双相情感障碍患者抑郁首发与躁狂首发的临床特点比较  

Comparison of clinical characteristics between first-episode depression and first-episode mania in bipolar disorder patients

作　　者：张莹洁[1] 迟勇[1] 刘竞[1] 于海婷[1] 王琰[1] 于红晔 罗炯[2] 

机构地区：[1]首都医科大学附属北京安定医院13病区,北京100088 [2]首都医科大学附属北京安定医院9病区,北京100088

出　　处：《中国医刊》2017年第4期84-87,共4页Chinese Journal of Medicine

基　　金：首都临床特色应用研究(Z141107002514032);首都卫生发展科研专项项目(首发2014-4-2123)

摘　　要：目的探讨双相情感障碍患者抑郁首发与躁狂首发的临床特点的异同,为实现个体化治疗提供依据,提高双相障碍的诊疗水平。方法选取2013年6~12月于本院就诊的双相情感障碍患者456例,按首次发作形式分为抑郁首发组和躁狂首发组两组,对两组的性别、年龄、婚姻状况、受教育年限等人口学资料和临床资料进行统计描述及分析。结果抑郁首发组和躁狂首发组患者的性别、年龄差异具有显著性(P<0.05),而婚姻状况和受教育年限比较差异无显著性(P>0.05)。抑郁首发组和躁狂首发组在确诊时间、躁狂发作次数、抑郁发作次数、自杀史、住院次数上差异具有显著性(P<0.05),而两组病程、首次发病年龄、首次就诊年龄、确诊年龄、总发作次数比较差异无显著性(P>0.05)。两组误诊为其他疾病、误诊为单相抑郁以及服药不依从和治疗不规范引起复发的比例差异均具有显著性(P<0.05)。结论抑郁首发患者存在更多不利的临床特征,误诊率、复发率和自杀率高,治疗依从性差,应根据其首次发作形式给予预测性的建议,实现个体化治疗。Objectives To improve the diagnosis and treatment level of bipolar disorder and provide evidence for individualized treatment, we compared the clinical characteristics between first-episode depression and first-episode mania in bipolar disorder patients. Method A total of 456 patients with bipolar disorder who were hospitalizedbetween Jun. 2013 and Dec. 2013 were selected and divided into first-episode depression group and first-episode mania group according to the first-episode type. The descriptive statistics was adopted to analyze the demographic data including gender, age, marriage, education, and clinical symptoms. Result The two groups showed significant differences in age and gender （P~ 0.05）, while did not differ significantly in marriage and education（P^0.05）. There were significant differences in diagnosis time, frequencies of mania, frequencies of depression, history of suicide attempts, frequencies of hospitalization between the two groups （P〈0.05）, while no significant difference was found in disease course, first onset age, visiting age, age at first diagnosis, and total number of attack （P〉O.05）. Significant differences were observed in rate of misdiagnosing as other diseases, rate of misdiagnosing as unipolar depression, relapse due to medication non- compliance, and relapse due to non-standard treatment between the two groups （P〈0.05）. Conclusion Patients with first-episode depression showed more adverse clinical features, including higher misdiagnosis rate, recurrence rate, suicide rate, and bad therapeutic compliance. Some predictive suggestions should be given based on the first episode so as to realize the individualized treatment.

关 键 词：双相情感障碍 抑郁 躁狂 首次发作 

分 类 号：R749[医药卫生—神经病学与精神病学]