Baldessarini R J, Tondo L, Visioli C
International Consortium for Bipolar Disorder Research, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
Acta Psychiatr Scand. 2014 May;129(5):383-92. doi: 10.1111/acps.12204. Epub 2013 Oct 24.
Characteristics of initial illness in bipolar disorder (BD) may predict later morbidity.
We reviewed computerized clinical records and life charts of DSM-IV-TR BD-I or BD-II patients at affiliated mood-disorder centers to ascertain relationships of initial major illnesses to later morbidity and other clinical characteristics.
Adult BD patient-subjects (N=1081; 59.8% BD-I; 58.1% women; 43% ever hospitalized) were followed 15.7±12.8 years after onsets ranking: depression (59%)>mania (13%)>psychosis (8.0%)≥anxiety (7.6%)≥hypomania (6.7%)>mixed states (5.5%). Onset types differed in clinical characteristics and strongly predicted later morbidity. By initial episode types, total time-ill ranked: mania≥hypomania≥mixed-states≥psychosis>depression>anxiety. Depression was most prevalent long-term, overall; its ratio to mania-like illness (D/M, by per cent-time-ill) ranked by onset type: anxiety (4.75)>depression (3.27)>mixed states (1.39)>others (all<1.00). The MDI (mania or hypomania-depression-euthymia interval) course-pattern was most common (34.4%) and associated with psychotic or manic onset; the depression before mania (DMI) pattern (25.0%) most often followed anxiety (38.8%), depression (30.8%), or mixed onsets (13.3%); both were predicted by initial mania depression sequences.
First-lifetime illnesses and cycles predicted later morbidity patterns among BD patients, indicating value of early morbidity for prognosis and long-term planning.
双相情感障碍（BD）的初始疾病特征可能预测后期发病率。
我们回顾了附属情绪障碍中心DSM-IV-TR BD-I或BD-II患者的计算机化临床记录和生活图表，以确定初始重大疾病与后期发病率及其他临床特征之间的关系。
对成年BD患者（N = 1081；59.8%为BD-I；58.1%为女性；43%曾住院）发病后15.7±12.8年进行随访，发病类型排序为：抑郁（59%）>躁狂（13%）>精神病性发作（8.0%）≥焦虑（7.6%）≥轻躁狂（6.7%）>混合状态（5.5%）。不同的发病类型在临床特征上存在差异，并强烈预测后期发病率。按初始发作类型，总患病时间排序为：躁狂≥轻躁狂≥混合状态≥精神病性发作>抑郁>焦虑。总体而言，抑郁是最常见的长期发病类型；其与躁狂样疾病的比例（D/M，按患病时间百分比计算）按发病类型排序为：焦虑（4.75）>抑郁（3.27）>混合状态（1.39）>其他（均<1.00）。MDI（躁狂或轻躁狂-抑郁-心境正常间隔）病程模式最为常见（34.4%），且与精神病性或躁狂发作相关；躁狂前抑郁（DMI）模式（25.0%）最常继发于焦虑（38.8%）、抑郁（30.8%）或混合发作（13.3%）；两者均由初始躁狂抑郁序列预测。
首次发病的疾病和发作周期可预测BD患者后期的发病模式，表明早期发病率对预后和长期规划具有重要价值。
