Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
J Affect Disord. 2018 May;232:73-78. doi: 10.1016/j.jad.2018.02.032. Epub 2018 Feb 17.
Bipolar disorder is a complicated and chronic mental disorder. This study investigated factors affecting time to remission for inpatients with bipolar mania after 4 weeks of acute treatment.
This naturalistic study recruited inpatients with bipolar mania for acute treatment. Symptom severity was assessed using the Young Mania Rating Scale (YMRS) at weeks 0, 1, 2, 3, and 4. Patients were included if they had had assessments at weeks 0 and 1 Remission was defined as an YMRS score ≤ 12. The Cox regression analysis was used to analyze factors associated with time to remission after 4 weeks of acute treatment.
Four hundred and forty-nine patients entered the analysis. Seventy-one of the 449 subjects (15.8%) reached symptomatic remission within 4 weeks of acute treatment. Using forward multivariate Cox regression analysis, comorbid substance use disorders, earlier age at onset, and greater manic symptom severity at baseline found to be statistically significant predictors of a longer time to reach remission after 4 weeks of treatment.
As a retrospective chart review and naturalistic design, placebo effect and potentially confounding factors such as the possibility of missing records may have limited our results.
Early identification and intervention with integrated therapy is considered to shorten time to remission for patients at high risk of poor treatment outcome. More studies are needed in other real-world settings to generalize our results.
双相情感障碍是一种复杂且慢性的精神障碍。本研究旨在探讨影响双相情感障碍躁狂症患者急性治疗 4 周后缓解时间的因素。
本自然主义研究纳入了接受急性治疗的双相情感障碍躁狂症住院患者。在第 0、1、2、3 和 4 周时使用 Young 躁狂评定量表（YMRS）评估症状严重程度。如果患者在第 0 周和第 1 周进行了评估，则将其纳入研究。缓解定义为 YMRS 评分≤12。采用 Cox 回归分析来分析急性治疗 4 周后缓解时间的相关因素。
449 例患者纳入分析。在 449 例患者中，有 71 例（15.8%）在急性治疗 4 周内达到症状缓解。使用正向多变量 Cox 回归分析，共病物质使用障碍、发病年龄较早以及基线时的躁狂症状严重程度较高被发现是治疗 4 周后达到缓解时间较长的统计学显著预测因素。
由于本研究是回顾性病历审查和自然主义设计，安慰剂效应以及可能存在的记录缺失等潜在混杂因素可能限制了我们的研究结果。
早期识别和综合治疗被认为可以缩短治疗效果差的高危患者的缓解时间。需要在其他真实环境中开展更多研究来推广我们的研究结果。
