Helsinki University Central Hospital, Department of Psychiatry, Helsinki, Finland; National Institute of Health and Welfare, Mental Health Unit, Helsinki, Finland; University of Helsinki, Department of Psychiatry, Helsinki, Finland.
Helsinki City Department of Social Services and Healthcare, Psychiatric and Substance Abuse Services, Helsinki, Finland.
J Affect Disord. 2019 Mar 1;246:806-813. doi: 10.1016/j.jad.2018.12.093. Epub 2018 Dec 25.
Patients with bipolar disorder (BD) differ in their relative predominance of types of episodes, yielding predominant polarity, which has important treatment implications. However, few prospective studies of predominant polarity exist.
In the Jorvi Bipolar Study (JoBS), a regionally representative cohort of 191 BD I and BD II in- and outpatients was followed for five years using life-chart methodology. Differences between depressive (DP), manic (MP), and no predominant polarity (NP) groups were examined regarding time ill, incidence of suicide attempts, and comorbidity.
At baseline, 16% of patients had MP, 36% DP, and 48% NP. During the follow-up the MP group spent significantly more time euthymic, less time in major depressive episodes, and more time in manic states than the DP and NP groups. The MP group had significantly lower incidence of suicide attempts than the DP and NP group, lower prevalence of comorbid anxiety disorders but more psychotic symptoms lifetime and more often (hypo)manic first phase of the illness than the DP group. Classification of predominant polarity was influenced by the timeframe used.
The retrospective counting of former phases is vulnerable to recall bias. Assignment of dominant polarity may necessitate a sufficient number of illness phases.
Predominant polarity has predictive value in predicting group differences in course of illness, but individual patients' classification may change over time. Patients with manic polarity may represent a more distinct subgroup than the two others regarding illness course, suicide attempts, and psychiatric comorbidity.
双相障碍（BD）患者的发作类型存在相对优势，表现为主要极性，这对治疗具有重要意义。然而，关于主要极性的前瞻性研究很少。
在 Jorvi 双相研究（JoBS）中，使用生命图表方法对 191 名 BD I 和 BD II 门诊和住院患者进行了为期五年的随访，这些患者具有区域代表性。检查了抑郁（DP）、躁狂（MP）和无主要极性（NP）组之间的患病时间、自杀企图发生率和合并症的差异。
在基线时，16%的患者为 MP，36%的患者为 DP，48%的患者为 NP。在随访期间，MP 组处于轻躁狂状态的时间显著更长，处于重度抑郁发作的时间显著更短，处于躁狂状态的时间显著更长，而 DP 和 NP 组则相反。MP 组自杀企图的发生率显著低于 DP 和 NP 组，合并焦虑障碍的患病率较低，但终生出现精神病症状的比例较高，且首次发病时（轻躁狂）的比例较高。主要极性的分类受使用的时间框架的影响。
回顾性计数以前的阶段容易受到回忆偏倚的影响。主导极性的分配可能需要足够数量的疾病阶段。
主要极性对预测疾病过程中的组间差异具有预测价值，但个体患者的分类可能随时间而变化。与另外两组相比，躁狂极性的患者在疾病过程、自杀企图和精神共病方面可能代表一个更为独特的亚组。
