Bonnín C Mar, Reinares María, Hidalgo-Mazzei Diego, Undurraga Juan, Mur Maria, Sáez Cristina, Nieto Evaristo, Vázquez Gustavo H, Balanzá-Martínez Vicent, Tabarés-Seisdedos Rafael, Vieta Eduard
Bipolar Disorders Unit, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Catalonia, Barcelona, Spain.
Bipolar Disorders Unit, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Catalonia, Barcelona, Spain; Department of Psychiatry, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile.
J Affect Disord. 2015 Aug 15;182:121-5. doi: 10.1016/j.jad.2015.04.043. Epub 2015 May 2.
The identification of functional outcome predictors after acute episodes of bipolar disorders (BD) may allow designing appropriate treatment aiming at restoring psychosocial functioning. Our objective was to identify the best functional outcome predictors at a 6-month follow-up after an index manic episode.
We conducted a naturalistic trial (MANACOR) focusing on the global burden of BD, with special emphasis on manic episode-associated costs. We observed patients with BD seen in services of four hospitals in Catalonia (Spain).The total sample included 169 patients with chronic DSM-IV-TR BD I suffering from an acute manic episode who were followed-up for 6 months. In this subanalysis we report the results of a stepwise multiple regression conducted by entering in the model those clinical and sociodemographic variables that were identified through preliminary bivariate Pearson correlations and using total scores on the Functioning Assessment Short Test (FAST) at the 6-month follow-up as the dependent variable.
Number of previous depressive episodes (Beta=3.25; t=3.23; p=0.002), presence of psychotic symptoms during the manic index episode (Beta=7.007; t=2.2; p=0.031) and the Body Mass Index (BMI) at baseline (Beta=0.62; t=2.09; p=0.041) were best predictors of functional outcome after a manic episode.
The main limitations of this study include the retrospective assessment of the episodes, which can be a source of bias, and the 6-month follow-up might have been too short for assessing the course of a chronic illness.
Psychotic symptoms at index episode, number of past depressive episodes, and BMI predict worse outcome after 6 months follow-up after a manic episode, and may constitute the target of specific treatment strategies.
识别双相情感障碍（BD）急性发作后的功能转归预测因素，有助于设计旨在恢复社会心理功能的恰当治疗方案。我们的目标是确定首次躁狂发作后6个月随访时最佳的功能转归预测因素。
我们开展了一项针对BD总体负担的自然主义试验（MANACOR），特别关注与躁狂发作相关的费用。我们观察了在西班牙加泰罗尼亚四家医院就诊的BD患者。总样本包括169例患有慢性DSM-IV-TR I型双相情感障碍且经历急性躁狂发作的患者，对其进行了6个月的随访。在本次亚分析中，我们报告了逐步多元回归的结果，该回归通过将经初步双变量Pearson相关性确定的临床和社会人口统计学变量纳入模型，并以6个月随访时功能评估简短测试（FAST）的总分作为因变量。
既往抑郁发作次数（β=3.25；t=3.23；p=0.002）、躁狂发作指数期出现精神病性症状（β=7.007；t=2.2；p=0.031）以及基线时的体重指数（BMI）（β=0.62；t=2.09；p=0.041）是躁狂发作后功能转归的最佳预测因素。
本研究的主要局限性包括发作的回顾性评估，这可能是偏差的来源，且6个月的随访对于评估慢性病病程可能太短。
发作指数期的精神病性症状、既往抑郁发作次数和BMI可预测躁狂发作后6个月随访时较差的转归，可能构成特定治疗策略的目标。
