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双相 I 型和 II 型障碍长期治疗期间复发的预测因素。一项为期 4 年的前瞻性自然研究。

Predictors of recurrence during long-term treatment of bipolar I and II disorders. A 4 year prospective naturalistic study.

机构信息

Istituto di Psicopatologia, Rome, Italy.

Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.

出版信息

J Affect Disord. 2018 Jan 1;225:123-128. doi: 10.1016/j.jad.2017.08.013. Epub 2017 Aug 14.

Abstract

BACKGROUND

Despite the large number of treatments available for bipolar disorder (BD), more than one half of patients have a recurrence within 2 years, and over 90% experience at least one additional affective episode during their lifetime.

METHODS

The aim of this study was to test the impact of a number of demographic and clinical features on the risk to recurrence in a real- word representative sample of 266 outpatients with BD-I or II treated in a naturalistic setting during a 4-years-follow-up period.

RESULTS

We found that the number of episodes per year after study entry, compared to the number of episodes per year before study entry,significantly decreased and that about one third of patients had no recurrences during the observation period. The length of follow-up and the number of previous episodes, mainly depressive, predicted the risk of recurrence, while female gender, higher age at intake, and a higher frequency of past mixed episodes predicted a higher frequency of recurrences.

LIMITATIONS

The study had some limitations to consider: i.e. the risk of poor reliability of information on the previous course of illness or the naturalistic treatment during the follow-up.

CONCLUSIONS

Our study suggests that (a) an evidence-based long-term treatment, with regular follow-up visits could improve the course of disease and prognosis; (b) clinicians should carefully consider the presence of a high number of mixed episodes, to provide more targeted treatment strategies; (c) an appropriate use of antidepressants in selected patients did not worsen the course of illness.

摘要

背景

尽管有许多治疗方法可用于治疗双相情感障碍(BD),但仍有超过一半的患者在 2 年内复发,超过 90%的患者在其一生中至少经历过一次额外的情感发作。

方法

本研究旨在测试在自然环境中治疗的 266 名双相 I 或 II 型门诊患者的真实代表性样本中,多种人口统计学和临床特征对复发风险的影响,随访时间为 4 年。

结果

我们发现,与入组前每年发作次数相比,入组后每年发作次数显著减少,约三分之一的患者在观察期间无复发。随访时间和既往发作次数,主要是抑郁发作,预测了复发的风险,而女性、入组时年龄较大以及过去混合发作的频率较高则预测了复发的频率较高。

局限性

本研究存在一些需要考虑的局限性:即既往疾病过程或随访期间自然治疗信息的可靠性风险较差。

结论

我们的研究表明:(a)基于证据的长期治疗,定期随访可以改善疾病的进程和预后;(b)临床医生应仔细考虑混合发作次数较多的情况,以提供更有针对性的治疗策略;(c)在选择的患者中适当使用抗抑郁药不会加重病情。

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