A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder
A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder
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DOI：
10.1001/archpsyc.60.3.261
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发表时间：
2003-03-01
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，这是第一个关于双相情感障碍（BP-II）每周症状状态的自然史的前瞻性纵向研究。方法：86例BP-II患者的每周情感症状状态评分是基于在平均13.4年的预期随访期间每隔6个月或12个月进行的访谈。检查每个症状严重程度的周数百分比以及症状状态和极性的变化次数。使用新的慢性指标评估BP-II的慢性预测因子。还分析了慢性性与不同类型躯体治疗的随访周数百分比的关系。结果：BP-II患者在所有随访周中有53.9%的症状：抑郁症状（50.3%的周）在轻度躁狂（1.3%的周）和循环/混合型（2.3%的周）症状中占主导地位。亚综合征、轻度抑郁和轻度躁狂症状合并出现的几率是重度抑郁症状的3倍。较长的摄入时间、情感障碍家族史和先前较差的社会功能预示着更大的慢性。处方躯体治疗与症状的慢性性无显著相关。短期（2-6天）BP-II轻度躁狂患者与较长（大于或等于7天）轻度躁狂患者在任何指标上均无显著差异。结论：BP-II的纵向症状过程是慢性的，以抑郁为主，而不是轻躁或循环/混合症状。同一患者的症状严重程度随时间波动频繁，主要包括轻微症状和亚综合征严重程度。纵向上，BP-II表现为一种维度疾病，包括抑郁和轻度躁狂症状的全部严重程度。BP-II患者长时间或短时间的轻躁似乎是同一疾病过程的一部分。
Background: This is the first prospective longitudinal study, to our knowledge, of the natural history of the weekly symptomatic status of bipolar 11 disorder (BP-II).Methods: Weekly affective symptom status ratings for 86 patients with BP-II were based on interviews conducted at 6- or 12-month intervals during a mean of 13.4 years of prospective follow-up. Percentage of weeks at each symptom severity level and the number of shifts in symptom status and polarity were examined. Predictors of chronicity for BP-II were evaluated using new chronicity measures. Chronicity was also analyzed in relation to the percentage of follow-up weeks with different types of somatic treatment.Results: Patients with BP-II were symptomatic 53.9% of all follow-up weeks: depressive symptoms (50.3% of weeks) dominated the course over hypomanic (1.3% of weeks) and cycling/mixed (2.3% of weeks) symptoms. Subsyndromal, minor depressive, and hypomanic symptoms combined were 3 times more common than major depressive symptoms. Longer intake episodes, a family history of affective disorders, and poor previous social functioning predicted greater chronicity. Prescribed somatic treatment did not correlate significantly with symptom chronicity. Patients with BP-II of brief (2-6 days) vs longer (greater than or equal to7 days) hypomanias were not significantly different on any measure.Conclusions: The longitudinal symptomatic course of BP-II is chronic and is dominated by depressive rather than hypomanic or cycling/mixed symptoms. Symptom severity fluctuates frequently within the same patient over time, involving primarily symptoms of minor and subsyndromal severity. Longitudinally, BP-II is expressed as a dimensional illness involving the full severity range of depressive and hypomanic symptoms. Hypomania of long or short duration in BP-II seems to be part of the same disease process.