Aggression among 216 patients with a first-psychotic episode of bipolar I disorder
Aggression among 216 patients with a first-psychotic episode of bipolar I disorder
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DOI：
10.1186/s40345-018-0126-8
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发表时间：
2018-08-11
影响因子：
4
通讯作者：
Salvatore, Paola
中科院分区：
文献类型：
--
作者：
Khalsa, Hari-Mandir K.;Baldessarini, Ross J.;Salvatore, Paola
背景：双相I型障碍(BD-I)患者的攻击性并不罕见。在病程早期识别潜在的危险因素应告知临床管理和降低风险。方法：在216例首次住院的首次精神病发作患者中，我们确定了最近(入院前1个月内)在简明精神病学评定量表上的攻击行为-扩展和回顾详细的临床研究记录。我们比较了有和没有攻击行为的受试者与选定的人口统计学和临床因素的相关性。结果：在216名受试者中，有23人(10.6%)被识别出攻击性。与最近自杀未遂(OR=4.86)、酗酒(OR=3.63)、学习障碍(OR=3.14)、首次躁狂发作(OR=2.59)显著相关，而与年龄、性别、发病类型、人格障碍、康复时间或功能状态无关。结论：在首发具有精神病性特征的BD-I患者中，10.6%的患者近期对他人有严重攻击行为。与最近的一次自杀未遂有关的攻击性几率增加了4.9倍，酗酒或学习障碍的几率增加了3倍以上，如果发作的极性是躁狂的话，攻击的几率增加了2.6倍。这些发现鼓励对酒精滥用、自杀风险和躁狂症状进行更密切的管理，并及早发现BD-I患者的学习问题。
Background: Aggression by patients with bipolar I disorder (BD-I) is not uncommon. Identifying potential risk factors early in the illness-course should inform clinical management and reduce risk.Methods: In a study sample of 216 initially hospitalized, first-psychotic episode subjects diagnosed with DSM-IV-TR BD-I, we identified recent (within 1 month before hospitalization) aggression by ratings on the Brief Psychiatric Rating Scale-Expanded and review of detailed clinical research records. We compared subjects with versus without aggressive behavior for associations with selected demographic and clinical factors.Results: Aggression was identified in 23/216 subjects (10.6%). It was associated significantly with recent suicide attempt (OR = 4.86), alcohol abuse (OR = 3.63), learning disability (OR = 3.14), and initial manic episode (OR = 2.59), but not with age, sex, onset-type, personality disorder, time to recovery, or functional status.Conclusions: Among first-major episode BD-I patients with psychotic features, recent serious aggression towards others was identified in 10.6%. The odds of aggression increased by 4.9-times in association with a recent suicide attempt, more than 3-times with alcohol-abuse or learning disability, and by 2.6-times if the episode polarity was manic. The findings encourage closer management of alcohol misuse, suicide risk, and manic symptoms, and early detection of learning problems in BD-I patients.