Biomedical Research Centre in Mental Health Net (CIBERSAM), Hospital Santiago Apóstol, University of the Basque Country, Vitoria, Spain.
J Affect Disord. 2010 Aug;124(3):250-5. doi: 10.1016/j.jad.2009.11.005. Epub 2009 Dec 2.
There is a need for comparisons of long-term outcomes in bipolar disorder patients with predominantly manic symptoms vs. predominantly depressive symptoms, especially the course of comorbid alcohol/substance abuse.
A naturalistic sample of bipolar I patients (n=120) was followed prospectively for up to 10years. At baseline, number and polarity of past episodes were used to classify patients as predominantly manic or predominantly depressive if there were more manic or more depressive episodes, respectively. 25 patients were excluded from the analyses. Outcomes including episodes, hospitalisations and suicide attempts were recorded at bimonthly visits. Mixed effects models compared the course of alcohol and other substance abuse in predominantly manic vs. depressive patients.
Of the 95 patients analyzed, 44 (46.3%) had predominantly manic episodes and 51 (53.7%) had predominantly depressive episodes. At baseline, the predominantly depressive group had more history of suicide attempts (45.1% vs. 20.5%; p=0.021) and more family history of affective disorders (64.7% vs. 38.6%; p=0.020), but they had fewer previous hospitalisations than the manic group (mean 0.38 vs. 0.50; p=0.025). During the 10-year follow-up, the predominantly depressive group was associated with more episodes (p=0.001), more hospitalisations (p=0.004) and more suicide attempts (p=0.002). At baseline, there were no differences between the manic and depressive groups in the frequency of alcohol abuse (43.2% and 35.3%, p=0.565) or other substance abuse (13.6% and 9.8%, p=0.794). During the 10-year follow-up, the frequency of alcohol and other substance abuse decreased significantly in the manic group only, after controlling by age at onset and civil (marital) status.
Long-term clinical outcomes differ between predominantly manic vs. depressive bipolar patients, with the predominantly depressive group having a worse prognosis and maintained alcohol and other substance abuse. These differences should be considered when designing treatment approaches for bipolar patients with comorbid alcohol/substance abuse.
需要比较以躁狂症状为主和以抑郁症状为主的双相情感障碍患者的长期结局，特别是共病酒精/物质滥用的病程。
对 120 例双相情感障碍 I 型患者进行前瞻性随访，随访时间最长 10 年。基线时，根据过去发作的次数和极性，如果躁狂发作次数更多或抑郁发作次数更多，则将患者分为以躁狂为主或以抑郁为主。25 例患者被排除在分析之外。在每两个月的就诊时记录发作、住院和自杀企图等结局。混合效应模型比较了以躁狂为主和以抑郁为主的患者中酒精和其他物质滥用的病程。
在分析的 95 例患者中，44 例（46.3%）以躁狂发作为主，51 例（53.7%）以抑郁发作为主。基线时，以抑郁为主的组自杀企图史更多（45.1%比 20.5%；p=0.021），家族情感障碍史更多（64.7%比 38.6%；p=0.020），但住院次数少于躁狂组（平均 0.38 比 0.50；p=0.025）。在 10 年随访期间，以抑郁为主的组与更多的发作（p=0.001）、更多的住院（p=0.004）和更多的自杀企图（p=0.002）相关。基线时，躁狂组和抑郁组的酒精滥用频率（43.2%和 35.3%，p=0.565）或其他物质滥用频率（13.6%和 9.8%，p=0.794）无差异。在 10 年随访期间，仅在躁狂组中，在控制发病年龄和民事（婚姻）状况后，酒精和其他物质滥用的频率显著下降。
以躁狂为主和以抑郁为主的双相情感障碍患者的长期临床结局不同，以抑郁为主的组预后较差，且持续存在酒精和其他物质滥用。在为共病酒精/物质滥用的双相情感障碍患者设计治疗方法时，应考虑这些差异。
