Nolen Willem A, Luckenbaugh David A, Altshuler Lori L, Suppes Trisha, McElroy Susan L, Frye Mark A, Kupka Ralph W, Keck Paul E, Leverich Gabriele S, Post Robert M
Altrecht Institute for Mental Health Care, Utrecht, The Netherlands.
Am J Psychiatry. 2004 Aug;161(8):1447-54. doi: 10.1176/appi.ajp.161.8.1447.
The purpose of the study was to examine potential correlates of outcome in patients treated for bipolar disorder.
During a 1-year period, 258 patients with DSM-IV bipolar disorder or schizoaffective disorder were rated with the prospective NIMH-Life Chart Method, which characterizes each day in terms of the severity of manic and depressive symptoms on the basis of patients' mood-related impairment in their usual educational, social, or occupational roles. Mean ratings for the severity of mania, depression, and overall bipolar illness and the number of manic, depressive, and overall illness episodes were calculated. Potential risk factors were assessed at the start of the study, and multivariate linear regression analysis was used to determine the correlates of the six 1-year outcome measures.
Three of the six outcome measures were largely independent of each other and were used in the analysis. The mean rating for severity of mania was associated with comorbid substance abuse, history of more than 10 prior manic episodes, and poor occupational functioning at study entry. The mean rating for severity of depression was associated with a history of more than 10 prior depressive episodes and poor occupational functioning at study entry. The total number of overall illness episodes was associated with a positive family history of drug abuse, a history of prior rapid cycling, and poor occupational functioning. In addition, the mean rating for severity of mania and the total number of overall illness episodes were both initially associated with a history of childhood abuse, but these relationships were lost with the addition of other illness variables to the analysis.
Clinicians who treat patients with bipolar disorder should consider a family history of drug abuse, a history of childhood abuse, prior course of illness, comorbid substance abuse, and occupational functioning in determining prognosis and setting goals for further treatment.
本研究旨在探讨双相情感障碍患者治疗结局的潜在相关因素。
在为期1年的时间里，对258例符合《精神疾病诊断与统计手册》第四版（DSM-IV）双相情感障碍或分裂情感性障碍诊断标准的患者，采用前瞻性的美国国立精神卫生研究所生活图表法（NIMH-Life Chart Method）进行评定，该方法根据患者在日常教育、社交或职业角色中与情绪相关的功能损害情况，对躁狂和抑郁症状的严重程度进行每日评估。计算躁狂、抑郁及双相情感障碍总体症状严重程度的平均评分，以及躁狂、抑郁和总体疾病发作的次数。在研究开始时评估潜在风险因素，并采用多元线性回归分析来确定六项1年结局指标的相关因素。
六项结局指标中的三项在很大程度上相互独立，并用于分析。躁狂严重程度的平均评分与合并物质滥用、既往有超过10次躁狂发作史以及研究入组时职业功能差有关。抑郁严重程度的平均评分与既往有超过10次抑郁发作史以及研究入组时职业功能差有关。总体疾病发作的总次数与药物滥用的阳性家族史、既往快速循环发作史以及职业功能差有关。此外，躁狂严重程度的平均评分和总体疾病发作的总次数最初均与童年期虐待史有关，但在分析中加入其他疾病变量后，这些关系消失了。
治疗双相情感障碍患者的临床医生在确定预后和设定进一步治疗目标时，应考虑药物滥用家族史、童年期虐待史、既往病程、合并物质滥用以及职业功能等因素。
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