Winokur G, Coryell W, Keller M, Endicott J, Akiskal H
National Institute of Mental Health Collaborative Program on the Psychobiology of Depression-Clinical Studies, Bethesda, Md.
Arch Gen Psychiatry. 1993 Jun;50(6):457-65. doi: 10.1001/archpsyc.1993.01820180059006.
As part of the National Institute of Mental Health Collaborative Study of the Psychobiology of Depression, the comparative course of manic depressive (bipolar) and primary unipolar patients was assessed.
Systematic evaluation using structured instruments every 6 months for a period of 5 years with the recording of remissions, new episodes, and subsequent hospitalizations.
The number of subjects varied somewhat depending on the analyses conducted. For a comparison of course in bipolar patients and unipolar patients, 148 bipolars were compared with 172 unipolar patients.
Both unipolar and bipolar patients were more likely to have episodes if they had episodes prior to index admission. Likewise, prior hospitalizations predicted multiple hospitalizations in follow-up. Chronicity was significantly more prevalent among unipolar depressives but in both unipolar and bipolar patients, chronicity diminished over time. Bipolar patients were more likely than unipolar patients to have multiple episodes at the 2-year and 5-year follow-ups. In bipolar patients, there was no difference in the number of episodes in follow-up between males and females but in unipolar patients, females were significantly more likely to have subsequent hospitalizations and episodes than males. Treatment variables did not relate to these differences. A family history of mania or schizoaffective mania predicted multiple episodes in bipolar patients but not in primary unipolar depressives. A family history of all affective illness (mania, schizoaffective mania, bipolar II illness, and depression) did not predict a multiple-episode course in either bipolar or unipolar illness. In unipolar patients, the independent variables leading to multiple-episode course in follow-up are being female, an early age of onset, and prior episodes.
As a result of this systematic follow-up study, new data add to the distinction between bipolar and primary unipolar patients both as regards number of episodes in follow-up and also as regards risk factors that are associated with the multiple-episode course.
作为美国国立精神卫生研究所抑郁症心理生物学合作研究的一部分，对躁郁症（双相）患者和原发性单相患者的病程进行了比较评估。
每6个月使用结构化工具进行系统评估，为期5年，记录缓解情况、新发作情况及随后的住院情况。
根据所进行的分析，受试者数量略有不同。为比较双相患者和单相患者的病程，将148名双相患者与172名单相患者进行了比较。
单相和双相患者如果在首次入院前有发作史，则更有可能再次发作。同样，既往住院史可预测随访期间的多次住院情况。慢性病程在单相抑郁症患者中更为普遍，但在单相和双相患者中，慢性病程均随时间推移而减少。在2年和5年随访中，双相患者比单相患者更有可能出现多次发作。在双相患者中，随访期间发作次数在男性和女性之间没有差异，但在单相患者中，女性比男性更有可能随后住院和发作。治疗变量与这些差异无关。躁狂症或分裂情感性躁狂症家族史可预测双相患者的多次发作，但对原发性单相抑郁症患者则不然。所有情感性疾病（躁狂症、分裂情感性躁狂症、双相II型障碍和抑郁症）的家族史均不能预测双相或单相疾病的多次发作病程。在单相患者中，导致随访期间多次发作病程的独立变量为女性、发病年龄早和既往发作史。
通过这项系统的随访研究，新数据增加了双相患者和原发性单相患者在随访发作次数以及与多次发作病程相关的危险因素方面的差异。
