Karthick Subramanian, Kattimani Shivanand, Rajkumar Ravi Philip, Bharadwaj Balaji, Sarkar Siddharth
Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India.
Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India.
J Affect Disord. 2015 Mar 1;173:255-60. doi: 10.1016/j.jad.2014.10.056. Epub 2014 Nov 13.
There are grounds to believe that the course of bipolar disorder may be different in tropical countries such as India when compared to temperate nations. There is a dearth of literature about the course of bipolar I disorder from India.
This study was conducted in a multispecialty teaching hospital in southern India. Patients with a DSM-IV TR diagnosis of bipolar I disorder, confirmed using SCID-I, with a minimum duration of illness of 3 years were assessed. Information was gathered on demographic and clinical variables, and the life course of episodes was charted using the National Institute of Mental Health - Life Chart Methodology Clinician Retrospective Chart (NIMH-LCM-CRC).
A total of 150 patients with bipolar disorder were included. The mean age at onset of illness was 24.8 (± 8.2) years. Mania was the first episode in a majority (85%) of the cases, and was the most frequent episode in the course of the illness, followed by depression. Patients spent an average of 11.1% of the illness duration in a mood episode, most commonly a manic episode. The median duration of manic or depressive episode was 2 months. Median time to recurrence after the first episode was 21 months (inter-quartile range of 10-60 months), and was shorter for women than men.
The hospital based sample from a particular region limits generalizability. Recall bias may be present in this retrospective information based study. Medical illness, personality disorders, other Axis I psychiatric disorders (apart from substance use disorder) and influence of adherence to treatment on the course of the disorder were not assessed systematically.
Bipolar I disorder among Indian patients has a course characterized by predominantly manic episodes, which is in line with previous reports from tropical countries and substantially different from that of temperate regions.
有理由相信，与温带国家相比，在印度等热带国家双相情感障碍的病程可能有所不同。关于印度双相I型障碍病程的文献匮乏。
本研究在印度南部的一家多专科医院进行。对使用SCID-I确诊为双相I型障碍、病程至少3年的患者进行评估。收集了人口统计学和临床变量信息，并使用美国国立精神卫生研究所-生命图表方法临床医生回顾性图表（NIMH-LCM-CRC）绘制发作的生命历程。
共纳入150例双相情感障碍患者。发病的平均年龄为24.8（±8.2）岁。在大多数（85%）病例中，躁狂是首发发作，且是病程中最常见的发作类型，其次是抑郁。患者在情绪发作（最常见的是躁狂发作）期间平均花费病程的11.1%。躁狂或抑郁发作的中位持续时间为2个月。首次发作后复发的中位时间为21个月（四分位间距为10 - 60个月），女性比男性短。
来自特定地区的基于医院的样本限制了普遍性。在这项基于回顾性信息的研究中可能存在回忆偏倚。未系统评估躯体疾病、人格障碍、其他轴I精神障碍（除物质使用障碍外）以及坚持治疗对疾病病程的影响。
印度患者的双相I型障碍病程以躁狂发作为主，这与热带国家先前的报告一致，与温带地区有很大不同。
