The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, No 5. Ankang Alley, Deshengmen Wai, Xicheng District, Beijing, China.
Unit of Psychiatry, Department of Public Health and Medicinal Administration, Faculty of Health Sciences, Institute of Translational Medicine, University of Macau, 3/F, Building E12, Taipa, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China; Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China.
J Affect Disord. 2021 Nov 1;294:908-915. doi: 10.1016/j.jad.2021.07.079. Epub 2021 Jul 22.
This study aimed to assess the clinical phenomenology and characteristics of prodromal symptoms in Chinese patients with bipolar disorder (BPD) prior to their index mood episode.
Semi-structured interviews [Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R)] were administered to patients within 3 years of BPD (I and II) onset.
120 stable inpatients and outpatients were included (65% males, mean age: 26.5±10.0 years). Feeling extremely energetic (61.8%), overly cheerful (49.1%), racing thoughts (48.2%), overly talkative (47.3%), and decreased need for sleep (43.6%) most frequently preceded the first (hypo)manic episode, whereas depressed mood (78.5%), tiredness (53.9%), reduction of enjoyment (52.3%), trouble concentrating (49.2%) and insomnia (47.7%) often occurred prior to the index depressive episode. The prevalence of anxiety or nervousness (p = 0.009), social isolation (p = 0.004), and losing temper (p < 0.001) differed significantly depending on the different episodes. Prior to any depressive episode, insomnia (p = 0.035) lasted significantly longer and sleeping too much (p = 0.033) was more severe, whereas oppositionality (p < 0.001), hallucinations (p = 0.024) and psychosis index score (p = 0.044) were more severe before any (hypo) manic episode. Furthermore, depressed mood (p = 0.006) was more frequent prior to depression, while anxiety or nervousness (p = 0.018), oppositionality (p = 0.001), and psychosis index score (p = 0.009) were more frequent before any (hypo) manic episode.
Characteristic affective and psychotic symptoms, including depressed mood and subthreshold hypo (manic) symptoms occurred in the prodromal phase. The pre-depression prodromal symptoms lasted longer than the pre-(hypo) mania prodromal symptoms. Our findings indicated that identifying prodromal symptoms of BPD may be beneficial for early diagnosis and intervention before the development of full episodes.
本研究旨在评估中国双相障碍（BPD）患者在首发心境发作前的前驱症状的临床现象学和特征。
对发病后 3 年内的 BPD（I 型和 II 型）患者进行半结构式访谈[双相前驱症状量表回顾性版（BPSS-R）]。
共纳入 120 例稳定住院和门诊患者（65%为男性，平均年龄：26.5±10.0 岁）。感觉异常精力充沛（61.8%）、过度愉快（49.1%）、思维奔逸（48.2%）、过于健谈（47.3%）和睡眠需求减少（43.6%）最常发生在前（轻）躁狂发作之前，而情绪低落（78.5%）、疲倦（53.9%）、享受减少（52.3%）、注意力不集中（49.2%）和失眠（47.7%）通常发生在首发抑郁发作之前。焦虑或紧张（p=0.009）、社会孤立（p=0.004）和脾气暴躁（p<0.001）的发生率因不同的发作而异。在任何抑郁发作之前，失眠（p=0.035）持续时间显著更长，过度嗜睡（p=0.033）更为严重，而对立性（p<0.001）、幻觉（p=0.024）和精神病指数评分（p=0.044）在任何（轻）躁狂发作之前更为严重。此外，在抑郁发作之前，情绪低落（p=0.006）更为频繁，而在任何（轻）躁狂发作之前，焦虑或紧张（p=0.018）、对立性（p=0.001）和精神病指数评分（p=0.009）更为频繁。
前驱期出现特征性的情感和精神病症状，包括抑郁情绪和阈下轻（躁狂）症状。抑郁发作的前驱症状持续时间长于（轻）躁狂发作的前驱症状。我们的发现表明，识别 BPD 的前驱症状可能有助于在完全发作之前进行早期诊断和干预。
