Keck Paul E, McElroy Susan L, Havens Jennifer Rochussen, Altshuler Lori L, Nolen Willem A, Frye Mark A, Suppes Trisha, Denicoff Kirk D, Kupka Ralph, Leverich Gabrielle S, Rush A John, Post Robert M
Department of Psychiatry, University of Cincinnati College of Medicine, OH 45267-0559, USA.
Compr Psychiatry. 2003 Jul-Aug;44(4):263-9. doi: 10.1016/S0010-440X(03)00089-0.
Although psychosis is common in bipolar disorder, few studies have examined the prognostic significance of psychotic features. In addition, some studies suggest that the presence of mood-incongruent psychosis, in particular, is associated with poorer outcome compared with mood-congruent psychosis. We assesses the phenomenology and prevalence of mood-congruent and mood-incongruent psychotic symptoms in 352 patients with bipolar I disorder participating in the Stanley Foundation Bipolar Treatment Network. We compared the demographic and clinical features, and measures of psychosocial and vocational functioning in patients with and without a history of psychosis. The phenomenology of psychosis in this cohort of patients with bipolar disorder was similar to that reported in earlier studies and supported the lack of diagnostic specificity of any one type of psychotic symptom. There were no significant differences between patients with and without a history of psychosis on any demographic, psychosocial, vocational, or course of illness variables. Only family history of bipolar disorder was significantly more common in patients with nonpsychotic bipolar disorder compared to patients with a history of psychosis. Among bipolar patients with a history of psychosis, only the proportion of women and lifetime prevalence rates of anxiety disorders occurred significantly more in patients with mood-incongruent delusions. In this large cohort of outpatients with bipolar I disorder, neither a history of psychosis nor of mood-incongruent psychosis had prognostic significance at entry into the Network. The lack of observable prognostic impact may have been, in part, due to the relatively high morbidity and poor functional outcome of a substantial portion of the total cohort.
尽管精神病在双相情感障碍中很常见，但很少有研究探讨精神病性特征的预后意义。此外，一些研究表明，与心境一致的精神病相比，心境不一致的精神病的存在尤其与较差的预后相关。我们评估了参与斯坦利基金会双相情感障碍治疗网络的352例双相I型障碍患者中心境一致和心境不一致的精神病性症状的现象学及患病率。我们比较了有和没有精神病病史患者的人口统计学和临床特征，以及心理社会和职业功能的测量指标。该双相情感障碍患者队列中精神病的现象学与早期研究报告的相似，支持了任何一种精神病性症状缺乏诊断特异性的观点。在任何人口统计学、心理社会、职业或疾病病程变量方面，有和没有精神病病史的患者之间均无显著差异。与有精神病病史的患者相比，非精神病性双相情感障碍患者中只有双相情感障碍家族史显著更常见。在有精神病病史的双相情感障碍患者中，只有心境不一致性妄想患者中女性比例和焦虑障碍的终生患病率显著更高。在这个大型双相I型障碍门诊患者队列中，在进入该网络时，精神病病史和心境不一致性精神病病史均无预后意义。缺乏可观察到的预后影响可能部分是由于整个队列中相当一部分患者发病率相对较高且功能结局较差。
