Predictors of recurrence in bipolar disorder: Primary outcomes from the systematic treatment enhancement program for bipolar disorder (STEP-BD)
Predictors of recurrence in bipolar disorder: Primary outcomes from the systematic treatment enhancement program for bipolar disorder (STEP-BD)
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DOI：
10.1176/appi.ajp.163.2.217
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发表时间：
2006-02-01
影响因子：
17.7
通讯作者：
Thase, ME
中科院分区：
文献类型：
--
作者：
Perlis, RH;Ostacher, MJ;Thase, ME
目的：根据现代实践指南接受治疗的双相情感障碍患者中与复发风险相关的临床特征知之甚少。作者寻找与复发风险相关的特征。方法：作者检查了参与双相障碍多中心系统治疗强化计划(STEP-BD)研究长达24个月的双相情感障碍患者队列的前瞻性数据。对于那些在研究开始时有症状但后来恢复的人，用Cox回归分析躁狂、轻躁狂、混合状态或抑郁发作的复发时间。结果：在研究开始时有症状的1,469名参与者中，858人(58.4%)随后恢复。在长达2年的随访中，416人(48.5%)经历了复发，其中发展中的抑郁发作(298，34.7%)是那些出现躁狂、躁狂或混合发作的人(118，13.8%)的两倍多。25%的人经历抑郁发作的时间是21.4周，直到25%的人经历躁狂/躁狂/混合性发作的时间是85.0周。康复时残留的抑郁或躁狂症状以及前一年抑郁或焦虑的天数比例与抑郁复发的时间较短显著相关。恢复时的残余躁狂症状和前一年情绪高涨的天数比例与躁狂、躁狂或混合性发作复发的时间较短显著相关。结论：复发频繁，并与最初康复时存在残余情绪症状有关。在维持治疗中针对残留症状可能是降低复发风险的机会。
Objective: Little is known about clinical features associated with the risk of recurrence in patients with bipolar disorder receiving treatment according to contemporary practice guidelines. The authors looked for the features associated with risk of recurrence.Method: The authors examined prospective data from a cohort of patients with bipolar disorder participating in the multicenter Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study for up to 24 months. For those who were symptomatic at study entry but subsequently achieved recovery, time to recurrence of mania, hypomania, mixed state, or a depressive episode was examined with Cox regression.Results: Of 1,469 participants symptomatic at study entry, 858 (58.4%) subsequently achieved recovery. During up to 2 years of follow-up, 416 (48.5%) of these individuals experienced recurrences, with more than twice as many developing depressive episodes (298, 34.7%) as those who developed manic, hypomanic, or mixed episodes (118, 13.8%). The time until 25% of the individuals experienced a depressive episode was 21.4 weeks and until 25% experienced a manic/hypomanic/mixed episode was 85.0 weeks. Residual depressive or manic symptoms at recovery and proportion of days depressed or anxious in the preceding year were significantly associated with shorter time to depressive recurrence. Residual manic symptoms at recovery and proportion of days of elevated mood in the preceding year were significantly associated with shorter time to manic, hypomanic, or mixed episode recurrence.Conclusions: Recurrence was frequent and associated with the presence of residual mood symptoms at initial recovery. Targeting residual symptoms in maintenance treatment may represent an opportunity to reduce risk of recurrence.