Department of Psychiatry, The Fourth People's Hospital of Chengdu, Chengdu, 610031, China.
Department of Psychiatry, West China Hospital, Sichuan University, Chengdu, 610041, China.
BMC Psychiatry. 2017 Oct 24;17(1):351. doi: 10.1186/s12888-017-1509-6.
In clinical practice, some patients diagnosed with anxiety disorder (AD) may develop bipolar disorder (BD) many years later, and some cases of AD may be cured by the use of mood stabilizers. However, the relationship between AD and BD should be explored further.
To track how many cases of AD turned to BD and to discover the differences between them, we recruited 48 patients diagnosed with BD, who were assigned to the BD group for the retrospective analysis, and we also recruited 186 patients diagnosed with AD at enrolment; this latter group was asked to complete follow-up surveys conducted 3 months, 6 months, 12 months and 18 months after the primary stage of the study. We defined another two groups according to the usage of mood stabilizers, the rates of reduction in scores on the Hamilton Anxiety Scale and Yale-Brown Obsessive Compulsive Scale, and the changes in Clinical Global Impression scores at different follow-up times: the anxiety group and the atypical BD group (who used mood stabilizers to treat AD). All subjects also completed the NEO Five-Factor Inventory and supplied blood samples to be tested for several endocrine indices (TSH, T3, FT3, T4, FT4, ACTH,PTC) and inflammatory cytokines (IL-6, IL-8, IL-10, TNF-α, CRP) at enrolment.
In total, 14 subjects developed BD by the end of the study. One hundred eleven subjects were included in the anxiety group. Sixty-three subjects were assigned to the atypical BD group, and they had similar features to the 48 subjects in the BD group in terms of personality traits, abnormality rates of endocrine indices and levels of inflammatory cytokines. From the anxiety group to the atypical BD group and then the BD group, the age of first onset gradually decreased, while the frequency of onset and the score of suicidal ideation gradually increased. Furthermore, the atypical BD group showed markedly higher levels of TSH, IL-6, TNF-α and CRP than the other two groups.
Some ADs with unique features might belong to the prodromal stage or the atypical presentation of BD, and recognizing these ADs early will economize many medical resources.
在临床实践中，一些被诊断为焦虑障碍（AD）的患者多年后可能会发展为双相障碍（BD），而一些 AD 病例可能通过使用情绪稳定剂得到治愈。然而，AD 和 BD 之间的关系仍需进一步探索。
为了跟踪有多少例 AD 转为 BD，并发现它们之间的差异，我们招募了 48 例被诊断为 BD 的患者，将其分配到 BD 组进行回顾性分析，同时还招募了 186 例在入组时被诊断为 AD 的患者；后者被要求在研究的初级阶段后 3 个月、6 个月、12 个月和 18 个月进行随访调查。我们根据情绪稳定剂的使用情况、汉密尔顿焦虑量表和耶鲁-布朗强迫症量表评分的降低率以及不同随访时间的临床总体印象评分的变化情况，将另外两组定义为：焦虑组和非典型 BD 组（使用情绪稳定剂治疗 AD）。所有受试者还完成了 NEO 五因素量表，并在入组时提供血样进行多项内分泌指标（TSH、T3、FT3、T4、FT4、ACTH、PTC）和炎症细胞因子（IL-6、IL-8、IL-10、TNF-α、CRP）的检测。
研究结束时，共有 14 例受试者发展为 BD。共有 111 例受试者纳入焦虑组。63 例受试者被分配到非典型 BD 组，他们在人格特征、内分泌指标异常率和炎症细胞因子水平方面与 BD 组的 48 例受试者具有相似特征。从焦虑组到非典型 BD 组再到 BD 组，首发年龄逐渐降低，而发病频率和自杀意念评分逐渐升高。此外，非典型 BD 组的 TSH、IL-6、TNF-α 和 CRP 水平明显高于其他两组。
一些具有独特特征的 AD 可能属于 BD 的前驱期或非典型表现，早期识别这些 AD 将节省许多医疗资源。
