Duration of untreated bipolar disorder: missed opportunities on the long road to optimal treatment
Duration of untreated bipolar disorder: missed opportunities on the long road to optimal treatment
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DOI：
10.1111/j.1600-0447.2012.01917.x
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发表时间：
2013-02-01
影响因子：
6.7
通讯作者：
Bellivier, F.
中科院分区：
文献类型：
--
作者：
Drancourt, N.;Etain, B.;Bellivier, F.
目的：未经治疗的疾病持续时间是任何诊断-治疗途径中一个潜在的可修改的组成部分。在双相情感障碍(BD)中，这一概念很少被系统地定义，或者没有被应用于具有临床代表性的大样本。方法：在501例BD患者的典型样本中，我们估计了未经治疗的双相情感障碍的持续时间(DUB：首次主要情绪发作与首次情绪稳定剂治疗之间的间隔)。研究了DUB与临床发病的关系，以及关键临床里程碑的时间序列。结果：平均DUB为9.6年(SD为9.7；中位数为6)。低躁狂者(14.5岁)的中位DUB高于抑郁症(13岁)和躁狂者(8年)。早发性BD患者的DUB时间最长(P<；0.0001)。更长的配音与更多的情绪发作(P<；0.0001)，更多的自杀行为(P=0.0003)和更大的终生情绪不稳定的趋势(例如，快速循环，可能由抗抑郁药物引起的躁狂)相关。结论：只有通过更积极的病例发现策略，才能显著缩短双相情感障碍(DUB)的未治疗时间。可靠的诊断(尤其是BD-II)和/或推荐的治疗目前由于对BD的早期、多种多样的表现缺乏足够的认识、缺乏系统的筛查和/或没有遵循既定的指南而被延误。
Objective: Duration of untreated illness represents a potentially modifiable component of any diagnosis-treatment pathway. In bipolar disorder (BD), this concept has rarely been systematically defined or not been applied to large clinically representative samples. Method: In a well-characterized sample of 501 patients with BD, we estimated the duration of untreated bipolar disorder (DUB: the interval between the first major mood episode and first treatment with a mood stabilizer). Associations between DUB and clinical onset and the temporal sequence of key clinical milestones were examined. Results: The mean DUB was 9.6 years (SD 9.7; median 6). The median DUB for those with a hypomanic onset (14.5 years) exceeded that for depressive (13 years) and manic onset (8 years). Early onset BD cases have the longest DUB (P < 0.0001). An extended DUB was associated with more mood episodes (P < 0.0001), more suicidal behaviour (P = 0.0003) and a trend towards greater lifetime mood instability (e.g. rapid cycling, possible antidepressant-induced mania). Conclusion: Duration of untreated bipolar disorder (DUB) will only be significantly reduced by more aggressive case finding strategies. Reliable diagnosis (especially for BD-II) and/or instigation of recommended treatments is currently delayed by insufficient awareness of the early, polymorphous presentations of BD, lack of systematic screening and/or failure to follow established guidelines.