结果 分层聚类分析共检测出3个认知亚型:亚型1为中度受损型,亚型2为重度受损型,亚型3为轻度受损型;分3类认知亚型对应的五折交叉平均ARI值(反映聚类稳定性)为0.462;三个认知亚型里正常人占比差异有显著统计学意义(x2=77.26,P<0.001),各疾病(双相Ⅰ型、Ⅱ型、MDD)占比差异无显著统计学意义;认知亚型3的焦虑、抑郁、躁狂及精神病性症状严重程度较认知亚型1、2均轻.结论 认知损害轻的亚型抑郁、焦虑、躁狂、精神病性症状均轻;多病种认知表型的跨诊断聚类分析在青少年BD、MDD的症状严重程度划分中有一定实际临床意义,但缺乏诊断特异性.
Objective To study the clinical significance of cross-diagnostic cluster analysis of cognitive phenotypes of major depressive disorder(MDD)and bipolar disorder(BD)in adolescents.Methods A total of 335 subjects were enrolled in this study:84 BD patients,58 MDD patients,and 193 adolescent healthy controls.Hamilton Anxiety Scale(HAMA-14)and Hamilton Depression Scale(HAMD-24)scales,Brief Psychiatric Rating Scale(BPRS)and Young Mania Rating Scale(YMRS)were assessed.Cognitive subtypes were detected by hierarchical clustering.The difference of symptom severity among different subtypes was compared.Results Three cognitive subtypes were detected by hierarchi-cal cluster analysis:subtype 1 was moderately impaired,subtype 2 was severely impaired,and subtype 3 was mildly im-paired.The average ARI(response cluster stability)of cognitive 3 subtype was 0.462.Among the three cognitive subtypes,there was significant difference in the proportion of normal people(x 2=77.26,P<0.001),but there was no significant difference in the proportion of diseases(bipolar Ⅰ,Ⅱ,MDD).The symptoms of anxiety,depression,psychosis and mania in cognitive subtype 3 were less severe than those in cognitive subtype 1 and 2.Conclusion The mild cognitive im-pairment subtype showed the mildest symptoms of depression,anxiety,mania and psychosis.The cross-diagnostic cluster analysis of multi-disease cognitive phenotypes has certain practical clinical significance in the classification of symptom severity of BD and MDD in adolescent patients,despite of lack of diagnostic specificity.