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与双相情感障碍延迟诊断相关的临床和人口统计学因素:来自双相情感障碍患者健康结局和患者评估研究(HOPE-BD)的数据。

Clinical and demographic factors associated with delayed diagnosis of bipolar disorder: Data from Health Outcomes and Patient Evaluations in Bipolar Disorder (HOPE-BD) study.

机构信息

Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.

University Hospital, Federal University of Santa Catarina, Florianópolis, SC, Brazil.

出版信息

J Affect Disord. 2022 Jan 1;296:506-513. doi: 10.1016/j.jad.2021.09.094. Epub 2021 Oct 1.

Abstract

BACKGROUND

The diagnosis of Bipolar Disorder (BD) is frequently delayed. In this study, we aimed to examine the clinical and demographic factors associated with delayed diagnosis of BD, defined as the difference between the age at first mood episode (depressive, manic, or hypomanic) and the age at the correct diagnosis of BD, using data from a Canadian multicentre naturalistic study.

METHODS

The sample included 192 patients with Bipolar I Disorder (BD-I) and 127 with Bipolar II Disorder (BP-II) who participated in the Health Outcomes and Patient Evaluations in Bipolar Disorder (HOPE-BD) study. Sociodemographic characteristics and clinical features that had been previously associated with delayed diagnosis of BD were included in the analysis.

RESULTS

The median delay in diagnosis was 5.0 years in BD-I and 11.0 years in BD-II. Clinical factors such as earlier age of onset, lifetime suicide attempts and comorbid anxiety disorders were associated with a longer delay, whereas the presence of lifetime psychotic symptoms and psychiatric hospitalizations were associated with a shorter delay. Quantile regression analysis showed older age at which professional help was first sought and younger age of onset as predictors of increased delay in diagnosis of BD-I and BD-II. Depression as first episode predicted longer delay in diagnosis of BD-I but not BD-II.

CONCLUSION

Our findings identified the ongoing lag in identification of a BD diagnosis and the clinical markers most associated with this delay, highlighting the need for implementation of strategies for early identification and interventions in BD.

摘要

背景

双相情感障碍(BD)的诊断常常被延误。本研究旨在利用加拿大多中心自然主义研究的数据,探讨与 BD 诊断延迟相关的临床和人口统计学因素,将 BD 的诊断延迟定义为首次心境发作(抑郁、躁狂或轻躁狂)与正确诊断 BD 的年龄之间的差异。

方法

该样本包括参加双相情感障碍健康结局和患者评估研究(HOPE-BD)的 192 例 1 型双相情感障碍(BD-I)患者和 127 例 2 型双相情感障碍(BP-II)患者。分析中纳入了先前与 BD 诊断延迟相关的社会人口统计学特征和临床特征。

结果

BD-I 的中位诊断延迟为 5.0 年,BD-II 的中位诊断延迟为 11.0 年。临床因素,如发病年龄较早、一生中自杀未遂和共患焦虑障碍与更长的延迟相关,而一生中出现精神病症状和精神病院住院与更短的延迟相关。分位数回归分析显示,首次寻求专业帮助的年龄较大和发病年龄较小是 BD-I 和 BD-II 诊断延迟增加的预测因素。首发抑郁预测 BD-I 的诊断延迟时间更长,但对 BD-II 则不然。

结论

我们的研究结果发现了 BD 诊断的持续滞后,以及与这种延迟最相关的临床标志物,这突出了需要实施早期识别和干预 BD 的策略。

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