双相情感障碍未缓解的相关因素：精神科门诊双相情感障碍多中心治疗调查（MUSUBI）
Factors Associated with Non-Remission in Bipolar Disorder: The Multicenter Treatment Survey for Bipolar Disorder in Psychiatric Outpatient Clinics (MUSUBI).
作者信息
Tsuboi Takashi, Suzuki Takefumi, Azekawa Takaharu, Adachi Naoto, Ueda Hitoshi, Edagawa Kouji, Katsumoto Eiichi, Kubota Yukihisa, Goto Eiichiro, Hongo Seiji, Watanabe Yoichiro, Kato Masaki, Yasui-Furukori Norio, Yoshimura Reiji, Nakagawa Atsuo, Kikuchi Toshiaki, Watanabe Koichiro
机构信息
Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan.
The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan.
出版信息
Neuropsychiatr Dis Treat. 2020 Mar 31;16:881-890. doi: 10.2147/NDT.S246136. eCollection 2020.
PURPOSE
The aim of this study was to identify factors associated with non-remission in bipolar disorder.
PATIENTS AND METHODS
The multicenter treatment survey for bipolar disorder in psychiatric outpatient clinics (MUSUBI) study used a questionnaire administered at 176 clinics throughout Japan from September to October 2016. Clinic psychiatrists performed a retrospective medical record survey of consecutive cases with bipolar disorder. Patients were considered to be in remission if they met all of the following criteria: they were not in a mixed state, their manic or depressive symptoms were either borderline or nonexistent (corresponding to 2 or 1 points on the Clinical Global Impressions Scale, Bipolar Version), and their psychiatrists clinically considered them to be in remission. Enrolled patients were classified into remitters group and non-remitters group and demographic and clinical characteristics were contrasted between the groups. Non-remitters were compared with remitters, using a series of logistic regression analyses.
RESULTS
A total of 3130 patients (1420 men; mean age: 50.3 years) were included in this study; 1307 patients (41.8%) were in remission. Of the remaining 1823 patients, 1260 (40.3%) had mild to severe depression, 261 (8.3%) suffered from manic or hypomanic episodes, and 302 (9.6%) were in a mixed state. Logistic regression analyses found the following eight factors to be significantly correlated with non-remission in patients with bipolar disorder: female gender, younger age, unemployed status, rapid cycling pattern, comorbid alcohol/substance abuse, poorer social function, lithium non-use, and antidepressant use.
CONCLUSION
The MUSUBI study, the largest nationwide investigation on bipolar disorder, identified eight clinically relevant factors associated with non-remission in bipolar patients. They have important clinical implications; further prospective studies are necessary to replicate these findings and to guide better managements for those in serious needs.
目的
本研究旨在确定与双相情感障碍未缓解相关的因素。
患者与方法
双相情感障碍多中心治疗调查（MUSUBI）研究采用问卷调查，于2016年9月至10月在日本全国176家诊所进行。诊所精神科医生对双相情感障碍连续病例进行回顾性病历调查。如果患者符合以下所有标准，则被认为处于缓解期：未处于混合状态，其躁狂或抑郁症状为临界或不存在（相当于双相情感障碍临床总体印象量表中的2分或1分），且其精神科医生临床认为其处于缓解期。将纳入的患者分为缓解组和未缓解组，并对比两组的人口统计学和临床特征。使用一系列逻辑回归分析对未缓解组与缓解组进行比较。
结果
本研究共纳入3130例患者（1420例男性；平均年龄：50.3岁）；1307例患者（41.8%）处于缓解期。在其余1823例患者中，1260例（40.3%）有轻度至重度抑郁，261例（8.3%）有躁狂或轻躁狂发作，302例（9.6%）处于混合状态。逻辑回归分析发现以下八个因素与双相情感障碍患者的未缓解显著相关：女性、年龄较小、失业状态、快速循环型、合并酒精/物质滥用、社会功能较差、未使用锂盐以及使用抗抑郁药。
结论
MUSUBI研究是全国范围内关于双相情感障碍的最大规模调查，确定了与双相情感障碍患者未缓解相关的八个临床相关因素。它们具有重要的临床意义；有必要进行进一步的前瞻性研究以重复这些发现，并为有严重需求的患者提供更好的管理指导。
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