Department of Psychiatry, University Hospital La Paz, IDIPAZ, Madrid, Spain.
J Affect Disord. 2012 Dec 10;141(2-3):406-14. doi: 10.1016/j.jad.2012.03.009. Epub 2012 May 18.
The objective of this study was to evaluate demographic, psychosocial and clinical predictors of mood recurrences in bipolar disorder (BD) euthymic outpatients followed-up for 12 months in a naturalistic setting.
The study included 595 consecutive BD patients, diagnosed according to DSM-IV-TR criteria, in clinical remission at baseline. Quarterly assessments were scheduled. Clinical evaluation as well as mood and functioning psychometric evaluations were performed. We applied logistic regression analysis to determine predictors of presenting an affective recurrence, and Cox regression analysis to examine the association between individual predictors and time to affective recurrence.
Of the 593 patients finally included (60% women, 84.5% BD I), 141 (23.78%) had at least a recurrence during the 12 months follow-up. Time until 25% of the patients experienced a recurrence was 12 months (95% CI: 9.14-undetermined). In multivariate analysis, factors significantly related to relapse were living setting (p=0.002) and total number of previous episodes (p=0.01). Residents in mixed urban/rural catchment areas had 57% more risk than dwellers of cities with more than 100,000 people, and a higher number of previous episodes also increased the relapse risk. A shorter time to relapse was related to job status (p=0.004) and to living setting (p=0.002).
In our sample, living in environments of less than 100,000 inhabitants and having more previous affective episodes were related to an increased relapse risk in BD, and job status and living setting were related to a shorter time to relapse.
No specific contemporary practice guidelines were used. Drug treatment and plasma levels, although measured, were not registered.
本研究旨在评估在自然环境中随访 12 个月的双相情感障碍（BD）门诊缓解期患者的人口统计学、心理社会和临床预测因素，以评估其情绪复发情况。
该研究纳入了 595 名连续的 BD 患者，根据 DSM-IV-TR 标准诊断，基线时处于临床缓解期。每季度进行评估。进行临床评估以及情绪和功能的心理测量评估。我们应用逻辑回归分析来确定出现情感复发的预测因素，应用 Cox 回归分析来检验个体预测因素与情感复发时间之间的关联。
最终纳入 593 名患者（60%为女性，84.5%为 BD I 型），其中 141 名（23.78%）在 12 个月的随访期间至少发生了一次复发。25%的患者经历复发的时间为 12 个月（95%CI：9.14-未确定）。多变量分析显示，与复发相关的因素有居住环境（p=0.002）和既往发作总数（p=0.01）。居住在城乡混合地区的患者比居住在人口超过 10 万的城市的患者的复发风险高 57%，而既往发作次数的增加也会增加复发的风险。较短的复发时间与工作状态（p=0.004）和居住环境（p=0.002）相关。
在我们的样本中，生活在人口少于 10 万的环境中和有更多的既往情感发作与 BD 复发风险增加相关，而工作状态和居住环境与复发时间较短相关。
未使用特定的当代实践指南。尽管测量了药物治疗和血浆水平，但未进行登记。
