Strakowski Stephen M, Tsai Shang-Ying, Delbello Melissa P, Chen Chiao-Chicy, Fleck David E, Adler Caleb M, Arndt Stephan, Amicone Jennifer
Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0559, USA.
Bipolar Disord. 2007 Dec;9(8):820-7. doi: 10.1111/j.1399-5618.2007.00411.x.
Bipolar disorder (BD) is recognized as a significant psychiatric condition worldwide, yet little is known about cross-national differences in the course of illness. This information might clarify features of the disorder that are illness versus culturally specific. Therefore, the aim of this study was to identify differential and shared outcome predictors in first-episode manic bipolar patients in Cincinnati, OH, USA and Taipei, Taiwan.
DSM-IV bipolar patients were identified at the time of their first manic or mixed episode and were prospectively followed in a naturalistic, longitudinal study for one year. Patients were recruited from a first psychiatric hospitalization at university-affiliated, urban hospitals in Taipei and Cincinnati. The primary outcome measures were remission, recovery, recurrence and percent of follow-up spent with affective symptoms and syndromes. Treatment adherence was also assessed, as were a number of possible mediator variables.
The two patient groups showed a number of significant differences in index clinical presentation on characteristics previously associated with outcome in other studies (e.g., substance abuse). The patients in Taipei showed significantly better outcome on virtually all measures. Some of these findings reflected differences in index (mediator) variables, whereas others persisted after controlling for potential baseline confounds.
The early course of BD varies between Chinese and American patients. Some of this variance results from demographic and clinical cross-national differences in premorbid variables. Other sources of variance remain to be identified.
双相情感障碍（BD）在全球被公认为是一种重要的精神疾病，但对于疾病过程中的跨国差异知之甚少。这些信息可能会阐明该疾病中属于疾病本身特征与文化特异性特征。因此，本研究的目的是确定美国俄亥俄州辛辛那提市和中国台湾台北市首次发作躁狂的双相情感障碍患者的差异和共同的结局预测因素。
在首次躁狂或混合发作时识别出符合《精神疾病诊断与统计手册》第四版（DSM-IV）标准的双相情感障碍患者，并在一项自然主义的纵向研究中对其进行为期一年的前瞻性随访。患者从台北和辛辛那提市大学附属医院的首次精神科住院患者中招募。主要结局指标包括缓解、康复、复发以及伴有情感症状和综合征的随访时间百分比。还评估了治疗依从性以及一些可能的中介变量。
两组患者在先前其他研究中与结局相关的特征（如物质滥用）的初始临床表现上存在一些显著差异。台北的患者在几乎所有指标上都显示出明显更好的结局。其中一些发现反映了初始（中介）变量的差异，而其他差异在控制了潜在的基线混杂因素后仍然存在。
双相情感障碍的早期病程在中美患者之间存在差异。这种差异部分源于病前变量在人口统计学和临床方面的跨国差异。其他差异来源仍有待确定。
