Risk for bipolar illness in patients initially hospitalized for unipolar depression
Risk for bipolar illness in patients initially hospitalized for unipolar depression
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最初因单相抑郁症住院的患者患双相情感障碍的风险
DOI：
10.1176/appi.ajp.158.8.1265
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发表时间：
2001-08-01
影响因子：
17.7
通讯作者：
Whiteside, JE
中科院分区：
文献类型：
--
作者：
Goldberg, JF;Harrow, M;Whiteside, JE
目的：为了评估随后发展为躁狂或轻躁狂的风险，作者对一个大型的年轻队列患者进行了15年的前瞻性随访研究，这些患者最初因单相重性抑郁症住院。因单相抑郁症住院的患者（N=74，平均年龄=23.0岁，SD=3.8）作为住院患者进行前瞻性评估，然后在IS年内随访5次，分别在大约2、5、8、11、12、13、14、16、17、18、19出院后15年。躁狂或轻躁狂发作、药物治疗和再住院均在每次随访时通过标准化评估确定。极性转换进行了评估生存analysis.Results：15年的随访，27%的研究组已开发一个或多个不同时期的轻躁狂，而另外19%的至少有一个完整的双相I躁狂发作。抑郁发作时伴有精神病的抑郁患者在随访时比非精神病患者更容易表现出随后的躁狂或轻躁狂。那些有双相情感疾病家族史的人转为躁狂或轻躁狂的比例并不显着较高。自发性躁狂症和抗抑郁药相关躁狂症的发生频率没有差异。不到一半的患者，最终表现出双相过程中接受了处方情绪稳定剂在任何后续year.Conclusions：年轻的抑郁症住院患者的精神病特征可能是在特别高的风险，最终发展为躁狂症。在指数抑郁发作后的前10-15年内，有极性转换风险的患者发生双相谱系障碍的概率呈线性增加。
Objective: To assess the risk for subsequent development of mania or hypomania, the authors conducted a 15-year prospective follow-up study of a large, young cohort of patients originally hospitalized for unipolar major depression.Method: Patients who were hospitalized for unipolar major depression (N=74 mean age=23.0 years, SD=3.8) were assessed prospectively as inpatients and then followed up five times over IS years, at approximately 2, 5, 8, 11, and 15 years after discharge. Manic or hypomanic episodes, medications, and rehospitalizations were determined by standardized assessments at each follow-up. Polarity conversions were evaluated by survival analyses.Results: By the 15-year follow-up, 27% of the study group had developed one or more distinct periods of hypomania, while another 19% had at least one episode of full bipolar I mania. Depressed patients with psychosis at the index depressive episode were significantly more likely than nonpsychotic patients to demonstrate subsequent mania or hypomania at follow-up. Those with family histories of bipolar illness showed a nonsignificantly higher rate of switching to mania or hypomania. Spontaneous and antidepressant-associated manias did not differ in frequency. Fewer than one-half of the patients who showed an eventual bipolar course had received prescriptions for mood stabilizers in any follow-up year.Conclusions: Young depressed inpatients with psychotic features may be at especially high risk for eventually developing mania. The probability for developing a bipolar spectrum disorder increases in linear fashion for patients at risk for polarity conversion during the first 10-15 years after an index depressive episode.