Vocisano C, Klein D N, Keefe R S, Dienst E R, Kincaid M M
California School of Professional Psychology, Berkeley/Alameda, USA.
Am J Psychiatry. 1996 Feb;153(2):248-55. doi: 10.1176/ajp.153.2.248.
This exploratory study examined the characteristics of a group of unusual and previously undescribed patients with major affective disorder who not only had been continuously symptomatic for prolonged periods of time but were also so functionally impaired that they required years of continuous care in psychiatric facilities or by family members.
Twenty-seven inpatients with major mood disorders and 29 inpatients with schizophrenia were recruited from a large state hospital; 27 outpatients with major mood disorders were recruited from an affiliated outpatient facility. The research battery included the Structured Clinical Interview for DSM-III-R--Patient Version, the Premorbid Adjustment Scale, and a semistructured interview designed to assess demographic, family history, developmental, and course information.
Inpatients with deteriorated affective disorder differed from outpatients with nondeteriorated affective disorder along several important dimensions, including family history of mental illness, birth-related problems, physical disorders in infancy, premorbid functioning, presence of mixed episodes and rapid cycling, and medication non-compliance between hospitalizations. Inpatients with deteriorated affective disorder differed from inpatients with schizophrenia on the Premorbid Adjustment Scale. Patients with bipolar affective disorder differed from those with unipolar disorder on many of the variables associated with deterioration of functioning.
Birth-related problems, physical disorders in infancy, and poor premorbid adjustment in childhood and adolescence appear to play an important role in deterioration of functioning among patients with unipolar depression. Disruption in treatment because of medication noncompliance and the appearance of mixed episodes and rapid cycling are associated with functional decline in bipolar affective disorder. Several characteristics previously considered specific to deterioration of functioning in schizophrenia, such as a high rate of birth complications and poor premorbid adjustment, appear to be associated with functional deterioration among patients with major depression as well.
本探索性研究考察了一组患有重度情感障碍的特殊患者的特征，这些患者此前未被描述过，他们不仅长期持续出现症状，而且功能严重受损，需要在精神病院接受数年的持续照料，或由家庭成员进行照料。
从一家大型州立医院招募了27名患有重度心境障碍的住院患者和29名精神分裂症住院患者；从附属门诊机构招募了27名患有重度心境障碍的门诊患者。研究项目包括《DSM-III-R结构临床访谈——患者版》、病前适应量表，以及一个旨在评估人口统计学、家族史、发育和病程信息的半结构化访谈。
病情恶化的情感障碍住院患者在几个重要方面与病情未恶化的情感障碍门诊患者不同，包括精神疾病家族史、与出生相关的问题、婴儿期身体疾病、病前功能、混合发作和快速循环的存在，以及两次住院之间的服药依从性。病情恶化的情感障碍住院患者在病前适应量表上与精神分裂症住院患者不同。双相情感障碍患者在许多与功能恶化相关的变量上与单相情感障碍患者不同。
与出生相关的问题、婴儿期身体疾病，以及儿童期和青少年期不良的病前适应似乎在单相抑郁症患者的功能恶化中起重要作用。由于服药不依从导致的治疗中断以及混合发作和快速循环的出现与双相情感障碍的功能衰退有关。一些先前被认为是精神分裂症功能恶化所特有的特征，如高出生并发症发生率和不良的病前适应，似乎也与重度抑郁症患者的功能恶化有关。
