Stang Paul, Frank Cathy, Ulcickas Yood Marianne, Wells Karen, Burch Steven
Galt Associates, Blue Bell, PA, USA.
Prim Care Companion J Clin Psychiatry. 2007;9(1):42-7. doi: 10.4088/pcc.v09n0107.
To characterize the extent and impact of bipolar I and II disorders and rapid cycling in a managed care population using both coded diagnostic claims and clinical screening.
The Mood Disorder Questionnaire (MDQ) was used to identify bipolar disorder among patients attending the psychiatry service of a large Midwestern health system. Suicidal ideation screening questions were also asked, along with a brief set of relevant history and medication questions. Patients scoring positive on the MDQ or identified as bipolar-positive according to DSM-IV criteria by the screening clinician were administered the Work and Social Adjustment Scale and an Employment questionnaire. Descriptive statistics were used to summarize results. The study was conducted from July 2004 to November 2004.
Seventy (6.4%) of 1087 patients had bipolar disorder, 59 of whom completed the entire study. For these patients, the mean time with bipolar disorder was 9.3 (SD 10.2) years. The mean length of the current episode was 10.4 (SD 14.4) weeks, with 22% of patients experiencing a mixed episode, 5% manic-predominant, 12% hypomanic-predominant, and 46% a depressive-predominant episode. Twenty-four percent of patients with bipolar disorder were rapid cycling at the time of their visit; for 5 of these patients, rapid cycling was thought to be related to antidepressant use. Sixty-one percent of patients with bipolar disorder were taking an antidepressant; 69.5% were taking a mood stabilizer. Of these patients with bipolar disorder, 19% were evaluated as high suicidality risk, while 47% were considered moderate risk. Bipolar disorder patients reported problems with employment/employability and social adjustment. About one quarter of these patients ranked problems with family and relationships as marked or severe. Fifty percent of these bipolar disorder patients reported missing at least 1 week of work during the past month; 41% reported fearing the loss of their current job due to their emotional state; and 20% reported being fired/laid off during the past 5 years due to their emotional state.
This research documents some of the clinical features and social and labor-force impact of bipolar disorder in a managed care population and adds several dimensions to data published to date. Fully two thirds of our study subjects with bipolar disorder were found to be at substantial risk of suicide, and bipolar disorder patients in this study reported substantial problems with employment/employability and social functioning.
通过编码诊断索赔和临床筛查来描述双相I型和II型障碍以及快速循环在管理式医疗人群中的程度和影响。
使用心境障碍问卷（MDQ）在中西部一个大型卫生系统的精神科就诊患者中识别双相情感障碍。还询问了自杀观念筛查问题，以及一组简短的相关病史和用药问题。MDQ得分呈阳性或经筛查临床医生根据《精神疾病诊断与统计手册》第四版（DSM-IV）标准确定为双相情感障碍阳性的患者，接受工作和社会适应量表以及就业问卷的评估。使用描述性统计来总结结果。该研究于2004年7月至2004年11月进行。
1087名患者中有70名（6.4%）患有双相情感障碍，其中59名完成了整个研究。对于这些患者，患双相情感障碍的平均时间为9.3（标准差10.2）年。当前发作的平均时长为10.4（标准差14.4）周，22%的患者经历混合发作，5%为躁狂为主型，12%为轻躁狂为主型，46%为抑郁为主型发作。24%的双相情感障碍患者在就诊时处于快速循环状态；其中5名患者的快速循环被认为与使用抗抑郁药有关。61%的双相情感障碍患者正在服用抗抑郁药；69.5%正在服用心境稳定剂。在这些双相情感障碍患者中，19%被评估为自杀风险高，而47%被认为是中度风险。双相情感障碍患者报告了就业/就业能力和社会适应方面的问题。这些患者中约四分之一将家庭和人际关系问题列为明显或严重。这些双相情感障碍患者中有50%报告在过去一个月中至少缺勤1周；41%报告担心由于自己的情绪状态而失去当前工作；20%报告在过去5年中由于自己的情绪状态而被解雇/裁员。
本研究记录了双相情感障碍在管理式医疗人群中的一些临床特征以及对社会和劳动力的影响，并为迄今发表的数据增添了几个维度。我们发现，完全有三分之二的双相情感障碍研究对象存在相当大的自杀风险，并且本研究中的双相情感障碍患者报告了就业/就业能力和社会功能方面的重大问题。
