当前的易激惹与双相情感障碍中抑郁复发的加速和抑郁恢复的延迟有关。
Current irritability associated with hastened depressive recurrence and delayed depressive recovery in bipolar disorder.
机构信息
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94305-5723, USA.
出版信息
Int J Bipolar Disord. 2016 Dec;4(1):15. doi: 10.1186/s40345-016-0056-2. Epub 2016 Jul 30.
BACKGROUND
Current irritability is associated with greater retrospective and current bipolar disorder (BD) illness severity; less is known about prospective longitudinal implications of current irritability. We examined relationships between current irritability and depressive recurrence and recovery in BD.
METHODS
Outpatients referred to the Stanford BD Clinic during 2000-2011 were assessed with the Systematic Treatment Enhancement Program for BD (STEP-BD) Affective Disorders Evaluation at baseline, and with the Clinical Monitoring Form during follow-up during up to 2 years of naturalistic treatment. Prevalence and clinical correlates of any current irritability in depressed and recovered (euthymic ≥8 weeks) BD patients were assessed. Kaplan-Meier analyses (Log-Rank tests) assessed relationships between current irritability and longitudinal depressive severity, with Cox Proportional Hazard analyses assessing potential mediators.
RESULTS
Recovered BD outpatients with vs. without current irritability had significantly higher rates of 13/19 (68.4 %) other baseline unfavorable illness characteristics/current mood symptoms and hastened depressive recurrence (Log-Rank p = 0.020), driven by lifetime history of anxiety disorder and prior year rapid cycling, and attenuated by history of psychosis. Depressed BD outpatients with vs. without current irritability had significantly higher rates of 7/19 (36.8 %) other unfavorable illness characteristics/current mood symptoms and delayed depressive recovery (Log-Rank p = 0.034), NOT mediated by any assessed parameter.
LIMITATIONS
Limited generalizability beyond our predominately white, female, educated, insured American BD specialty clinic sample.
CONCLUSIONS
Current irritability was associated with hastened depressive recurrence and delayed depressive recovery in BD. Treatment studies targeting irritability may yield strategies to mitigate increased longitudinal depressive burden.
背景
目前的易怒与更大的回顾性和当前双相情感障碍（BD）疾病严重程度有关；目前尚不清楚当前易怒对前瞻性纵向的影响。我们研究了当前易怒与 BD 中的抑郁复发和恢复之间的关系。
方法
2000 年至 2011 年期间，斯坦福 BD 诊所转诊的门诊患者在基线时接受了系统性治疗增强计划双相情感障碍（STEP-BD）情感障碍评估，并在长达 2 年的自然治疗期间接受了临床监测表随访。评估了抑郁和恢复（≥8 周的心境正常）BD 患者中当前易怒的患病率和临床相关性。Kaplan-Meier 分析（对数秩检验）评估了当前易怒与纵向抑郁严重程度之间的关系，Cox 比例风险分析评估了潜在的中介因素。
结果
与没有当前易怒的恢复性 BD 门诊患者相比，具有当前易怒的患者具有更高的 13/19（68.4%）其他基线不良疾病特征/当前情绪症状，且抑郁复发更快（对数秩 p=0.020），这是由焦虑障碍和前一年快速循环的终生病史驱动的，而精神病病史则减轻了这种影响。与没有当前易怒的抑郁性 BD 门诊患者相比，具有当前易怒的患者具有更高的 7/19（36.8%）其他不良疾病特征/当前情绪症状，且抑郁恢复延迟（对数秩 p=0.034），这并非由任何评估参数介导。
局限性
我们的研究仅限于以白人、女性、受过教育、有保险的美国 BD 专业诊所样本，因此具有一定的局限性。
结论
目前的易怒与 BD 中的抑郁复发和抑郁恢复延迟有关。针对易怒的治疗研究可能会产生减轻纵向抑郁负担的策略。
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