Department of Psychiatry,Dalhousie University,Halifax,Nova Scotia,Canada.
Mental Health Unit,National Institute of Health and Welfare,Helsinki,Finland.
Psychol Med. 2019 May;49(7):1109-1117. doi: 10.1017/S0033291718001678. Epub 2018 Jun 28.
The long-term outcomes of bipolar disorder range from lasting remission to chronic course or frequent recurrences requiring admissions. The distinction between bipolar I and II disorders has limited utility in outcome prediction. It is unclear to what extent the clinical course of bipolar disorder predicts long-term outcomes.
A representative sample of 191 individuals diagnosed with bipolar I or II disorder was recruited and followed for up to 5 years using a life-chart method. We previously described the clinical course over the first 18 months with dimensional course characteristics and latent classes. Now we test if these course characteristics predict long-term outcomes, including time ill (time with any mood symptoms) and hospital admissions over a second non-overlapping follow-up period in 111 individuals with available data from both 18 months and 5 years follow-ups.
Dimensional course characteristics from the first 18 months prospectively predicted outcomes over the following 3.5 years. The proportion of time depressed, the severity of depressive symptoms and the proportion of time manic predicted more time ill. The proportion of time manic, the severity of manic symptoms and depression-to-mania switching predicted a greater likelihood of hospital admissions. All predictions remained significant after controlling for age, sex and bipolar I v. II disorder.
Differential associations with long-term outcomes suggest that course characteristics may facilitate care planning with greater predictive validity than established types of bipolar disorders. A clinical course dominated by depressive symptoms predicts a greater proportion of time ill. A clinical course characterized by manic episodes predicts hospital admissions.
双相情感障碍的长期结局范围从持久缓解到慢性病程或频繁复发需要住院治疗。双相 I 型和 II 型障碍的区别在预测结果方面的作用有限。目前尚不清楚双相情感障碍的临床病程在多大程度上预测长期结局。
采用生命图表法，对 191 名被诊断为双相 I 型或 II 型障碍的代表性样本进行了招募和长达 5 年的随访。我们之前描述了前 18 个月的临床病程，包括维度病程特征和潜在类别。现在，我们检验这些病程特征是否可以预测长期结局，包括 111 名患者在 18 个月和 5 年随访中都有可用数据的情况下，第二个非重叠随访期间的患病时间（有任何情绪症状的时间）和住院次数。
前 18 个月的维度病程特征前瞻性地预测了随后 3.5 年的结局。抑郁时间比例、抑郁症状严重程度和躁狂时间比例预测了更长的患病时间。躁狂时间比例、躁狂症状严重程度和从抑郁到躁狂的转换预测了更高的住院可能性。在控制年龄、性别和双相 I 型与 II 型障碍后，所有预测结果仍然显著。
与长期结局的不同关联表明，病程特征可能比已确立的双相障碍类型更能促进护理计划，具有更高的预测准确性。以抑郁症状为主的临床病程预测患病时间比例更高。以躁狂发作为特征的临床病程预测住院次数。
