Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
Eur Arch Psychiatry Clin Neurosci. 2018 Dec;268(8):749-755. doi: 10.1007/s00406-017-0811-0. Epub 2017 May 22.
The chronic, long-term evolution of bipolar disorder (BD) requires a careful clinical characterization with prognostic implications in terms of symptom and functional control. The OPTHYMUM multicenter study was conducted in France with the objective of evaluating residual symptoms on overall functioning of BD patients during inter-episodic period. The aims of the present study were to identify the potentially modifiable (e.g., treatable) and non-modifiable variables associated with functional impairment during the inter-episodic periods of BD. Sample was divided into two groups according to level of functioning (adequate vs. impaired), based on the FAST scale total score. FAST cut-off for functional impairment is a score >11. The two subgroups were compared as per sociodemographic and clinical variables with standard univariate analyses, and a logistic regression model was created. The model as a whole contained independent non-modifiable factors (age, gender, BD type, illness duration) and modifiable factors (illness severity, predominant polarity, depressive and manic residual symptoms, comorbidities). The final model was statistically significant (χ = 53.89, df = 5, p < 0.001). Modifiable factors most strongly associated with functional impairment were manic predominant polarity (OR = 1.79, CI 95% 1.09-2.96, p = 0.022), residual depressive symptoms (OR = 1.30, CI 95% 1.18-1.43, p < 0.001) and illness severity (OR = 1.24, CI 95% 1.01-1.52, p = 0.037), whilst non-modifiable factor was illness duration (OR = 1.03, CI 95% 1.01-1.05, p = 0.017). Despite intrinsic and non-modifiable illness characteristics, a clinical-wise choice of treatment may help to improve control of manic relapses. Potential improvement of residual depressive symptoms may alleviate the functional burden associated with bipolar disorder.
双相障碍（BD）的慢性、长期演变需要进行仔细的临床特征描述，这对症状和功能控制的预后具有重要意义。OPTHYMUM 多中心研究在法国进行，目的是评估 BD 患者在发作间期的残留症状对整体功能的影响。本研究的目的是确定与 BD 发作间期功能障碍相关的可改变（例如，可治疗）和不可改变的变量。根据 FAST 量表总分，将样本分为功能正常组（足够）和功能障碍组（受损）。FAST 功能障碍的截断值为>11。根据标准单变量分析，对两组进行了社会人口统计学和临床变量的比较，并建立了逻辑回归模型。该模型整体包含不可改变的独立因素（年龄、性别、BD 类型、病程）和可改变的因素（疾病严重程度、主要极性、抑郁和躁狂残留症状、合并症）。最终模型具有统计学意义（χ 2=53.89，df=5，p<0.001）。与功能障碍最密切相关的可改变因素是躁狂主导极性（OR=1.79，95%CI 1.09-2.96，p=0.022）、残留抑郁症状（OR=1.30，95%CI 1.18-1.43，p<0.001）和疾病严重程度（OR=1.24，95%CI 1.01-1.52，p=0.037），而不可改变的因素是病程（OR=1.03，95%CI 1.01-1.05，p=0.017）。尽管存在内在的和不可改变的疾病特征，但治疗方案的临床选择可能有助于改善躁狂发作的控制。残留抑郁症状的潜在改善可能减轻与双相障碍相关的功能负担。
