FIDMAG Germanes Hospitalàries, Sant Boi de Llobregat, Spain.
Psychother Psychosom. 2017;86(2):90-98. doi: 10.1159/000449417. Epub 2017 Feb 10.
Reported relapse and recurrence rates in bipolar disorder (BD) differ significantly between studies. Most data originate from highly selective patients participating in sponsored randomized controlled trials with narrow inclusion criteria. To estimate the true risk of a subsequent mood episode (SME) under real-world conditions, we conducted a meta-analysis of rates of SME as reported in naturalistic BD studies.
PubMed, ScienceDirect, Scopus, and Web of Knowledge were searched until July 2015. Studies reporting the time until the emergence of an SME, from which individual data or Kaplan-Meier plots with censors marked could be retrieved, were included.
Twelve studies comprising 5,837 patients met the inclusion criteria. The median time to an SME in adults after an index episode was 1.44 years. The risk of an SME was 44% during the first year. Not having a SME during this first year lowered this risk to 19% in the second year. The risk was higher in bipolar II disorder (BD-II) than in bipolar I disorder (BD-I; HR = 1.5). In BD-I, the risk of a subsequent manic, mixed, or depressive mood episode was higher after an index episode of the same polarity (HR = 1.89-5.14). The overall risk of an SME was higher in patients with persisting subsyndromal symptoms (HR = 2.17).
The data from this study provide a more reliable estimate of the risk of an SME in BD in real-world settings. Further research into the longitudinal course of BD-II is warranted to confirm its role as a risk factor for SME.
双相情感障碍（BD）的复发和再发率在不同研究之间差异显著。大多数数据来源于参与有赞助的随机对照试验的高度选择性患者，这些试验的纳入标准较窄。为了在真实环境下估计随后出现情绪发作（SME）的真实风险，我们对自然发生的 BD 研究中报告的 SME 发生率进行了荟萃分析。
检索 PubMed、ScienceDirect、Scopus 和 Web of Knowledge，检索截至 2015 年 7 月。纳入报告 SME 出现时间的研究，这些研究可从中获取个体数据或带有标记的删失 Kaplan-Meier 图。
12 项研究共纳入 5837 例患者，符合纳入标准。成人在首发发作后出现 SME 的中位时间为 1.44 年。首发后第一年 SME 的风险为 44%。第一年无 SME 可将第二年的风险降低至 19%。双相 II 型障碍（BD-II）的风险高于双相 I 型障碍（BD-I；HR=1.5）。在 BD-I 中，与首发同极性的躁狂、混合或抑郁发作后出现后续躁狂、混合或抑郁发作的风险更高（HR=1.89-5.14）。存在持续亚综合征症状的患者出现 SME 的总体风险更高（HR=2.17）。
本研究的数据为真实环境下 BD 中 SME 风险提供了更可靠的估计。进一步研究 BD-II 的纵向病程是必要的，以证实其作为 SME 风险因素的作用。
