初级保健视角下双相Ⅱ型情感障碍与抑郁障碍的鉴别诊断研究进展

doi:10.12114/j.issn.1007-9572.2024.0634

中国全科医学 ›› 2026, Vol. 29 ›› Issue (15): 2092-2099.DOI: 10.12114/j.issn.1007-9572.2024.0634

• 综述与专论 • 上一篇

初级保健视角下双相Ⅱ型情感障碍与抑郁障碍的鉴别诊断研究进展

姚丁烨¹^,², 罗桂平³, 孙俊生¹^,²^,^*(), 李慧⁴

1．518116　广东省深圳市，广州中医药大学深圳临床医学院
2．518116　广东省深圳市龙岗中心医院全科医学科
3．518116　广东省深圳市龙岗区人民医院中央悦城社区健康服务中心
4．515063　广东省汕头市，汕头大学医学院精神卫生中心

收稿日期:2025-01-10 修回日期:2025-05-25 出版日期:2026-05-20 发布日期:2026-04-14
通讯作者: 孙俊生
姚丁烨与罗桂平为共同第一作者

作者贡献：
姚丁烨负责文章设计与构思；罗桂平负责文献检索与整理，撰写论文；孙俊生负责文章修订与指导，对文章整体负责；李慧负责文章的指导及审核。
基金资助:
广东省本科高校教学质量与教学改革工程项目(粤教高函〔2023〕4号，粤教高函〔2024〕30号); 深圳市龙岗区医学学科建设经费资助; 汕头大学医学院本科教学改革与研究项目(24JXGG05)

Research Progress on Identifying Bipolar Ⅱ Disorder and Depressive Disorder in Primary Care

YAO Dingye¹^,², LUO Guiping³, SUN Junsheng¹^,²^,^*(), LI Hui⁴

1. Shenzhen Clinical College of Medicine, Guangzhou University of Chinese Medicine, Shenzhen 5181116, China
2. Department of General Practice, Longgang Central Hospital of Shenzhen, Shenzhen 5181116, China
3. Yuecheng Central Community Health Service Center of Shenzhen Longgang District People's Hospital, Shenzhen 518116, China
4. The Mental Health Center, Shantou University Medical College, Shantou 515063, China

Received:2025-01-10 Revised:2025-05-25 Published:2026-05-20 Online:2026-04-14
Contact: SUN Junsheng
About author:
YAO Dingye and LUO Guiping are co-first authors

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摘要/Abstract

摘要： 双相Ⅱ型情感障碍与抑郁障碍在临床表现上存在重叠，使得在初级保健领域中两者的鉴别面临严峻挑战。早期准确诊断对于改善患者预后至关重要，全科医生作为初级保健体系中的首诊医师，在疾病的早期筛查、识别和初始治疗方案制订中发挥重要作用。然而，目前全科医生在精准鉴别双相Ⅱ型情感障碍与抑郁障碍方面仍存在困难。本文总结了近年来双相Ⅱ型情感障碍与抑郁障碍鉴别诊断的研究进展，重点从临床特征、筛查工具的应用及随访策略等方面阐述两种疾病在初级保健领域的鉴别方法，并探讨现有筛查工具的优势与局限性。此外，文章也展望了人工智能、生物标志物及远程监测等工具在提升鉴别诊断准确性方面的应用前景，以期为后续研究和临床实践提供参考。

关键词: 初级保健, 全科医生, 双相Ⅱ型情感障碍, 抑郁障碍, 诊断，鉴别

Abstract:

The overlap in clinical presentation between bipolarⅡdisorder (BD-Ⅱ) and depressive disorders (DD) poses a significant challenge for differential diagnosis in primary care. Early and accurate diagnosis is critical to improve patient prognosis, and general practitioners (GPs), as frontline healthcare providers, play a pivotal role in initial screening, diagnosis, and treatment planning. However, GPs currently face challenges in accurately distinguishing BD-Ⅱ from DD. This paper summarises recent research advances in the differential diagnosis of BD-Ⅱ and DD, with a focus on clinical features, use of screening tools and follow-up strategies, and further evaluates the strengths and limitations of existing screening instruments in primary care settings. Additionally, emerging tools such as artificial intelligence, biomarkers and remote monitoring technologies are discussed for their potential to enhance diagnostic accuracy, offering valuable insights for follow-up research and clinical practice.

Key words: Primary care, General practitioners, Bipolar Ⅱ disorder, Depressive disorder, Diagnosis, differential

中图分类号:

R 749.4

姚丁烨,罗桂平,孙俊生,等. 初级保健视角下双相Ⅱ型情感障碍与抑郁障碍的鉴别诊断研究进展[J]. 中国全科医学, 2026, 29(15): 2092-2099. DOI: 10.12114/j.issn.1007-9572.2024.0634.
YAO Dingye,LUO Guiping,SUN Junsheng, et al. Research Progress on Identifying Bipolar Ⅱ Disorder and Depressive Disorder in Primary Care[J]. Chinese General Practice, 2026, 29(15): 2092-2099. DOI: 10.12114/j.issn.1007-9572.2024.0634.

