The duration of undiagnosed bipolar disorder: Effect on outcomes and treatment response
The duration of undiagnosed bipolar disorder: Effect on outcomes and treatment response
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DOI：
10.1016/j.jad.2014.07.025
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发表时间：
2014-10-15
影响因子：
6.6
通讯作者：
Mitchell, P. B.
中科院分区：
文献类型：
--
作者：
McCraw, Stacey;Parker, Gordon;Mitchell, P. B.
导言：在双相情感障碍(BP)的发病、寻求治疗和获得双相情感障碍的诊断之前，通常会有很长的延迟。方法：我们对首次诊断为BP的BP患者进行了两项独立样本的研究--首先调查评估时双相情感障碍是否与临床和社会结局相关(n=173)，其次是在评估和干预后三个月评估时是否影响对情绪稳定剂药物的反应(n=)。结果：参与者的平均双相情感障碍时间为18-20年(从情绪发作开始)。在控制了年龄后，较长的DUBP与就业困难有关，而较短的DUBP与从事自我伤害行为的历史有关，以及由于情绪障碍而经历社会代价的可能性降低。大多数研究变量是统计学上不相关的Lo DUBP。在多变量分析中，年龄是唯一对DUBP有显著贡献的预测变量(33%)。在为期3个月的干预期间，参与者除了一项结果指标外，其他指标都有显著改善。参与者在研究期间改善、恶化或经历微小或无变化的可能性与DUBP没有显著关系。局限性：自我报告对测量精度构成风险。作为一种自然主义的观察，没有开出具体剂量的药物。小样本的BP I患者不足以对BP和BP II参与者进行有意义的单独分析。结论：早期发现和干预对于帮助降低与未经治疗的BR相关的发病率和风险仍然很重要。然而，DUBP的变化主要是年龄的函数，并不会对评估时的临床状态产生实质性影响，也不会导致对稳定情绪的药物的不良反应。(C)2014 Elsevier by，保留所有权利。
Introduction: There are commonly long delays beLvveen the onset of bipolar disorder (BP), seeking of treatment and acquiring a bipolar disorder diagnosis. Whether a longer duration of undiagnosed bipolar disorder (DUBP) leads to an inferior treatment response is unclear in the literature.Method: We conducted two studies with independent samples of BP patients who had received a first-time diagnosis of BP - first investigating whether DUBP was related to clinical and social outcomes at the time of assessment (n=173) and, second, whether response to mood stabiliser medication was affected by DUBP when assessed three months following assessment and intervention (n=64).Results: Participants' mean DUBP was 18-20 years (from the onset of mood episodes). After controlling for age, a longer DUBP was associated with employment difficulties, whereas a shorter DUBP was associated with a history of engaging in self-harm behaviours, as well as a reduced likelihood of experiencing social costs as consequence of the mood disorder. The majority of study variables were statistically unrelated Lo DUBP. In a multivariate analysis, age was the only predictor variable to make a significant contribution to the DUBP (33%). Across the 3-month intervention period, participants improved significantly on all but one outcome measure. The participants likelihood to improve, become worse or experience minimal/no change over the study period was not significantly related to the DUBP. Limitations: Self-reporting poses a risk to measurement precision. Being a naturalistic observation, no specific dose of medication was prescribed. The small sample of BP I patients provided insufficient statistical power to undertake meaningful separate analyses of the BP land BP II participants.Conclusion: Early detection and intervention remains important for helping to reduce morbidity and risks associated with untreated BR However, the variation in DUBP was mostly a function of age and did not substantially affect clinical status at assessment, or lead to an inferior response to mood stabilising medication. (C) 2014 Elsevier By, All rights reserved.