Recognising prodromes of manic or depressive recurrence in outpatients with bipolar disorder: A cross-sectional study
Recognising prodromes of manic or depressive recurrence in outpatients with bipolar disorder: A cross-sectional study
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DOI：
10.1016/j.ijnurstu.2010.01.010
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发表时间：
2010-10-01
影响因子：
8.1
通讯作者：
van Achterberg, T.
中科院分区：
文献类型：
--
作者：
Goossens, P. J. J.;Kupka, R. W.;van Achterberg, T.
背景：有一些证据表明，教导患者识别躁狂和抑郁发作的前驱症状可以改善复发和住院时间、社会功能和就业表现。关于双相情感障碍患者将哪些前驱症状视为复发的第一个症状的信息很少。目的：本研究的目的是描述双相情感障碍患者报告的躁狂或抑郁复发的最初症状，并探讨识别这些前驱症状的能力与这些患者的临床特征之间的关联。设计：横断面描述性设计。设置：荷兰的五个精神科门诊诊所。参与者： 111 名门诊患者被诊断患有双相情感障碍，目前尚未发作。方法：通过开放式问题的面对面访谈以及人口和临床特征调查问卷获得数据。报告的前驱症状根据文献综述和专家意见在归纳构建的工具中进行分类。用卡方计算关联性。结果：躁狂症复发的第一个公认症状是能量水平（21%）、睡眠（17%）和社交功能（16%）的变化。在抑郁症中，影响因素包括思想的改变（15%）、情绪稳定性（12%）、精力水平（12%）、社交功能（11%）和睡眠（10%）。百分之二十八的患者无法识别躁狂症复发的前驱症状。此外，28% 的人无法识别抑郁症的前驱症状，12% 的人无法识别其中任何一个。识别抑郁前驱症状的能力与终生抑郁发作次数之间存在显着关联（p = 0.033）。结论：大多数心境正常的双相情感障碍患者能够识别复发前驱症状。这些警告信号通常在复发过程的早期出现。我们的结果表明，患者学会识别复发的前驱症状，而不是通过经验而不是通过治疗干预。从发作中恢复后与患者及其亲属密切交谈以了解复发的早期阶段对于提高认识并预防未来躁狂或抑郁的发作非常重要。 (C) 2010 Elsevier Ltd. 保留所有权利。
Background: There is some evidence that teaching patients to recognise prodromes of manic and depressive episodes improved time to recurrence and hospitalization, social function, and performance in employment. Little information is available about which prodromal symptom patients with bipolar disorder recognise as being the very first symptom of recurrence.Objectives: The aims of this study were to describe the very first symptoms in manic or depressive recurrence reported by patients with bipolar disorder and to explore associations between the ability to recognise these prodromal symptoms and the clinical characteristics of these patients.Design: A cross-sectional, descriptive design.Settings: Five psychiatric outpatient clinics in the Netherlands.Participants: 111 outpatients diagnosed with bipolar disorder, currently not in an episode.Methods: Data were obtained through a face-to-face interview with open ended questions and a questionnaire for demographic and clinical characteristics. Reported prodromes were categorised in an instrument inductively constructed and based on literature review and expert opinion. Associations were calculated with chi squares.Results: The first recognised symptom of recurrence in mania was change in energy level (21%), sleep (17%), and social functioning (16%). In depression it was change in thought (15%), mood stability (12%), energy level (12%), social functioning (11%), and sleep (10%). Twenty-eight percent of the patients were not able to recognise prodromes of recurrence in mania. Also 28% was not able to recognise prodromes of depression, and 12% was not able to recognise either of them. A significant association (p = 0.033) was found between the ability to recognise prodromes of depression and the lifetime number of depressive episodes.Conclusions: The majority of euthymic patients with bipolar disorder are able to recognise prodromes of recurrence. These warning signs often emerge early in the process of recurrence. Our results suggest that patients learn to recognise prodromes of recurrence rather by experience than from therapeutic interventions. Talking to patients and their relatives closely after recovered from an episode to construct the early phase of recurrence can be important to improve recognition and prevent future episodes of mania or depression. (C) 2010 Elsevier Ltd. All rights reserved.