Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea.
IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong 3220, VIC, Australia; Department of Psychiatry, University of Melbourne, Parkville, VIC 3052, Australia.
J Affect Disord. 2014 Sep;166:243-8. doi: 10.1016/j.jad.2014.05.017. Epub 2014 May 23.
This study investigated the impact of comorbid obsessive-compulsive disorder (OCD) and four anxiety disorders [panic disorder (PD), agoraphobia, social anxiety disorder (SAD), and generalized anxiety disorder (GAD)] on the clinical outcomes of bipolar disorder.
This study analysed data of 174 patients with bipolar I disorder who participated in the prospective observational study. Participants were assessed every 3 months for 24 months. The primary outcome measure was the achievement of symptomatic remission, defined by a total score on the Young Mania Rating Scale (YMRS) of ≤12 and a total score on the 21-item Hamilton Depression Rating Scale (HAMD-21) of ≤8.
Comorbidity was associated with decreased likelihood of remission. However, the impact of individual disorders on outcome differed according to clinical and treatment situations. Most comorbid anxiety disorders and OCD had a negative effect on remission during the first year of evaluation, as measured by the HAMD-21, and in patients taking a conventional mood stabilizer alone. However, the association with poorer outcome was observed only for a few specific comorbid disorders in the second year (GAD and OCD), as measured by YMRS-defined remission (OCD), and in patients with olanzapine therapy (GAD and OCD).
Follow-up evaluation of comorbid disorders was lacking.
Comorbid anxiety disorders and OCD negatively influenced the clinical course of bipolar disorder. Specifically, OCD had a consistently negative impact on the outcome of bipolar I disorder regardless of clinical situation. Effective strategies for the control of these comorbidities are required to achieve better treatment outcomes.
本研究调查了共病强迫症（OCD）和四种焦虑障碍（惊恐障碍[PD]、广场恐惧症、社交焦虑障碍[SAD]和广泛性焦虑障碍[GAD]）对双相情感障碍临床结局的影响。
本研究分析了参加前瞻性观察研究的 174 名双相 I 型障碍患者的数据。参与者每 3 个月评估一次，共 24 个月。主要结局指标是症状缓解的实现，定义为 Young Mania Rating Scale（YMRS）总分≤12 和 Hamilton Depression Rating Scale 21 项（HAMD-21）总分≤8。
共病与缓解可能性降低有关。然而，个体障碍对结局的影响因临床和治疗情况而异。在评估的第一年，大多数共病焦虑障碍和 OCD 对缓解有负面影响，这是通过 HAMD-21 测量的，并且在单独使用传统心境稳定剂的患者中。然而，只有在第二年（GAD 和 OCD），作为 YMRS 定义的缓解（OCD）的测量，以及在接受奥氮平治疗的患者中（GAD 和 OCD），观察到与较差结局相关的仅为少数特定共病障碍。
缺乏对共病障碍的随访评估。
共病焦虑障碍和 OCD 对双相情感障碍的临床病程产生负面影响。具体而言，无论临床情况如何，OCD 对双相 I 型障碍的结局始终具有负面影响。需要采取有效的策略来控制这些共病，以实现更好的治疗结果。
