Dhiman Shallu, Subodh B N, Chakrabarti Subho
Department of Psychiatry, Institute of Human Behaviour and Allied Sciences, New Delhi, India.
Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Psychiatry. 2022 Sep-Oct;64(5):510-517. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_129_21. Epub 2022 Oct 12.
Indian studies on the course and outcome of bipolar disorder (BD) are scarce and their methodologies vary. Nevertheless, differences from Western ones have been noted.
A systematic random sample of 200 patients with BD attending a general hospital psychiatric unit was chosen. They were assessed using the clinician and self-rated versions of the National Institute of Mental Health-Retrospective Life Charts, the lifetime version of the Columbia Suicide Severity Rating Scale, the Medication Adherence Questionnaire, the Indian Disability Evaluation and Assessment Scale, and the Presumptive Stressful Life Events Scale.
The mean age of onset of BD was 26 years. About 11%-13% of the illness was spent in acute episodes, mostly in depression (60%). Episode frequency was 0.4-0.6 annually. The first episode was more likely to be manic, and manic episodes outnumbered depressive episodes. The average duration of episodes was 3 months. Depressive episodes were longer and the time spent in depression was greater than mania. Psychotic symptoms (48%), a mania-depression-interval pattern (61%), and recurrent mania (19%) were common while rapid cycling and seasonal patterns were uncommon. Comorbidity (40%), functional impairment (77%), and lifetime nonadherence (58%) were high, whereas lifetime suicide attempts (16%) were low. Stressful life events were very common prior to episodes (80%), particularly early in the illness.
This study suggests differences between Indian and Western patients in the demographic profile and the course and outcome of BD. A more benign presentation in the current study including Indian studies is indicated by their later age of presentation and illness onset, higher rates of marriage, education, and employment, a mania predominant course, lower rates of rapid cycling, comorbidity, and suicidal attempts. Factors associated with better outcomes such as longer time to recurrence, Manic Depressive pattern of illness, and low rates of hospitalizations also appear to be commoner in our study and also in other Indian studies.
印度关于双相情感障碍（BD）病程及结局的研究较少，且研究方法各异。然而，已注意到其与西方研究存在差异。
选取了在一家综合医院精神科就诊的200例双相情感障碍患者的系统随机样本。使用美国国立精神卫生研究所回顾性生命图表的临床医生版和自评版、哥伦比亚自杀严重程度评定量表终身版、药物依从性问卷、印度残疾评估量表以及推定应激性生活事件量表对他们进行评估。
双相情感障碍的平均发病年龄为26岁。约11% - 13%的病程处于急性发作期，大部分时间处于抑郁发作（60%）。发作频率为每年0.4 - 0.6次。首次发作更可能为躁狂发作，且躁狂发作次数多于抑郁发作。发作的平均持续时间为3个月。抑郁发作持续时间更长，处于抑郁状态的时间比躁狂状态更长。精神病性症状（48%）、躁狂 - 抑郁间歇模式（61%）和复发性躁狂（19%）较为常见，而快速循环和季节性模式不常见。共病率（40%）、功能损害（77%）和终身不依从率（58%）较高，而终身自杀未遂率（16%）较低。应激性生活事件在发作前非常常见（80%），尤其是在疾病早期。
本研究表明，印度患者与西方患者在双相情感障碍的人口统计学特征、病程及结局方面存在差异。本研究（包括印度的其他研究）中更良性的表现体现在发病年龄和疾病起病较晚、结婚率、教育程度和就业率较高、以躁狂发作为主的病程、快速循环率、共病率和自杀未遂率较低。与更好结局相关的因素，如复发时间更长、躁狂抑郁疾病模式以及住院率较低，在我们的研究以及其他印度研究中似乎也更为常见。
