Psychosocial disability in the course of bipolar I and II disorders - A prospective, comparative, longitudinal study
Psychosocial disability in the course of bipolar I and II disorders - A prospective, comparative, longitudinal study
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DOI：
10.1001/archpsyc.62.12.1322
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发表时间：
2005-12-01
影响因子：
--
通讯作者：
Keller, MB
中科院分区：
文献类型：
--
作者：
Judd, LL;Akiskal, HS;Keller, MB
内容：双相情感障碍的社会心理残疾的证据主要是基于双相I型障碍（BP-I），并没有将残疾与情感症状的严重程度和极性或双相II型障碍（BP-II）联系起来。目的：提供BP-I和BP-II长期病程中与症状状态有关的社会心理残疾的详细数据。一项20年前瞻性系统随访的自然主义研究。设置：美国5个学术中心的住院和门诊治疗机构。患者：158例BP-I患者和133例BP-II患者接受随访，平均（SD）为15（4.8）年的国家精神卫生研究所协作抑郁症研究。主要结果测量：通过随机回归，从6个月到每年纵向间隔随访的长期病程期间，1个月内功能受损工具心理社会损伤评分范围与情感症状状态之间的关系-结果：BP-I和BP-II的抑郁症状严重程度每增加一次，心理社会损害就显著增加，BP-I的躁狂症状严重程度增加最多。亚综合征轻躁狂症状在BP-II中并不致残，它们甚至可能增强功能。抑郁症状在相应的严重程度上至少与躁狂或轻躁狂症状一样致残，在某些情况下，更是如此。在抑郁症状严重程度的每一个水平上，BP-I和BP-II的损害程度相同。无症状时，双相情感障碍患者有良好的社会心理功能，虽然它是不如良好controls.Conclusions：社会心理残疾波动与情感症状的严重程度在BP-I和BP-II的变化平行。临床处理的重要发现如下：（1）抑郁发作和症状，占BP-I和BP-II的病程的主导地位，与相应水平的躁狂或轻躁狂症状相当或更致残;（2）亚综合征抑郁症状，但不是亚综合征躁狂或轻躁狂症状，与显著的损害有关;（3）亚综合征轻躁狂症状似乎增强了BP-II的功能。
Context: Evidence of psychosocial disability in bipolar disorder is based primarily on bipolar I disorder (BP-I) and does not relate disability to affective symptom severity and polarity or to bipolar II disorder (BP-II).Objective: To provide detailed data on psychosocial disability in relation to symptom status during the long-term course of BP-I and BP-II.Design: A naturalistic study with 20 years of prospective, systematic follow-up.Setting: Inpatient and outpatient treatment facilities at 5 US academic centers.Patients: One hundred fifty-eight patients with BP-I and 133 patients with BP-II who were followed up for a mean (SD) of 15 (4.8) years in the National Institute of Mental Health Collaborative Depression Study.Main Outcome Measures: The relationship, by random regression, between Range of Impaired Functioning Tool psychosocial impairment scores and affective symptom status in 1-month periods during the long-term course of illness from 6-month and yearly Longitudinal Interval Follow-up Evaluation interviews.Results: Psychosocial impairment increases significantly with each increment in depressive symptom severity for BP-I and BP-II and with most increments in manic symptom severity for BP-I. Subsyndromal hypomanic symptoms are not disabling in BP-II, and they may even enhance functioning. Depressive symptoms are at least as disabling as manic or hypomanic symptoms at corresponding severity levels and, in some cases, significantly more so. At each level of depressive symptom severity, BP-I and BP-II are equally impairing. When asymptomatic, patients with bipolar disorder have good psychosocial functioning, although it is not as good as that of well controls.Conclusions: Psychosocial disability fluctuates in parallel with changes in affective symptom severity in BP-I and BP-II. Important findings for clinical management are the following: (1) depressive episodes and symptoms, which dominate the course of BP-I and BP-II, are equal to or more disabling than corresponding levels of manic or hypomanic symptoms; (2) subsyndromal depressive symptoms, but not subsyndromal manic or hypomanic symptoms, are associated with significant impairment; and (3) subsyndromal hypomanic symptoms appear to enhance functioning in BP-II.