Malkoff-Schwartz S, Frank E, Anderson B, Sherrill J T, Siegel L, Patterson D, Kupfer D J
Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, PA 15213, USA.
Arch Gen Psychiatry. 1998 Aug;55(8):702-7. doi: 10.1001/archpsyc.55.8.702.
The association between stressful life events and onset of bipolar episodes is unclear. The association between bipolar episode onset and types of life events that disrupt social routines, and potentially sleep, has not yet been investigated.
Thirty-nine bipolar patients with primarily manic (n = 20) or depressed (n = 19) index episodes were interviewed with the Bedford College Life Event and Difficulty Schedule to determine the presence of severe events during 8-week pre-onset and control periods. All life events were also rated for degree of social rhythm disruption (SRD).
More bipolar subjects experienced at least 1 SRD event and severe event in the pre-onset vs control periods. When subjects were divided into those with manic or depressive onsets, the only significant pre-onset vs control difference was for manic patients with SRD events. Additionally, the proportion of subjects with a pre-onset SRD event was greater for manic than for depressed patients.
We found evidence that life events characterized by SRDs routines are associated with the onset of manic, but not depressive, episodes. Severe events seem to be related to onset of bipolar episodes, although it remains unclear whether severe events relate differentially to depressive and manic onsets.
生活应激事件与双相情感障碍发作之间的关联尚不清楚。双相情感障碍发作与扰乱社会日常活动以及可能影响睡眠的生活事件类型之间的关联尚未得到研究。
对39例以躁狂发作（n = 20）或抑郁发作（n = 19）为主要发作类型的双相情感障碍患者进行访谈，采用贝德福德学院生活事件与困难量表来确定在发作前8周和对照期内是否存在严重事件。所有生活事件还根据社会节律紊乱（SRD）程度进行评分。
与对照期相比，更多双相情感障碍患者在发作前经历了至少1次SRD事件和严重事件。当将患者分为躁狂发作组和抑郁发作组时，发作前与对照期之间唯一显著的差异在于有SRD事件的躁狂患者。此外，发作前有SRD事件的躁狂患者比例高于抑郁患者。
我们发现有证据表明，以社会日常活动紊乱为特征的生活事件与躁狂发作相关，但与抑郁发作无关。严重事件似乎与双相情感障碍发作有关，尽管严重事件与抑郁发作和躁狂发作之间的关系是否存在差异仍不清楚。
