Department of Psychiatry and Behavioral Sciences, Stony Brook University School of Medicine, Stony Brook, NY, USA.
Bipolar Disord. 2012 Feb;14(1):19-30. doi: 10.1111/j.1399-5618.2012.00982.x.
Bipolar disorder with psychosis is common in inpatient settings and is associated with diverse outcomes after hospital discharge, which can range from a return to premorbid functioning with no recurrence, to a chronic or recurring illness. Less is known, however, about factors that can predict a better or worse clinical outcome. The present study sought to assess four-year clinical outcomes and their predictors in patients hospitalized for bipolar I disorder with psychosis.
Participants from the Suffolk County Mental Health Project (SCMHP) with a baseline diagnosis of bipolar I disorder with psychotic features (N=126) were reassessed using face-to-face interviews at six months, two years, and four years following their first hospitalization. At each time point, clinical status, role functioning, and treatment were assessed by highly trained interviewers using standardized instruments.
The majority of participants (73.2%) returned to their premorbid level of role functioning by the four-year follow-up and the median percentage of time ill during the interval was less than 20%. Nevertheless, almost half of the sample (46.9%) was rehospitalized at least once. Psychotic symptoms at baseline (particularly Schneiderian symptoms), depressive phenomenology, childhood psychopathology, and younger age at first hospitalization predicted worse outcome, whereas mood-incongruent psychotic features and age of mood disorder onset did not.
The four-year outcomes of a first-admission cohort with bipolar I disorder with psychosis were generally favorable. Poorer premorbid functioning, Schneiderian delusions, greater depressive symptoms, and a younger age of first hospitalization portend a worse course.
精神病性双相障碍在住院患者中较为常见，与出院后的多种结局相关，这些结局的范围从恢复到发病前的功能且无复发，到慢性或复发性疾病。然而，人们对能够预测更好或更差临床结局的因素知之甚少。本研究旨在评估因双相 I 型障碍伴精神病性特征住院的患者四年的临床结局及其预测因素。
萨福克县心理健康项目（SCMHP）的参与者具有基线诊断为双相 I 型障碍伴精神病性特征（N=126），在首次住院后六个月、两年和四年时通过面对面访谈进行重新评估。在每个时间点，由经过高度培训的访谈者使用标准化工具评估临床状况、角色功能和治疗情况。
大多数参与者（73.2%）在四年随访时恢复到发病前的角色功能水平，在此期间患病的中位数百分比不到 20%。然而，几乎一半的样本（46.9%）至少住院一次。基线时的精神病症状（特别是 Schneiderian 症状）、抑郁表现、儿童期精神病理学和首次住院时的年龄较小，预示着预后较差，而心境不一致的精神病特征和心境障碍发病年龄则不然。
首次入院的双相 I 型障碍伴精神病性特征患者的四年结局总体良好。较差的发病前功能、Schneiderian 妄想、更多的抑郁症状和首次住院的年龄较小预示着更差的病程。
