Post Robert M, Altshuler Lori L, Leverich Gabriele S, Nolen Willem A, Kupka Ralph, Grunze Heinz, Frye Mark A, Suppes Trisha, McElroy Susan L, Keck Paul E, Rowe Mike
Bipolar Collaborative Network, Bethesda, Maryland (Drs Post and Rowe and Mr Leverich); UCLA Mood Disorders Research Program and VA Medical Center, Los Angeles (Dr Altshuler); Universitair Medisch Centrum Groningen (UMCG), Groningen, The Netherlands (Dr Nolen); Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands (Dr Kupka); Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, United Kingdom (Mr Grunze); Department of Psychiatry, Mayo Clinic, Rochester, Minnesota (Dr Frye); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto and VA Palo Alto Health Care System, Palo Alto, California (Dr Suppes); Lindner Center of HOPE, Mason, Ohio and Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, Ohio (Dr McElroy); and Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio and Lindner Center of HOPE, Mason, Ohio (Dr Keck).
Prim Care Companion CNS Disord. 2014 Dec 18;16(6). doi: 10.4088/PCC.14m01677. eCollection 2014.
Many patients with bipolar disorder in the United States experience a deteriorating course of illness despite naturalistic treatment in the community. We examined a variety of factors associated with this pattern of illness progression.
From 1995 to 2002, we studied 634 adult outpatients with bipolar disorder (mean age of 40 years) emanating from 4 sites in the United States. Patients gave informed consent and completed a detailed questionnaire about demographic, vulnerability, and course-of-illness factors and indicated whether their illness had shown a pattern of increasing frequency or severity of manic or depressive episodes. Fifteen factors previously linked in the literature to a poor outcome were examined for their relationship to illness progression using Kruskal-Wallis test, followed by a 2-sample Wilcoxon rank sum (Mann-Whitney) test, χ(2), and logistical regression.
All of the putative poor prognosis factors occurred with a high incidence, and, with the exception of obesity, were significantly (P < .05) associated with illness progression. These factors included indicators of genetic and psychosocial risk and loss of social support, early onset, long delay to first treatment, anxiety and substance abuse comorbidity, rapid cycling in any year, and the occurrence of more than 20 prior episodes prior to entering the network. A greater number of factors were linearly associated with the likelihood of a progressively worsening course.
Multiple genetic, psychosocial, and illness factors were associated with a deteriorating course of bipolar disorder from onset to study entry in adulthood. The identification of these factors provides important targets for earlier and more effective therapeutic intervention in the hope of achieving a more benign course of bipolar disorder.
在美国，许多双相情感障碍患者尽管在社区接受了自然主义治疗，但病情仍不断恶化。我们研究了与这种疾病进展模式相关的多种因素。
1995年至2002年，我们对来自美国4个地点的634名双相情感障碍成年门诊患者（平均年龄40岁）进行了研究。患者签署了知情同意书，并完成了一份关于人口统计学、易感性和疾病过程因素的详细问卷，并指出其疾病是否表现出躁狂或抑郁发作频率增加或严重程度加重的模式。使用Kruskal-Wallis检验，随后进行双样本Wilcoxon秩和（Mann-Whitney）检验、χ²检验和逻辑回归，研究了先前文献中与不良预后相关的15个因素与疾病进展的关系。
所有假定的不良预后因素发生率都很高，除肥胖外，均与疾病进展显著相关（P < 0.05）。这些因素包括遗传和心理社会风险指标、社会支持丧失、发病早、首次治疗延迟时间长、焦虑和物质滥用共病、任何一年的快速循环发作，以及进入研究网络之前有超过20次既往发作。更多的因素与病情逐渐恶化的可能性呈线性相关。
从成年期发病到进入研究阶段，多种遗传、心理社会和疾病因素与双相情感障碍病情恶化相关。识别这些因素为早期和更有效的治疗干预提供了重要靶点，以期实现双相情感障碍更良性的病程。
