双相障碍Ⅰ型首发躁狂患者7年后功能结局及其影响因素研究  

The study of functional outcomes and related influencing factors in patients with bipolar I first-episode mania after 7 years

作　　者：崔伟[1] 芦云平 郑冬瑞[1] 于超[1] 严保平[1] 崔利军[1] 张云淑[1] CUI Wei;LU Yunping;ZHENG Dongrui;YU Chao;YAN Baoping;CUI Lijun;ZHANG Yunshu(Mental Health Center of Hebei Province,Baoding 071000,China)

机构地区：[1]河北省第六人民医院(河北省精神卫生中心),保定071000

出　　处：《中国神经精神疾病杂志》2021年第4期203-207,共5页Chinese Journal of Nervous and Mental Diseases

基　　金：保定市科技计划项目(编号:18ZF175)。

摘　　要：目的了解双相障碍Ⅰ型(bipolar disorder-I,BP-Ⅰ)首发躁狂患者7年后的功能结局,探讨不良结局可能的影响因素。方法纳入杨氏躁狂量表≥20分、年龄18~60岁的单次躁狂发作患者,共147例。通过自然观察随访,于第2年、第4年、第7年随访,收集人口学特征、疾病特征、治疗情况、复发情况等资料,末次随访采用整体功能评定量表(global assessment function,GAF)评估患者功能水平,并用药物依从性评定量表和药物副反应量表(treatment emergent symptom scale,TESS)分别评估药物治疗依从性和药物副反应等。将缓解期患者分组,GAF总分≤70分为功能不良组,>70分为功能良好组。结果完成7年随访101例患者,末次随访处于缓解期者87例。其中功能不良组50例(57.5%),功能良好组37例(42.5%)。功能不良组较功能良好组,男性、首发时非初婚和伴攻击特征者多,急性期治疗时间长,威斯康星卡片分类测验正确应答数和社会支持评定量表总分低,7年间仅有躁狂发作者少,伴有精神病性症状的发作多,第7年末次随访时TESS总分高(均P<0.05)。多因素logistic回归分析显示,7年间发作中伴精神病性症状发作构成比高(OR=8.456)、首发时非初婚(OR=5.905)、男性(OR=5.083)、TESS总分高(OR=1.118)、仅有躁狂发作(OR=0.155)与BP-Ⅰ首发躁狂患者7年后功能结局不良相关联(均P<0.05)。结论伴有精神病性症状发作、不良婚姻、男性、药物副反应等特征增加BP-Ⅰ首发躁狂患者功能结局不良的发生风险,而仅有躁狂发作患者的功能结局相对较好。Objective To investigate the social functional outcomes 7 years after bipolar I first manic episode,and to explore the possible influence factors of adverse outcomes.Methods A total of 147 patients with single manic episode aged 18~60 years and Young Mania Rating Scale≥20 points were included.Observational follow-up was conducted at the onset,2,4 and 7 years.Demographic data,disease characteristics,and treatment status were collected.At the last follow-up,the Global Assessment Function(GAF),Drug Compliance Rating Scale and Treatment Emergent Symptom Scale(TESS)were used to evaluate patients’functional level,compliance to medication and adverse reactions.GAF scores were used to divide the patients into following groups:GAF≤70 was divided into dysfunctional group,and GAF>70 was divided into well function group.Results One hundred and one patients were followed up for 7 years.At the last follow-up,87 patients were in remission,including 50 patients(57.5%)in the dysfunctional group and 37 patients(42.5%)in the well function group.Compared with the well-functioning group,the dysfunctional group had more male,more non-first marriage and more aggressive characteristics.In addition,patients in the dysfunctional group had longer duration of treatment in the acute phase,lower number of correct responses on the Wisconsin Card Classification Test and the total score on the Social Support Rating Scale,fewer episodes of pure mania and more episodes of psychotic symptoms during the 7-year period and higher total score of TESS at the last follow-up 7 years(all P<0.05).Dichotomous unconditional logistic regression analysis revealed that the proportion of patients with episodes of psychotic symptoms(OR=8.456),non-first marriage at first episode(OR=5.905),male(OR=5.083),TESS total score(OR=1.118),and only manic episodes(OR=0.155)were associated with dysfunction 7 years later in BP-Ⅰpatients with first episode of manic symptoms.Conclusion The patients with psychotic symptoms,bad marriage,male and drug side effects have an in

关 键 词：双相障碍Ⅰ型 躁狂首发 功能结局 影响因素 

分 类 号：R749.4[医药卫生—神经病学与精神病学]