Adequacy of treatment received by diagnosed and undiagnosed patients with bipolar I and II disorders
Adequacy of treatment received by diagnosed and undiagnosed patients with bipolar I and II disorders
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DOI：
10.4088/jcp.v68n0114
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发表时间：
2007-01-01
影响因子：
5.3
通讯作者：
Isometsae, Erkki T.
中科院分区：
文献类型：
--
作者：
Arvilommi, Petri;Suominen, Kirsi S.;Isometsae, Erkki T.
目的：调查研究诊断为双相I型或II型障碍的精神科住院患者和门诊患者接受药物治疗的充分性，包括有和没有双相障碍临床诊断的患者。方法：在Jorvi双相研究（JoBS）中，在2002年1月1日至2003年2月28日期间，对芬兰3个城市的1630名精神病住院患者和门诊患者进行了系统筛查，双相I型和II型情感障碍。通过使用SCID-I和-II访谈，191例患者被诊断为双相情感障碍（90双相I和101双相II）。收集临床病史、诊断和治疗信息。接受的治疗的充分性evaluated.Results：162例患者与以前的双相情感障碍发作，只有34（20.9%）的所有和30（55.5%）的临床诊断为双相情感障碍使用情绪稳定剂在发病的指数发作。在所有191例患者中，只有81例（42.4%）和76例（65.0%）诊断为双相情感障碍的患者在急性指数期接受了充分的治疗。与充分治疗最强独立相关的因素是双相情感障碍的临床诊断（OR=25.34）。此外，快速循环（OR=2.45），多相指数发作（OR=2.41），或抑郁指数阶段（OR=3.36）独立预测治疗不足。门诊患者接受充分的治疗显着低于住院patients.Conclusions：双相情感障碍的临床诊断是迄今为止最重要的先决条件，充分的治疗。治疗中的问题大多与门诊环境有关，其中双相抑郁症的治疗充分性是一个主要问题。对疾病的纵向进程缺乏关注是另一个主要问题领域。
Objective: To investigate the adequacy of pharmacotherapy received by psychiatric inpatients and outpatients with a research diagnosis of bipolar I or II disorder, including patients both with and without a clinical diagnosis of bipolar disorder.Method: In the Jorvi Bipolar Study (JoBS), 1630 psychiatric inpatients and outpatients in 3 Finnish cities were systematically screened between January 1, 2002, and February 28, 2003, for bipolar I and II disorders using the Mood Disorder Questionnaire. By using SCID-I and -II interviews, 191 patients were diagnosed with bipolar disorder (90 bipolar I and 101 bipolar II). Information was collected on clinical history, diagnosis, and treatment. The adequacy of treatment received was evaluated.Results: Of the 162 patients with previous bipolar disorder episodes, only 34 (20.9%) of all and 30 (55.5%) of those with a clinical diagnosis of bipolar disorder were using a mood stabilizer at onset of the index episode. Only 81 (42.4%) of all 191 patients and 76 (65.0%) of those diagnosed with bipolar disorder received adequate treatment for the acute index phase. The factor most strongly independently associated with adequate treatment was clinical diagnosis of bipolar disorder (OR=25.34). In addition, rapid cycling(OR=2.45), polyphasic index episode (OR=2.41), or depressive index phase (OR=3.36) independently predicted inadequate treatment. Outpatients received adequate treatment markedly less often than inpatients.Conclusions: Clinical diagnosis of bipolar disorder is by far the most important prerequisite for adequate treatment. Problems in treatment are associated mostly with outpatient settings, where adequacy of treatment of bipolar depression is a major concern. Lack of attention to the longitudinal course of illness is another major problem area.