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[对有心理症状的初级保健患者进行双相情感障碍筛查]

[Screening for bipolar disorder in primary care patients with psychological symptoms].

作者信息

Aragonès Enric, López-Rodríguez Juan A, Escobar-Rabadán Francisco, Téllez-Lapeira Juan, Mínguez José, Párraga Ignacio, Suárez-Hernández Tatiana, Piñero María José, Guzón Marta-Magdalena

机构信息

Grupo semFYC de Salud Mental, España; IDIAP Jordi Gol, Barcelona, España; CAP de Constantí, Constantí, Tarragona, España.

Grupo semFYC de Salud Mental, España; CS Las Calesas, Madrid, España; Unidad Docente de Atención Familiar y Comunitaria - Madrid centro, Madrid, España.

出版信息

Aten Primaria. 2015 Mar;47(3):167-74. doi: 10.1016/j.aprim.2014.05.009. Epub 2014 Jul 5.

Abstract

OBJECTIVE

To estimate the proportion of positive results in the screening of bipolar disorder (BD) among primary care patients presenting with psychological symptoms, and to analyze their characteristics.

DESIGN

Multicenter cross-sectional study.

SETTINGS

Nineteen Primary Care clinics in different Spanish regions.

PATIENTS

A total of 360 consecutive primary care patients aged 18 to 70, presenting with psychological symptoms.

MEASUREMENTS

Screening for BP was performed by means of the Mood Disorders Questionnaire. Data on quality of life (EuroQol-5D) and functional impairment (Sheehan Disability Inventory) were obtained. Data on psychiatric comorbidity and data on the use of psychotropic medication were acquired by review of medical records.

RESULTS

Of the patients screened, 11.9% were positive (95%CI: 8.8%-15.7%). Only two patients had a diagnosis of BP in their clinical records and, although more than half received treatment with antidepressants, only two received treatment with mood stabilizers. Positive screening is associated with work, social and family dysfunction, greater perceived stress and poor quality of life.

CONCLUSIONS

BD screening in primary care patients with psychological problems leads to a striking proportion of positive results, indicating that there may be a significant prevalence of BP patients, most of them undiagnosed and untreated. Further research is needed to determine the role that Primary Care can or should assume in the screening, diagnosis and management of this disorder.

摘要

目的

评估在出现心理症状的初级保健患者中双相情感障碍(BD)筛查的阳性结果比例,并分析其特征。

设计

多中心横断面研究。

地点

西班牙不同地区的19家初级保健诊所。

患者

共有360名年龄在18至70岁之间、出现心理症状的连续初级保健患者。

测量

通过心境障碍问卷进行双相情感障碍筛查。获取生活质量(欧洲五维健康量表)和功能损害(希恩残疾量表)的数据。通过查阅病历获取精神共病数据和精神药物使用数据。

结果

在接受筛查的患者中,11.9%为阳性(95%置信区间:8.8%-15.7%)。临床记录中仅有两名患者被诊断为双相情感障碍,尽管超过一半的患者接受了抗抑郁药治疗,但只有两名患者接受了心境稳定剂治疗。筛查阳性与工作、社交和家庭功能障碍、更大的感知压力以及生活质量差有关。

结论

对有心理问题的初级保健患者进行双相情感障碍筛查会得出相当比例的阳性结果,这表明双相情感障碍患者可能有相当高的患病率,其中大多数未被诊断和治疗。需要进一步研究以确定初级保健在这种疾病的筛查、诊断和管理中可以或应该承担的作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/29e7/6983817/766bbfbc2947/gr1.jpg

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