Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
Bipolar Disord. 2010 Jun;12(4):404-13. doi: 10.1111/j.1399-5618.2010.00823.x.
The present study examined the relationship between medical burden in bipolar disorder and several indicators of illness severity and outcome. It was hypothesized that illnesses of the endocrine/metabolic system would be associated with greater psychiatric symptom burden and would impact the response to treatment with lithium and valproate.
Data were analyzed from two studies evaluating lithium and valproate for rapid-cycling presentations of bipolar I and II disorder. General medical comorbidity was assessed by the Cumulative Illness Rating Scale (CIRS). Descriptive statistics and logistic regression analyses were conducted to explore the relationships between medical burden, body mass index (BMI), substance use disorder status, and depressive symptom severity.
Of 225 patients enrolled, 41.8% had a recent substance use disorder, 50.7% were male, and 69.8% had bipolar I disorder. The mean age of the sample was 36.8 (SD = 10.8) years old. The mean number of comorbid medical disorders per patient was 2.5 (SD = 2.5), and the mean CIRS total score was 4.3 (SD = 3.1). A significant positive correlation was observed between baseline depression severity and the number of organ systems affected by medical illness (p = 0.04). Illnesses of the endocrine/metabolic system were inversely correlated with remission from depressive symptoms (p = 0.02), and obesity was specifically associated with poorer treatment outcome. For every 1-unit increase in BMI, the likelihood of response decreased by 7.5% [odds ratio (OR) = 0.93, 95% confidence interval (CI): 0.87- 0.99; p = 0.02] and the likelihood of remission decreased by 7.3% (OR = 0.93, 95% CI: 0.87-0.99; p = 0.03). The effect of comorbid substance use on the likelihood of response differed significantly according to baseline BMI. The presence of a comorbid substance use disorder resulted in lower odds of response, but only among patients with a BMI > or = 23 (p = 0.02).
Among patients with rapid-cycling bipolar disorder receiving lithium and valproate, endocrine/metabolic illnesses, including overweight and obesity, appear to be associated with greater depressive symptom severity and poorer treatment outcomes.
本研究旨在探讨双相情感障碍患者的医疗负担与多种疾病严重程度和结局指标之间的关系。研究假设内分泌/代谢系统疾病与更严重的精神症状负担相关，并影响锂盐和丙戊酸盐治疗的反应。
本研究对两项评估锂盐和丙戊酸盐治疗双相 I 型和 II 型快速循环发作的研究数据进行了分析。采用累积疾病评分量表（CIRS）评估一般医学合并症。进行描述性统计和逻辑回归分析，以探讨医疗负担、体重指数（BMI）、物质使用障碍状态与抑郁症状严重程度之间的关系。
在纳入的 225 名患者中，41.8%有近期物质使用障碍，50.7%为男性，69.8%为双相 I 型障碍。样本的平均年龄为 36.8（SD=10.8）岁。每位患者的平均合并医学疾病数为 2.5（SD=2.5），CIRS 总分平均为 4.3（SD=3.1）。基线抑郁严重程度与受影响的器官系统数量呈显著正相关（p=0.04）。内分泌/代谢系统疾病与抑郁症状缓解呈负相关（p=0.02），肥胖与较差的治疗结果特别相关。BMI 每增加 1 个单位，反应的可能性降低 7.5%[比值比（OR）=0.93，95%置信区间（CI）：0.87-0.99；p=0.02]，缓解的可能性降低 7.3%（OR=0.93，95%CI：0.87-0.99；p=0.03）。物质使用共病对反应可能性的影响根据基线 BMI 显著不同。物质使用障碍共病的存在导致反应的可能性降低，但仅在 BMI≥23 的患者中（p=0.02）。
在接受锂盐和丙戊酸盐治疗的快速循环双相情感障碍患者中，内分泌/代谢疾病，包括超重和肥胖，与更严重的抑郁症状严重程度和较差的治疗结局相关。
