Suppes T, Leverich G S, Keck P E, Nolen W A, Denicoff K D, Altshuler L L, McElroy S L, Rush A J, Kupka R, Frye M A, Bickel M, Post R M
The Stanley Foundation Bipolar Network, 5430 Grosvenor Lane, Suite 200, Bethesda, MD 20814, USA.
J Affect Disord. 2001 Dec;67(1-3):45-59. doi: 10.1016/s0165-0327(01)00432-3.
Since recent NIMH Bipolar Disorder Workshops highlighted the dearth of longitudinal and controlled studies of bipolar illness, the Stanley Foundation Bipolar Network (SFBN) has recruited a large cohort of patients with bipolar disorder to begin to address these issues. This report describes the demographics and course of illness characteristics of this study population.
The first 261 outpatients to be diagnosed by the Structured Clinical Interview for DSM-IV (SCID) and complete a detailed patient and a brief clinician questionnaire are described. All patients met DSM-IV criteria for bipolar I (n=211), bipolar II (n=42), or NOS (n=5) or schizoaffective (n=3), bipolar type. Chi-square and t-tests were used to examine statistically significant associations among important demographic and descriptive items.
The general demographic and illness characteristics were similar to those in many bipolar clinical samples and not dissimilar from those reported in epidemiological surveys. The majority of patients had been hospitalized, with almost half reporting a worsening of illness over time, and two-thirds were not asymptomatic between episodes. First treatment for patients had been delayed by an average of 10 years from illness onset (by SCID). Almost a third of patients had attempted suicide at least once, and 30% reported current suicidal ideation at study entry. A total of 62% reported moderate to severe impact of the illness on occupational functioning. Early onset bipolar illness (< or =17 years old) was associated with increased frequency of mood switches, worsening course of illness, and history of early abuse (physical, verbal, or sexual).
The SFBN represents a sample of predominantly BP I patients largely recruited from the community who will be followed in detail longitudinally, participate in clinical trials, and thus help advance our understanding and treatment of this life-threatening medical disorder. While there is a broad range of illness characteristics and severity, the majority of patients have been severely impacted by their illness despite the availability of multiple conventional treatment approaches in the community. These data further underscore the need for development of new and earlier treatment interventions.
The SFBN population is limited by the lack of random selection and represents a cohort willing to be treated and followed intensively in academic tertiary referral centers. While its characteristics are similar to many clinical study populations, the generalizability to non-clinic populations remains uncertain.
由于美国国立精神卫生研究所（NIMH）近期举办的双相情感障碍研讨会强调了双相情感障碍纵向和对照研究的匮乏，斯坦利基金会双相情感障碍网络（SFBN）招募了一大批双相情感障碍患者，以开始解决这些问题。本报告描述了该研究人群的人口统计学特征和疾病病程特点。
描述了首批261名通过《精神疾病诊断与统计手册》第四版（DSM-IV）结构化临床访谈进行诊断，并完成详细患者问卷和简短临床医生问卷的门诊患者情况。所有患者均符合双相I型（n = 211）、双相II型（n = 42）、未特定型（n = 5）或分裂情感性障碍（双相型，n = 3）的DSM-IV标准。采用卡方检验和t检验来检验重要人口统计学和描述性项目之间的统计学显著关联。
总体人口统计学和疾病特征与许多双相情感障碍临床样本中的特征相似，与流行病学调查中报告的特征也无显著差异。大多数患者曾住院治疗，近一半患者报告病情随时间恶化，三分之二患者在发作间期并非无症状。患者首次治疗距发病（根据SCID）平均延迟了10年。近三分之一的患者至少有过一次自杀未遂，30%的患者在研究入组时报告有当前自杀意念。共有62%的患者报告疾病对职业功能有中度至重度影响。早发性双相情感障碍（≤17岁）与情绪转换频率增加、病情恶化以及早期虐待史（身体、言语或性虐待）相关。
SFBN代表了一个主要由I型双相情感障碍患者组成的样本，这些患者大多从社区招募，将接受详细的纵向随访，并参与临床试验，从而有助于推进我们对这种危及生命的疾病的理解和治疗。虽然疾病特征和严重程度范围广泛，但尽管社区有多种传统治疗方法，大多数患者仍受到疾病的严重影响。这些数据进一步强调了开发新的早期治疗干预措施的必要性。
SFBN人群因缺乏随机选择而受到限制，代表了愿意在学术三级转诊中心接受强化治疗和随访的队列。虽然其特征与许多临床研究人群相似，但对非临床人群的可推广性仍不确定。
