多中心首发精神病队列中双相情感障碍与精神分裂症诊断的预测因素：基线特征和 12 个月随访分析。

Predictors of Bipolar Disorder Versus Schizophrenia Diagnosis in a Multicenter First Psychotic Episode Cohort: Baseline Characterization and a 12-Month Follow-Up Analysis.

机构信息

Bipolar and Depressive Disorders Unit, Psychiatry and Psychology Department of the Hospital Clínic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Spain.

Biomedical Research Networking Center for Mental Health (CIBERSAM), Barcelona, Spain.

出版信息

J Clin Psychiatry. 2020 Nov 3;81(6):19m12996. doi: 10.4088/JCP.19m12996.

DOI:10.4088/JCP.19m12996

PMID:33147655

Abstract

OBJECTIVE

The aim of this study was to identify predisposing factors and clinical features at baseline that might help predict diagnosis of bipolar disorder vs schizophrenia in a first-episode psychosis (FEP) cohort.

METHODS

In this prospective, naturalistic study, we evaluated a cohort of 335 subjects with FEP recruited from April 2009 to April 2012. Baseline features were compared between subjects with a final DSM-IV diagnosis of bipolar disorder and schizophrenia at 12-month follow-up. A binary logistic regression model was used to assess predictors of diagnosis of bipolar disorder at follow-up.

RESULTS

At 12-month follow-up, 47 of the 335 subjects included in the study received the diagnosis of bipolar disorder and 105, of schizophrenia. Subjects with a final diagnosis of bipolar disorder had a higher prevalence of family history of mood disorders (38.2% vs 18.0%, P = .02), better baseline premorbid adjustment (Premorbid Adjustment Scale [PAS]: 38.4 vs 50.6, P < .01) and psychosocial functioning (Functional Assessment Short Test [FAST]: 23.6 vs 33.7, P = .001), better cognitive flexibility (number of perseverative errors on the Wisconsin Card Sorting Test [WCST]: 14.2 vs 19.7, P = .01), more manic symptoms (Young Mania Rating Scale [YMRS]: 14.1 vs 7.3, P < .01), lesser negative symptoms (Positive and Negative Syndrome Scale negative scale [PANSS-N]: 15.0 vs 22.3, P < .001), and shorter duration of untreated psychosis (144.2 vs 194.7 days, P < .01) than subjects with a schizophrenia diagnosis. Binary logistic regression model revealed that lower FAST scores (odds ratio [OR] = 0.956; P = .015), lower PANSS-N scores (OR = 0.93; P = .048), and lower number of perseverative errors on the WCST (OR = 0.946; P = .035) were significantly related to diagnosis of bipolar disorder at follow-up.

CONCLUSIONS

In our FEP cohort, better psychosocial functioning, lesser negative symptoms, and better cognitive flexibility were related to diagnosis of bipolar disorder at 12-month follow-up.

摘要

目的

本研究旨在确定首发精神病（FEP）患者队列中可能有助于预测双相障碍与精神分裂症诊断的基线时的易患因素和临床特征。

方法

在这项前瞻性、自然主义研究中，我们评估了 2009 年 4 月至 2012 年 4 月期间招募的 335 名 FEP 受试者。在 12 个月的随访中，比较了具有最终 DSM-IV 双相障碍和精神分裂症诊断的受试者的基线特征。使用二元逻辑回归模型评估随访时诊断为双相障碍的预测因素。

结果

在 12 个月的随访中，335 名入组受试者中有 47 名被诊断为双相障碍，105 名被诊断为精神分裂症。最终诊断为双相障碍的受试者有更高的心境障碍家族史患病率（38.2%比 18.0%，P=0.02），更好的基线发病前调整（发病前调整量表[PAS]：38.4 比 50.6，P<.01）和心理社会功能（功能评估简短测试[FAST]：23.6 比 33.7，P=0.001），更好的认知灵活性（威斯康星卡片分类测验中持续错误的数量[WCST]：14.2 比 19.7，P=0.01），更多的躁狂症状（Young Mania Rating Scale[YMRS]：14.1 比 7.3，P<.01），更少的阴性症状（阳性和阴性综合征量表阴性量表[PANSS-N]：15.0 比 22.3，P<.001），以及较短的未治疗精神病持续时间（144.2 比 194.7 天，P<.01）比精神分裂症诊断受试者。二元逻辑回归模型显示，较低的 FAST 评分（优势比[OR]=0.956；P=0.015）、较低的 PANSS-N 评分（OR=0.93；P=0.048）和较低的 WCST 中持续错误的数量（OR=0.946；P=0.035）与随访时的双相障碍诊断显著相关。