Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
Bipolar Disord. 2010 May;12(3):264-70. doi: 10.1111/j.1399-5618.2010.00812.x.
To test the hypotheses that: (i) depressive-dysthymic-dysphoric (D-type) morbidity is more prevalent than manic-hypomanic-psychotic (M-type) morbidity even from first episodes of bipolar I disorder (BPD-I) and despite treatment; (ii) initial presentations predict later morbidity; (iii) morbidity varies internationally; and (iv) early and later morbidity are similar.
We followed SCID-based, DSM-IV BPD-I patients (n = 303) systematically and prospectively for two years to estimate the percent of weeks in specific morbid states from first lifetime major episodes.
Total morbidity accounted for 44% of the first two years, and D-type exceeded M-type illnesses by 2.1-fold (30%/14%) among morbidities ranking: mixed states (major + minor) >or= dysthymia >or= mania >or= major depression > hypomania > psychosis. In 164 cases, morbidities at 0.5-2.5 and 2.5-4.5 years were very similar. Depressive or mixed initial episodes predicted a 3.6-fold excess of D-type morbidity, and initial M-type episodes predicted a 7.1-fold excess of M-type morbidity over two years. Morbidity in European (EU) sites was nearly half that in the U.S., and 22% greater overall among men than women. In five comparable studies, illness accounted for 54% of follow-up time, and the ratio of D/M morbidity averaged 3.0.
In accord with four midcourse studies, morbidity from BPD-I onset, despite treatment by community standards, averaged 44%, was 68% D-type morbidity, and was strongly predicted by first-episode polarity. Lower morbidity in EU than U.S. sites may reflect differences in healthcare or social systems.
检验以下假设：(i) 即使在双相 I 型障碍 (BPD-I) 的首发发作中并尽管接受了治疗，抑郁障碍-恶劣心境-心境恶劣 (D 型) 发病率也高于躁狂障碍-轻躁狂障碍-精神病性 (M 型) 发病率；(ii) 首发表现可预测后续发病情况；(iii) 发病率存在国际差异；以及 (iv) 早期和晚期发病情况相似。
我们对基于 SCID、DSM-IV 的 BPD-I 患者 (n=303) 进行了系统的前瞻性随访 2 年，以估计首发终生重大发作后特定病态状态的周数比例。
总发病率在头 2 年占 44%，且病态排名为混合状态 (重性+轻度)>=恶劣心境>=躁狂>=重性抑郁>=轻躁狂>=精神病性时，D 型发病率是 M 型的 2.1 倍 (30%/14%)。在 164 例患者中，0.5-2.5 年和 2.5-4.5 年的发病情况非常相似。抑郁或混合性首发发作预示着 D 型发病率增加 3.6 倍，而首发 M 型发作预示着两年内 M 型发病率增加 7.1 倍。欧洲 (EU) 研究地点的发病率接近美国的一半，且男性总体发病率比女性高 22%。在五项可比研究中，疾病占随访时间的 54%，D/M 发病率比平均为 3.0。
与四项中期研究一致，尽管按照社区标准进行了治疗，BPD-I 发病后的发病率平均仍为 44%，D 型发病率为 68%，且受首发发作极性的强烈影响。EU 与美国研究地点的发病率较低可能反映了医疗保健或社会系统的差异。
