Daban Claire, Colom Francesc, Sanchez-Moreno Jose, García-Amador Margarita, Vieta Eduard
Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain.
Compr Psychiatry. 2006 Nov-Dec;47(6):433-7. doi: 10.1016/j.comppsych.2006.03.009. Epub 2006 May 26.
To determine the clinical and long-term implications of mood polarity at illness onset.
During a 10-year follow-up prospective study, systematic clinical and outcome data were collected from 300 bipolar I and II patients. The sample was split into 2 groups according to the polarity of the onset episode (depressive onset [DO] vs manic/hypomanic onset [MO]). Clinical features and social functioning were compared between the 2 groups of patients.
In our sample, 67% of the patients experienced a depressive onset. Depressive onset patients were more chronic than MO patients, with a higher number of total episodes and a longer duration of illness. Depressive onset patients experienced a higher number of depressive episodes than MO patients, who in turn had more manic episodes. Depressive onset patients made more suicide attempts, had a later illness onset, were less often hospitalized, and were less likely to develop psychotic symptoms. Depressive onset was more prevalent among bipolar II patients. Bipolar I patients with DO had more axis II comorbidity and were more susceptible to have a history of psychotic symptoms than bipolar II patients with DO.
The polarity at onset is a good predictor of the polarity of subsequent episodes over time. A depressive onset is twice as frequent as MO and carries more chronicity and cyclicity.
确定疾病发作时情绪极性的临床及长期影响。
在一项为期10年的随访前瞻性研究中，收集了300例双相I型和II型患者的系统临床及转归数据。根据首发发作的极性（抑郁发作[DO]与躁狂/轻躁狂发作[MO]）将样本分为两组。比较两组患者的临床特征和社会功能。
在我们的样本中，67%的患者为抑郁发作。抑郁发作患者比MO患者病程更长，发作总数更多，患病时间更长。抑郁发作患者的抑郁发作次数比MO患者更多，而MO患者的躁狂发作次数更多。抑郁发作患者自杀未遂次数更多，起病较晚，住院频率较低，出现精神病性症状的可能性较小。抑郁发作在双相II型患者中更为常见。与抑郁发作的双相II型患者相比，抑郁发作的双相I型患者有更多的轴II共病，且更易有精神病性症状史。
发作时的极性是随时间推移后续发作极性的良好预测指标。抑郁发作的频率是MO的两倍，且具有更多的慢性和周期性。
