双相障碍Ⅰ型首发躁狂患者7年随访研究  

The 7 year follow-up study with a first episode mania of bipolar disorder-Ⅰ

作　　者：崔伟[1] 郑冬瑞[1] 芦云平 于超[1] 严保平[1] 张云淑[1] 崔利军[1] CUI Wei;ZHENG Dong-rui;LU Yun-ping;YU Chao;YAN Bao-ping;ZHANG Yun-shu;CUI Li-jun(Mental Health Center of Hebei Province,Baoding 071000,China)

机构地区：[1]河北省第六人民医院,保定071000

出　　处：《临床精神医学杂志》2021年第4期288-291,共4页Journal of Clinical Psychiatry

基　　金：保定市科技计划项目(18ZF175)。

摘　　要：目的:探讨双相障碍Ⅰ型(BD-I)首发躁狂患者7年间疾病发作特点及影响预后的因素。方法:对2011年10月至2013年10月本院门诊和住院首发躁狂BD-I患者进行7年随访;收集入组者人口学资料及其随访后的变化、7年间纵向疾病特征、治疗情况等资料;随访结束时进行药物依从性评定量表(MARS)及整体功能评定量表(GAF)评估。结果:共有101例患者完成7年随访;发病年龄(24.82±6.61)岁;首次发病至接受治疗的时间为10 d;随访7年后,患者体质量指数(t=3.445)、无业/失业比例(χ^(2)=17.756)、再婚比例(χ^(2)=5.698)、分居/离异比例(χ^(2)=20.404)明显高于首发时(P均<0.01);1年内复发40例(39.6%);7年间平均发作(4.95±1.81)次,躁狂发作次数为抑郁发作的4倍,只有躁狂发作者32例(31.7%);MARS总分(5.75±2.73)分,GAF总分(67.12±10.02)分,63例患者(62.4%)功能不良。多元线性回归分析显示,GAF总分与7年间总发作次数(t=-2.512)、易激惹型躁狂发作占比(t=-2.211)、伴精神病性症状发作占比(t=-2.205)呈负相关,与7年间只有躁狂发作呈正相关(t=2.281)(P均<0.05)。结论:BD-I首发躁狂患者7年间以躁狂发作为主,62.4%患者存在社会功能不良;复发次数越多、易激惹型躁狂和伴精神病性症状发作次数越多,患者远期社会功能越差。单纯躁狂发作患者远期社会功能相对良好。Objective:To explore the characteristics of the onset of a first episode mania of bipolar disorderI(BD-I)during 7 years and the factors affecting the prognosis.Method:Patients with first episode mania of BD-I in outpatients and inpatients of our hospital from October 2011 to October 2013 were followed-up for 7 years.Demographic data of the participants and their changes after follow-up,longitudinal disease characteristics and treatment status during 7 years were collected.Medication Adherence Rating Scale(MARS)and Global Assessment Function(GAF)were assessed at the end of follow-up.Results:A total of 101 patients completed the 7 years follow-up.The age of onset was(24.82±6.61)years old.The time from the first onset to treatment was 10 days.After 7 years of follow up,the body mass index(t=3.445),the proportion of unemployed/nojob(χ^(2)=17.756),the proportion of remarriage(χ^(2)=5.698)and the proportion of separation/divorce(χ^(2)=20.404)were significantly higher than those in the first patients(P<0.01).40 cases(39.6%)relapsed in the first year.In 7 years,the total number of episodes was(4.95±1.81),and the number of manic episodes was 4 times as much as that of depression.32 cases(31.7%)had simple mania.The total scores of MARS and GAF were(5.75±2.73)and(67.12±10.02)respectively.63 patients(62.4%)had dysfunction.Multiple linear regression analysis showed that the total score of GAF was negatively correlated with the total number of episodes in 7 years(t=-2.512),the proportion of irritable manic episodes(t=-2.211),and the proportion of episodes with psychotic symptoms(t=-2.205),and positively correlated with only manic episodes in 7 years(t=2.281)(all P<0.05).Conclusion:Manic episodes are the main form of episodes with first episode mania of BD-I.62.4%of the patients have poor social function.Patients with more relapses,episodes of irritable mania and associated psychotic symptoms have poorer long-term social functioning.The long-term social function are relatively good in simple manic episode patients.

关 键 词：双相障碍Ⅰ型 首发躁狂 随访研究 

分 类 号：R749.4[医药卫生—神经病学与精神病学]