双相情感障碍治疗结果的影响因素识别。

Identification of factors affecting treatment outcome in bipolar disorder.

作者信息

Vedanarayanan Lavanya, Munoli Ravindra, Thunga Girish, Nair Sreedharan, Poojari Pooja, Kunhikatta Vijayanarayana

机构信息

Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal, Karnataka, India.

Department of Psychiatry, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.

出版信息

Indian J Psychiatry. 2019 Jan-Feb;61(1):22-26. doi: 10.4103/psychiatry.IndianJPsychiatry_346_18.

DOI:10.4103/psychiatry.IndianJPsychiatry_346_18

PMID:30745650

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6341925/

Abstract

BACKGROUND AND AIM

Treatment outcomes in bipolar disorder are highly variable, and several sociodemographic, clinical characteristics, and comorbidities play an important role. Early recognition of these factors will help the physicians to implement individualized treatment and a better clinical outcome. The present study was aimed at identifying the factors affecting treatment outcomes in bipolar disorder.

MATERIALS AND METHODS

All patients diagnosed with bipolar disorder as per diagnostic and statistical manual-IV criteria were included in the study. Patients were followed for 6 months from the day of enrollment. Patient demography, age at bipolar disorder was diagnosed, age at treatment was started, social habits, signs and symptoms, comorbidities, symptoms, treatment pattern, and compliance to treatment were recorded in case record form. Based on the changes in young mania rating scale and Hamilton Depression Rating Scale (HAM-D) score from baseline to last follow-up, the patients were classified as remission and non-remission. Multiple logistic regression was used to identify risk factors associated nonremission in bipolar disorder patients and calculation of odds ratio (OR).

RESULTS

The mean age of the study population was 37.6 ± 14.1 years. Out of the 121 patients, 68 (56.2%) were female. At the end of the follow-up period, 41 (33.9%) had remission, and 80 (66.1%) had nonremission. Early onset (OR: 9.77; confidence intervals [CI]: 1.77-86.01), treatment delay (OR: 6.48; CI: 1.27-32.92), treatment noncompliance (OR: 4.64; CI: 1.37-15.64), and single living (OR: 4.26; CI: 1.56-11.66) were independently associated with nonremission in bipolar disorder patients.

CONCLUSIONS

Early-onset bipolar disorder, delay in treatment, treatment non-compliance, and single living adversely affect remission in bipolar disorder.

摘要

背景与目的

双相情感障碍的治疗结果差异很大，一些社会人口学、临床特征和合并症起着重要作用。尽早识别这些因素将有助于医生实施个体化治疗并取得更好的临床效果。本研究旨在确定影响双相情感障碍治疗结果的因素。

材料与方法

所有根据《诊断与统计手册》第四版标准诊断为双相情感障碍的患者均纳入本研究。患者从入组之日起随访6个月。患者人口统计学信息、双相情感障碍确诊时的年龄、开始治疗时的年龄、社会习惯、体征和症状、合并症、症状、治疗模式以及治疗依从性均记录在病例记录表中。根据从基线到最后一次随访时青年躁狂评定量表和汉密尔顿抑郁评定量表（HAM-D）评分的变化，将患者分为缓解组和未缓解组。采用多因素逻辑回归分析确定双相情感障碍患者未缓解的相关危险因素，并计算比值比（OR）。

结果

研究人群的平均年龄为37.6±14.1岁。121例患者中，68例（占56.2%）为女性。随访期末，41例（占33.9%）达到缓解，80例（占66.1%）未缓解。早发（OR：9.77；置信区间[CI]：1.77 - 86.01）、治疗延迟（OR：6.48；CI：1.27 - 32.92）、治疗不依从（OR：4.64；CI：1.37 - 15.64）以及独居（OR：4.26；CI：1.56 - 11.66）与双相情感障碍患者未缓解独立相关。