急性入院双相情感障碍患者病程加速的危险因素。
Risk factors of cycle acceleration in acutely admitted patients with bipolar disorder.
作者信息
Finseth P I, Morken G, Malt U F, Andreassen O A, Vaaler A E
机构信息
Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Østmarka Psychiatric Department, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
出版信息
Acta Psychiatr Scand. 2014 Nov;130(5):388-96. doi: 10.1111/acps.12308. Epub 2014 Jun 24.
OBJECTIVE
To identify risk factors associated with cycle acceleration (CA), that is, progressive decrease in duration of syndrome-free intervals between affective episodes, in acutely admitted patients with bipolar disorder (BD).
METHOD
All patients (n = 210) with BD I (67%) and BD II (33%) (DSM-IV) acutely admitted to a hospital serving a catchment area were compared in retrospect with regard to a positive or negative history of CA. Putative risk factors of CA with a P-value <0.05 in uni-variate tests were secondly entered into a logistic regression model.
RESULTS
The logistic regression model was statistically significant (P < 0.0001) and explained between 45.3% and 60.5% of the variance of CA status. 83.7% of the cases were correctly classified with a sensitivity of 87.2% and a specificity of 80.4%. Unique significant risk factors of CA were increasing severity of affective episodes (odds ratio (OR) = 28.8), BD II (OR = 3.3), hypomanic/manic episode induced by an antidepressant and/or alcohol (OR = 3.3), and female gender (OR = 3.1).
CONCLUSION
The clinical factors associated with CA may help targeting patients with BD with a course aggravation, and are in line with previously reported neuropathological processes of illness progression.
目的
确定双相情感障碍（BD）急性入院患者中与发作加速（CA）相关的危险因素，即情感发作之间无症状间隔期的持续时间逐渐缩短。
方法
回顾性比较所有急性入住某服务特定区域医院的BD I型（67%）和BD II型（33%）（DSM-IV）患者的CA阳性或阴性病史。其次，将单变量检验中P值<0.05的CA假定危险因素纳入逻辑回归模型。
结果
逻辑回归模型具有统计学意义（P<0.0001），解释了CA状态方差的45.3%至60.5%。83.7%的病例分类正确，敏感性为87.2%，特异性为80.4%。CA的独特显著危险因素包括情感发作严重程度增加（比值比（OR）=28.8）、BD II型（OR=3.3）、由抗抑郁药和/或酒精诱发的轻躁狂/躁狂发作（OR=3.3）以及女性（OR=3.1）。
结论
与CA相关的临床因素可能有助于确定病情加重的BD患者，并与先前报道的疾病进展神经病理过程一致。
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