ÁREA, Assistance and Research in Affective Disorders, Buenos Aires, Argentina; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
ÁREA, Assistance and Research in Affective Disorders, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.
Eur Psychiatry. 2019 Apr;57:52-57. doi: 10.1016/j.eurpsy.2018.10.003. Epub 2019 Jan 21.
BackgroundThe aim of this study was to characterize mood instability (MI) in Bipolar Disorder (BD) and to investigate potential differences between subtype I and II. MethodsLife-charts from weekly mood ratings of 90 patients were used to compute: weeks spent with symptoms, number of episodes, and MI. Regression analyses were conducted to assess the relationship between BD subtype and MI adjusting by all potential confounding factors. Hierarchical cluster analysis was performed to determine the appropriate number of clusters that described the data and to assign subjects to a specific cluster based on their MI. We then compared clusters on clinical and psychosocial outcomes. ResultsMedian follow-up was 5 years (IQR: 3.6-7.9). Patients spent 15.2%, 5%, and 3% of follow-up with depressive, manic, and mixed symptoms, respectively. BD type II presented higher MI (β = 1.83, 95% CI: 0.66-3.00) and subsydromal symptoms than BD type I patients. No differences in functioning or recurrences were found between subtypes. Differences in MI between the two clusters mimicked those between type I and II but enhanced (β = 3.86, 95%CI -4.72, -2.66). High MI (n = 43) patients presented poorer functioning and higher recurrences compared to Low MI patients (n = 43). ConclusionBD type II presented higher MI and subsyndromal symptoms than BD type I patients. However, these differences did not translate into clinically relevant outcomes. A classification based on MI may provide useful clinical insights.
本研究旨在描述双相障碍（BD）中的心境不稳（MI），并探讨其与 I 型和 II 型之间的潜在差异。
使用 90 名患者每周的心境评定生活图表来计算：出现症状的周数、发作次数和 MI。通过回归分析评估 BD 亚型与 MI 之间的关系，调整所有潜在混杂因素。进行层次聚类分析以确定描述数据的适当聚类数，并根据 MI 将患者分配到特定的聚类中。然后比较聚类在临床和心理社会结局方面的差异。
中位随访时间为 5 年（IQR：3.6-7.9）。患者分别有 15.2%、5%和 3%的随访时间出现抑郁、躁狂和混合症状。BD II 型患者的 MI（β=1.83，95%CI：0.66-3.00）和亚综合征症状高于 BD I 型患者。在功能或复发方面，两种亚型之间没有差异。两个聚类之间的 MI 差异与 I 型和 II 型之间的差异相似，但更明显（β=3.86，95%CI -4.72，-2.66）。MI 高（n=43）的患者与 MI 低（n=43）的患者相比，功能较差，复发率更高。
BD II 型患者的 MI 和亚综合征症状高于 BD I 型患者。然而，这些差异并未转化为临床相关结局。基于 MI 的分类可能提供有用的临床见解。
