Goikolea J M, Colom F, Martínez-Arán A, Sánchez-Moreno J, Giordano A, Bulbena A, Vieta E
Bipolar Disorders Program, Clinical Institute of Neuroscience, Hospital Clinic, Institut d'Investigacions Biomédiques August Pi Sunyer, Barcelona Stanley Foundation Center, Spain.
Psychol Med. 2007 Nov;37(11):1595-9. doi: 10.1017/S0033291707000864. Epub 2007 May 31.
More than 20% of bipolar patients may present with seasonal pattern (SP). Seasonality can alter the course of bipolar disorder. However, to date, long-term follow-up studies of bipolar patients presenting with SP are scarce. We present a 10-year follow-up study comparing clinical and demographic features of bipolar patients with and without SP.
Three hundred and twenty-five bipolar I and II patients were followed up for at least 10 years. SP was defined according to DSM-IV criteria. Clinical variables were obtained from structured interviews with the patients and their relatives. Patients with and without SP were compared regarding clinical and sociodemographic variables and a stepwise logistic regression was performed.
Seventy-seven patients (25.5%) were classified as presenting with SP, while 225 (74.5%) were considered as presenting with no significant seasonal variation. Twenty-three patients (7%) were excluded from the study because it was unclear whether they had seasonality or not. There were no differences between groups regarding demographic variables. Patients with SP predominantly presented with bipolar II disorder, depressive onset, and depressive predominant polarity. The greater burden of depression did not correlate with indirect indicators of severity, such as suicidality, hospitalizations or psychotic symptoms.
Our study links the presence of SP with both bipolar II disorder and predominant depressive component. However, we could not find any difference regarding functionality or hospitalization rates. Modifications in the criteria to define SP are suggested for a better understanding of bipolar disorder.
超过20%的双相情感障碍患者可能呈现季节性模式（SP）。季节性可改变双相情感障碍的病程。然而，迄今为止，对呈现SP的双相情感障碍患者的长期随访研究较少。我们开展了一项为期10年的随访研究，比较有和没有SP的双相情感障碍患者的临床和人口统计学特征。
对325例双相I型和II型患者进行了至少10年的随访。SP根据《精神疾病诊断与统计手册》第四版标准定义。临床变量通过对患者及其亲属的结构化访谈获得。比较有和没有SP的患者的临床和社会人口统计学变量，并进行逐步逻辑回归分析。
77例患者（25.5%）被归类为呈现SP，而225例（74.5%）被认为没有明显的季节性变化。23例患者（7%）被排除在研究之外，因为不清楚他们是否有季节性。两组在人口统计学变量方面没有差异。有SP的患者主要表现为双相II型障碍、抑郁发作和以抑郁为主的极性。抑郁负担较重与自杀倾向、住院或精神病症状等严重程度间接指标无关。
我们的研究将SP的存在与双相II型障碍和主要的抑郁成分联系起来。然而，我们在功能或住院率方面未发现任何差异。建议修改定义SP的标准，以便更好地理解双相情感障碍。
