伴混合特征和联用心境稳定剂对抑郁症患者治疗中转相躁狂的影响  

Analysis of influence of comorbidity with mixed feature and co-treatment with mood stabilizers on treatment-emergent affective switch to mania in the patients with major depressive disorder

作　　者：郭萍[1] 冯敏 王世锴[2] 杨胜良[1] 沈悦 钱敏才[2] GUO Ping;FENG Min;WANG Shikai;YANG Shengliang;SHEN Yue;QIAN Mincai(Department of Psychosomatic Medicine,Third People's Hospital of Huzhou,Huzhou 313000,China)

机构地区：[1]湖州市第三人民医院心身科,313000 [2]湖州市第三人民医院精神科,313000

出　　处：《浙江医学》2021年第5期488-491,496,共5页Zhejiang Medical Journal

基　　金：浙江省医药卫生科研面上项目(2018KY785);湖州市科技局公益性应用研究项目(2017GY50)。

摘　　要：目的探讨伴混合特征和联用心境稳定剂对抑郁症患者治疗中转相躁狂的影响。方法选取2018年1月至2019年12月在湖州市第三人民医院接受住院治疗的180例抑郁症患者为研究对象,其中单纯性单相抑郁症(PUD)60例,给予单用抗抑郁剂治疗;抑郁症伴混合特征(DMX)120例,按随机数字表法分为两组:DMX-1组60例,给予单用抗抑郁剂治疗,DMX-2组60例,给予抗抑郁剂联合心境稳定剂治疗。评估3组患者基线时汉密尔顿抑郁量表(HAMD-17)、杨氏躁狂量表(YMRS)、心境障碍问卷(MDQ)、临床总体印象-疾病严重程度量表(CGI-SI)等量表评分,以及治疗第1、2、4、6周末YMRS。结果3组患者治疗第1、2、4、6周末累计转相躁狂发生率比较,差异均有统计学意义(均P<0.05);PUD组、DMX-2组在治疗第1周末均无转相躁狂发生,DMX-1组治疗第1、2、4、6周末累计转相躁狂发生率均明显高于PUD组和DMX-2组(均P<0.05),DMX-2组治疗第2、4、6周末累计转相躁狂发生率均明显高于PUD组(均P<0.05)。发病年龄(OR=0.923)、是否伴混合特征(OR=91.460)、有无联用心境稳定剂(OR=0.299)以及基线时MDQ(OR=0.617)、CGI-SI(OR=0.588)等量表评分是抑郁症患者治疗中转相躁狂的影响因素(均P<0.05)。结论伴混合特征、低年龄起病、临床症状或(轻)躁狂症状较重均为抑郁症患者治疗中转相躁狂的危险因素,而联用心境稳定剂治疗是保护因素。Objective To explore the influence of comorbidity with mixed states and co-treatment with mood stabilizers on treatment-emergent affective switch(TEAS)to mania in the patients with depression.Methods One hundred and eighty hospitalized patients with depression in the Third Hospital in Huzhou Municipal from January 2018 to December 2019 were enrolled into this study,60 cases with pure unipolar depression(PUD)and 120 cases with major depressive disorder with mixed features(DMX)were included.According to the research design,the patients with DMX were divided into DMX-1 group(60 cases mono-treated with antidepressants)and DMX-2 group(60 cases co-treated with antidepressants and mood stabilizers),and 60 patients in PUD group were treated with antidepressants alone.The subjects were assessed with the scales of 17-item Hamilton depression rating scale(HAMD-17),Young mania scale(YMRS),mood disorder questionnaire(MDQ)and clinical global impression-severity of illness(CGI-SI)at baseline,and with the scale of YMRS at the 1,2,4 and 6 weekends during treatment period.Results There were statistically significant differences in the cumulative incidence of TEAS to mania among the three groups at the 1,2,4 and 6 weekends of treatment(P<0.05).There was no TEAS to mania in both the PUD group and the DMX-2 group at the 1 weekend of treatment,and the cumulative incidence of TEAS to mania in the DMX-1 group was significantly higher than that in the other two groups at the 1,2,4 and 6 weekends of treatment(P<0.05),and the cumulative incidence of TEAS to mania in the DMX-2 group was significantly higher than that in the PUD group at the 2,4 and 6 weekends of treatment(P<0.05).Age of onset(OR=0.923),mixed features(OR=91.460),mood stabilizers(OR=0.299),the total scale scores of MDQ(OR=0.617)and CGI-S(OR=0.588)at baseline were the risk factors of TEAS to mania in patients with depression(all P<0.05).Conclusion Comorbidity with mixed feature,onset in low age,severe clinical symptoms and(hypo)manic symptoms are the risk factors for TEAS to m

关 键 词：抑郁症伴混合特征 双相障碍 单纯性单相抑郁症 躁狂症状 

分 类 号：R749.4[医药卫生—神经病学与精神病学]