The long-term natural history of the weekly symptomatic status of bipolar I disorder
The long-term natural history of the weekly symptomatic status of bipolar I disorder
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DOI：
10.1001/archpsyc.59.6.530
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发表时间：
2002-06-01
影响因子：
--
通讯作者：
Keller, MB
中科院分区：
文献类型：
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作者：
Judd, LL;Akiskal, HS;Keller, MB
背景：据我们所知，这是长期随访期间双相情感障碍（BP-I）的每周症状状态的首次前瞻性自然史研究。方法：分析是基于持续的前瞻性随访146从1978年至1981年进入美国国家心理健康研究所（MD贝塞斯达）协作抑郁症研究的研究诊断标准BP-1的患者。每周的情感症状状态评级为通过极性和严重程度分析，从无症状到亚阈值水平到成熟的大抑郁症和躁狂症。在整个随访期间，每个级别的随访周的百分比以及症状状态和极性的变化数量被检查。最后，与先前确定的BP-I的慢性预测指标相关的2种新的慢性测量方法：BP-I的患者在整个12。8年的随访中平均为47.3％。抑郁症状（占总随访周的31.9％）占主导地位，占躁狂/弱势症状（占周数的8.9％）或骑自行车/混合症状（每周5.9％）。次龙，较小的抑郁症和易感性症状的频率比综合症的主要抑郁症和躁狂症状高3倍（分别为29.9％和每周的11.2％）。 BP-1的患者每年平均改变症状状态6次，极性每年超过3次。更长的摄入发作和只有抑郁或骑自行车极性的人，可以预测长期随访期间的慢性较高，并且共同使用药物障碍也是如此。总体而言，症状结构主要是抑郁症而不是躁狂，以及亚合成和次要的情感症状占主导地位。随着时间的流逝，症状严重程度通常会在同一患者中发生波动。双极I障碍表示为一种维度疾病，具有情感症状严重程度和极性的全范围（光谱）。
Background: To our knowledge, this is the first prospective natural history study of weekly symptomatic status of patients with bipolar I disorder (BP-I) during long-term follow-up.Methods: Analyses are based on ongoing prospective follow-up of 146 patients with Research Diagnostic Criteria BP-1, who entered the National Institute of Mental Health (Bethesda, Md) Collaborative Depression Study from 1978 through 1981. Weekly affective symptom status ratings were analyzed by polarity and severity, ranging from asymptomatic, to subthreshold levels, to full-blown major depression and mania. Percentages of follow-up weeks at each level as well as number of shifts in symptom status and polarity during the entire follow-up period were examined. Finally, 2 new measures of chronicity were evaluated in relation to previously identified predictors of chronicity for BP-I.Results: Patients with BP-I were symptomatically ill 47.3% of weeks throughout a mean of 12.8 years of follow-up. Depressive symptoms (31.9% of total follow-up weeks) predominated over manic/hypomanic symptoms (8.9% of weeks) or cycling/mixed symptoms (5.9% of weeks). Subsyndromal, minor depressive, and hypomanic symptoms combined were nearly 3 times more frequent than syndromal-level major depressive and manic symptoms (29.9% vs 11.2% of weeks, respectively). Patients with BP-I changed symptom status an average of 6 times per year and polarity more than 3 times per year. Longer intake episodes and those with depression-only or cycling polarity predicted greater chronicity during long-term follow-up, as did comorbid drug-use disorder.Conclusions: The longitudinal weekly symptomatic course of BP-I is chronic. Overall, the symptomatic structure is primarily depressive rather than manic, and sub-syndromal and minor affective symptoms predominate. Symptom severity levels fluctuate, often within the same patient over time. Bipolar I disorder is expressed as a dimensional illness featuring the full range (spectrum) of affective symptom severity and polarity.