García-Jiménez Jesús, Gutiérrez-Rojas Luis, Jiménez-Fernández Sara, González-Domenech Pablo José, Carretero María D, Gurpegui Manuel
Southern Mental Health Clinical Management Unit, Santa Ana Hospital, Motril, Spain.
Department of Psychiatry, University of Granada, Granada, Spain.
Front Psychiatry. 2020 Nov 16;11:584501. doi: 10.3389/fpsyt.2020.584501. eCollection 2020.
The aim of this study is to determine the prevalence of three possible diagnostic specifiers, namely predominant polarity (PP) throughout illness, polarity of the first episode and early age at onset, in a sample of bipolar disorder (BD) patients and their association with important socio-demographic, clinical and course-of-illness variables. A retrospective and naturalistic study on 108 BD outpatients, who were classified according to the PP, polarity of the first episode and early age at onset (≤ 20 years) [vs. late (>20 years)] and were characterized by their demographics, clinical data, functionality and social support, among others features. After bivariate analyses, those variables showing certain association ( value < 0.25) with the three dependent variables were entered in logistic regression backward selection procedures to identify the variables independently associated with the PP, polarity of the first episode and early age at onset. The sample consisted of 75 women ad 33 men, 74% with type I BD and 26% with type II. Around 70% had depressive PP, onset with a depressive episode and onset after age 20. Depressive PP was independently associated with depressive onset, higher score on the CGI severity scale and work disability. Onset with depressive episode was associated with type II BD, longer diagnostic delay and higher score on family disability. Early age at onset (≤ 20 years) was associate with younger age, longer diagnostic delay, presence of ever psychotic symptoms, current use of antipsychotic drugs and higher social support score. The results of this study show that BD patients with depressive PP, onset with depression and early age at onset may represent greater severity, because they are frequently associated with variables that worsen the prognosis. Our findings match up with the conclusions of two systematic reviews and we also include a disability factor (at family and work) that has not been previously reported. This work contributes to the use of polarity and age at onset in BD patients, as it can become a useful instrument in the prognostic and therapeutic applications.
本研究旨在确定双相情感障碍（BD）患者样本中三种可能的诊断说明符的患病率，即疾病全程的主要极性（PP）、首发极性和发病年龄早，并确定它们与重要的社会人口统计学、临床和疾病过程变量之间的关联。对108例BD门诊患者进行了一项回顾性自然主义研究，这些患者根据PP、首发极性和发病年龄早（≤20岁）[与晚发（>20岁）]进行分类，并以其人口统计学、临床数据、功能和社会支持等特征为特点。经过双变量分析后，将那些与三个因变量显示出一定关联（p值<0.25）的变量纳入逻辑回归向后选择程序，以确定与PP、首发极性和发病年龄早独立相关的变量。样本包括75名女性和33名男性，74%为I型BD，26%为II型。约70%的患者具有抑郁性PP，首发为抑郁发作且发病年龄在20岁之后。抑郁性PP与抑郁发作、CGI严重程度量表得分较高和工作残疾独立相关。首发抑郁发作与II型BD、诊断延迟较长和家庭残疾得分较高相关。发病年龄早（≤20岁）与年龄较小、诊断延迟较长、曾有精神病症状、目前使用抗精神病药物以及社会支持得分较高相关。本研究结果表明，具有抑郁性PP、首发抑郁和发病年龄早的BD患者可能代表更严重的病情，因为它们经常与预后较差的变量相关。我们的研究结果与两项系统评价的结论相符，并且我们还纳入了一个此前未报告的残疾因素（家庭和工作方面）。这项工作有助于在BD患者中使用极性和发病年龄，因为它可以成为预后和治疗应用中的一个有用工具。
