Laboratorio de Epidemiología Clínica, Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Ciudad de México, México.
Enseñanza Hospital Médica Sur, Ciudad de México, México.
Brain Behav. 2021 Nov;11(11):e2279. doi: 10.1002/brb3.2279. Epub 2021 Oct 9.
Early-stage predictors of illness course are needed in bipolar disorder (BD). Differences among patients with a first depressive versus maniac/hypomanic episode have been stated, although in most studies, memory bias and time from onset to start of specialized treatment might interfere. The aim was to compare the first 10 years of illness course according to polarity at onset.
49 type I BD patients admitted for treatment for a first-time affective episode and a following 10-year attendance to the institution were included. A retrospective year by year comparison according to polarity at onset (depressive (DPO) or maniac (MPO)) was performed. Cramer's V and Cohen d were computed to determine effect size.
59.2% (n = 29) started with MPO. Both groups were similar in demographic and social outcome characteristics, clinical features, and treatment variables. Patients with DPO reported more depressive episodes than MPO patients (U = 149.0 p < .001, Cohen's d = 0.87); both groups had a similar number of manic episodes. Only during the first year of follow-up, suicide attempts (SA) were more frequent in patients with DPO while the presence of a psychotic episode and psychiatric hospitalizations were more frequent in the MPO group.
According to these findings, it can be concluded that illness onset is only indicative of depressive predominant polarity but is not related to other poor prognostic variables after the first year of illness onset, in treated BD. SA in the first year of an affective disorder could represent a marker of BD.
在双相情感障碍（BD）中，需要早期预测疾病进程。已经指出了首发抑郁发作与躁狂/轻躁狂发作患者之间的差异，尽管在大多数研究中，记忆偏差和从发病到开始接受专业治疗的时间可能会产生干扰。本研究的目的是根据发病时的极性来比较疾病前 10 年的病程。
共纳入 49 例 I 型 BD 患者，他们因首次情感发作而入院治疗，并在随后的 10 年内到该机构就诊。根据发病时的极性（抑郁首发（DPO）或躁狂首发（MPO））进行回顾性逐年比较。使用 Cramer's V 和 Cohen d 来确定效应大小。
59.2%（n=29）首发为 MPO。两组在人口统计学和社会结局特征、临床特征和治疗变量方面相似。DPO 组报告的抑郁发作次数多于 MPO 组（U=149.0，p<0.001，Cohen's d=0.87）；两组的躁狂发作次数相似。只有在随访的第一年，DPO 患者的自杀企图（SA）更频繁，而 MPO 组的精神病发作和精神病院住院治疗更频繁。
根据这些发现，可以得出结论，疾病首发仅提示抑郁为主的极性，但与发病后第一年的其他预后不良变量无关，在治疗的 BD 中。在情感障碍的第一年出现 SA 可能是 BD 的一个标志物。
