Kessing L V
Department of Psychiatry, University of Copenhagen, Rigshospitalet, Denmark.
J Affect Disord. 1999 Jun;53(3):233-9. doi: 10.1016/s0165-0327(98)00126-8.
It is poorly understood how the course of illness in depressive patients is affected by a manic episode.
The course of hospitalised episodes was compared for patients with depressive episodes only, patients who presented with a manic or circular first episode and patients who presented with a depressive first episode and later developed mania. The Danish psychiatric central register was used as a study base, including all hospital admissions with primary affective disorder in Denmark during 1971-1993.
A total of 17,447 patients presented with a depressive first episode and 2903 patients with a manic or circular first episode. Among the 17,447 depressive patients, 762 patients presented with mania at later episodes (4.4%). Younger age at onset was associated with increased risk of developing mania. Patients who had a late first manic episode had the same rate of subsequent recurrence as patients with mania at first episode and this rate was higher than the rate of recurrence for patients who remained having depressive episodes only. Time since first manic episode was without importance in relation to the risk of subsequent recurrence.
Patients who present with depression and later develop mania have from onset the same risk of recurrence as initially bipolar patients.
The data relate to admissions rather than episodes.
Younger patients who present with depression have increased risk of developing bipolar disorder.
目前对于躁狂发作如何影响抑郁症患者的病程了解甚少。
比较了仅患有抑郁发作的患者、首次发作表现为躁狂或循环发作的患者以及首次发作表现为抑郁且随后发展为躁狂的患者的住院发作病程。丹麦精神病学中央登记册用作研究基础，包括1971年至1993年丹麦所有因原发性情感障碍住院的患者。
共有17447名患者首次发作表现为抑郁，2903名患者首次发作表现为躁狂或循环发作。在17447名抑郁症患者中，762名患者在后续发作中出现躁狂（4.4%）。发病年龄较小与发展为躁狂的风险增加相关。首次躁狂发作较晚的患者与首次发作即有躁狂的患者后续复发率相同，且该复发率高于仅持续有抑郁发作的患者的复发率。自首次躁狂发作后的时间与后续复发风险无关。
最初表现为抑郁且随后发展为躁狂的患者从发病起就与最初的双相情感障碍患者有相同的复发风险。
数据涉及住院情况而非发作情况。
首次发作表现为抑郁的年轻患者发展为双相情感障碍的风险增加。
