Bipolar Disorder in Primary Care: Clinical Characteristics of 740 Primary Care Patients With Bipolar Disorder
Bipolar Disorder in Primary Care: Clinical Characteristics of 740 Primary Care Patients With Bipolar Disorder
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DOI：
10.1176/appi.ps.201300374
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发表时间：
2014-08-01
影响因子：
3.8
通讯作者：
Unuetzer, Juergen
中科院分区：
文献类型：
--
作者：
Cerimele, Joseph M.;Chan, Ya-Fen;Unuetzer, Juergen
目的：本研究旨在描述参加全州精神卫生整合计划(MHIP)的双相情感障碍初级保健患者的特征。方法：采用综合国际诊断访谈(3.0版)和临床医生诊断，对华盛顿州2008年1月至2011年12月间740名双相情感障碍的初级保健患者进行鉴定。在登记时和治疗过程中对患者进行临床评定量表。护理质量结果是从对患者疾病登记的系统审查中获得的，并与先前对MHIP中有抑郁症状的患者的研究进行了比较。描述性分析技术用于描述患者的临床特征。结果：双相情感障碍患者在抑郁和焦虑方面的症状严重程度较高：患者健康问卷-9(平均+/-SD得分为18.1+/-5.9，满分27分)和7个条目的广泛性焦虑障碍量表(总分为15.7+/-4.7，满分21分)。心理社会问题很常见，大约53%的人报告了对住房的担忧，15%的人报告无家可归，22%的人报告缺乏支持。只有26%的患者被转介到专门的心理健康治疗。与先前研究中的抑郁症状患者相比，双相情感障碍患者在治疗过程中与临床医生的接触次数更多。结论：在MHIP中登记的双相情感障碍的初级保健患者有严重的抑郁、共病的精神疾病症状和多种心理社会问题。与先前研究中有抑郁症状的患者相比，双相情感障碍患者接受了更多的重症监护。即使大多数患者有持续的症状，转诊到社区精神卫生中心的情况也很少见。
Objective: This study aimed to describe the characteristics of primary care patients with bipolar disorder enrolled in a statewide mental health integration program (MHIP). Methods: With the Composite International Diagnostic Interview (Version 3.0) and clinician diagnosis, 740 primary care patients with bipolar disorder were identified in Washington State between January 2008 and December 2011. Clinical rating scales were administered to patients at the time of enrollment and during treatment. Quality-of-care outcomes were obtained from a systematic review of the patient disease registry and compared with a previous study of patients with depressive symptoms in an MHIP. Descriptive analysis techniques were used to describe patients' clinical characteristics. Results: Primary care patients with bipolar disorder had high symptom severity on depression and anxiety measures: Patient Health Questionaire-9 (mean +/- SD score of 18.1 +/- 5.9 out of 27) and the seven-item Generalized Anxiety Disorder scale (15.7 +/- 4.7 out of 21). Psychosocial problems were common, with approximately 53% reporting concerns about housing, 15% reporting homelessness, and 22% reporting lack of a support person. Only 26% of patients were referred to specialty mental health treatment. Patients with bipolar disorder had a greater amount of contact with clinicians during treatment compared with patients with depressive symptoms from a prior study. Conclusions: Primary care patients with bipolar disorder enrolled in MHIP had severe depression, symptoms of comorbid psychiatric illnesses, and multiple psychosocial problems. Patients with bipolar disorder received more intensive care compared with patients with depressive symptoms from a prior study. Referral to a community mental health center occurred infrequently even though most patients had persistent symptoms.