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鉴别要点	BD-Ⅱ	DD
躁狂症状	有轻躁狂期（急促言语、思维奔逸、冲动行为等）	无躁狂期，多为情绪低落、兴趣丧失等
认知功能	持续性认知损害（注意力、记忆力下降等）	认知问题与情绪低落密切相关
情绪波动	情绪周期性波动，抑郁期后常有轻躁狂期	情绪持续低落，无周期性波动
特征性症状	抑郁期非典型症状（食欲增加、睡眠增多等）	抑郁期典型症状（食欲丧失、失眠等）
病程特点	起病年龄早，抑郁、轻躁狂周期性发作	持续低落状态
治疗反应	抗抑郁药可能诱发轻躁狂症状	对抗抑郁药反应较好
家族史	遗传易感性，情感障碍家族史较常见	家族聚集性相对较弱

鉴别要点	BD-Ⅱ	DD
躁狂症状	有轻躁狂期（急促言语、思维奔逸、冲动行为等）	无躁狂期，多为情绪低落、兴趣丧失等
认知功能	持续性认知损害（注意力、记忆力下降等）	认知问题与情绪低落密切相关
情绪波动	情绪周期性波动，抑郁期后常有轻躁狂期	情绪持续低落，无周期性波动
特征性症状	抑郁期非典型症状（食欲增加、睡眠增多等）	抑郁期典型症状（食欲丧失、失眠等）
病程特点	起病年龄早，抑郁、轻躁狂周期性发作	持续低落状态
治疗反应	抗抑郁药可能诱发轻躁狂症状	对抗抑郁药反应较好
家族史	遗传易感性，情感障碍家族史较常见	家族聚集性相对较弱

筛查工具	优势	局限
MDQ	诊断效能好，临床实用性高	双相Ⅱ型识别灵敏度不足，存在回溯性偏差
HCL-32	对轻躁狂症状识别灵敏度高，跨文化适用性佳	特异度受限，混合特征鉴别能力不足
HCL-33-EA	内部一致性良好，多维度外部评估	诊断准确性中等，非典型表现识别率低
BSQ	心理测量学特性好，跨文化评估效能佳	正向评估维度缺乏，存在性别与文化局限
MINI	结构化程度高，精神障碍谱系评估全面	症状探查深度受限，复杂病例鉴别能力不足
BI	双相谱系障碍诊断效能佳，维度评估全面	非典型共病识别受限，文化适应性存在差异

筛查工具	优势	局限
MDQ	诊断效能好，临床实用性高	双相Ⅱ型识别灵敏度不足，存在回溯性偏差
HCL-32	对轻躁狂症状识别灵敏度高，跨文化适用性佳	特异度受限，混合特征鉴别能力不足
HCL-33-EA	内部一致性良好，多维度外部评估	诊断准确性中等，非典型表现识别率低
BSQ	心理测量学特性好，跨文化评估效能佳	正向评估维度缺乏，存在性别与文化局限
MINI	结构化程度高，精神障碍谱系评估全面	症状探查深度受限，复杂病例鉴别能力不足
BI	双相谱系障碍诊断效能佳，维度评估全面	非典型共病识别受限，文化适应性存在差异

临床特征	短期随访	长期随访
症状波动	BD-Ⅱ：短期内可能出现轻躁狂症状	BD-Ⅱ：抑郁与轻躁狂交替，周期性波动
症状波动	DD：症状稳定，以抑郁症状为主	DD：持续性抑郁，无周期性波动
轻躁狂表现	BD-Ⅱ：轻躁狂可能隐匿或轻微	BD-Ⅱ：轻躁狂症状逐渐显现，呈规律性波动
轻躁狂表现	DD：无轻躁狂表现	DD：无轻躁狂表现
治疗反应	BD-Ⅱ：抗抑郁药物可能诱发躁狂转相或症状加重	BD-Ⅱ：症状可能反复或波动
治疗反应	DD：治疗反应稳定或改善	DD：症状无波动或好转
情感特征	BD-Ⅱ：可能出现情感波动	BD-Ⅱ：规律性情感波动
情感特征	DD：情感反应相对单一	DD：情感基线相对稳定

初级保健视角下双相Ⅱ型情感障碍与抑郁障碍的鉴别诊断研究进展

Research Progress on Identifying Bipolar Ⅱ Disorder and Depressive Disorder in Primary Care

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