Schneck Christopher D, Miklowitz David J, Miyahara Sachiko, Araga Mako, Wisniewski Stephen, Gyulai Laszlo, Allen Michael H, Thase Michael E, Sachs Gary S
Department of Psychiatry, University of Colorado Health Sciences Center, Denver, CO 80220, USA.
Am J Psychiatry. 2008 Mar;165(3):370-7; quiz 410. doi: 10.1176/appi.ajp.2007.05081484. Epub 2008 Jan 15.
In a naturalistic follow-up of adult bipolar patients, the authors examined the contributions of demographic, phenomenological, and clinical variables, including antidepressant use, to prospectively observed mood episode frequency.
For 1,742 bipolar I and II patients in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), episodes of mood disorders were evaluated for up to 1 year of treatment.
At entry, 32% of the patients met the DSM-IV criteria for rapid cycling in the prestudy year. Of the 1,742 patients, 551 (32%) did not complete 1 year of treatment. Among the 1,191 patients remaining, those with prior rapid cycling (N=356) were more likely to have further recurrences, although not necessarily more than four episodes per year. At the end of 12 months, only 5% (N=58) of the patients could be classified as rapid cyclers; 34% (N=409) had no further mood episodes, 34% (N=402) experienced one episode, and 27% (N=322) had two or three episodes. Patients who entered the study with earlier illness onset and greater severity were more likely to have one or more episodes in the prospective study year. Antidepressant use during follow-up was associated with more frequent mood episodes.
While DSM-IV rapid cycling was prospectively observed in only a small percentage of patients, the majority of these patients had continued recurrences at lower but clinically significant rates. This suggests that cycling is on a continuum and that prevention of recurrences may require early intervention and restricted use of antidepressants.
在一项针对成年双相情感障碍患者的自然随访研究中，作者考察了人口统计学、现象学及临床变量（包括抗抑郁药使用情况）对前瞻性观察到的心境发作频率的影响。
对双相情感障碍系统治疗强化项目（STEP - BD）中的1742例双相I型和II型患者进行了长达1年治疗期的心境障碍发作评估。
入组时，32%的患者在前一年符合DSM - IV快速循环标准。1742例患者中，551例（32%）未完成1年治疗。在剩余的1191例患者中，既往有快速循环发作史的患者（N = 356）更易出现进一步复发，尽管不一定每年发作超过4次。12个月末，仅有5%（N = 58）的患者可被归类为快速循环型；34%（N = 409）未再出现心境发作，34%（N = 402）经历了1次发作，27%（N = 322）经历了2次或3次发作。在研究开始时起病较早且病情较重的患者在前瞻性研究年度更易出现1次或多次发作。随访期间使用抗抑郁药与更频繁的心境发作相关。
虽然前瞻性观察发现仅有一小部分患者符合DSM - IV快速循环标准，但这些患者中的大多数仍以较低但具有临床意义的频率持续复发。这表明循环发作是一个连续谱，预防复发可能需要早期干预并限制抗抑郁药的使用。
