Social rhythm disruption and stressful life events in the onset of bipolar and unipolar episodes
Social rhythm disruption and stressful life events in the onset of bipolar and unipolar episodes
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DOI：
10.1017/s0033291799002706
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发表时间：
2000-09-01
影响因子：
6.9
通讯作者：
Kupfer, DJ
中科院分区：
文献类型：
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作者：
Malkoff-Schwartz, S;Frank, E;Kupfer, DJ
背景最近观察到社会节奏中断（SRD）和躁狂发作之间的关联。其他类型的双相（抑郁和循环）或单相抑郁发作是否与SRD类似尚不清楚，严重威胁生命的事件与双相躁狂、抑郁和循环发作之间的关联也不清楚。采用贝德福德大学生活事件和困难量表对单纯躁狂（N = 21）、单纯抑郁（N = 21）和自行车（N = 24）发作的双相情感障碍患者以及44例复发性单相抑郁患者进行了访谈。然后确定在指数发作前一年中是否存在严重和SRD事件。躁狂受试者在8周和20周发作前发生SRD事件的比例高于骑自行车和单极受试者，在20周发作前发生重度事件的比例高于骑自行车和单极受试者。控制年龄和既往发作次数后，大多数结果保持不变。一个较早的发现，更多的躁狂症受试者与SRD事件在8周前的发作期相比，也复制。与其他类型的双相和单极发作相比，躁狂发作似乎以独特的方式受到压力性生活事件的影响，特别是涉及SRD的事件。相反，双相循环发作似乎相对不受SRD或严重生活事件的影响。这些研究结果完善了这一假设，即SRD可能会促使情感发作的发作是特定于躁狂发作。
Background. An association between social rhythm disruption (SRD) and onset of manic episodes has recently been observed. Whether other types of bipolar (depressive and cycling) or unipolar depressive episodes are similarly related to SRD is unclear, as is the association between severely threatening life events and onset of bipolar manic, depressed and cycling episodes.Methods. Bipolar patients with purely manic (N = 21), purely depressed (N = 21) and cycling (N = 24) episodes, and 44 patients with recurrent unipolar depression, were interviewed with the Bedford College Life Events and Difficulties Schedule. The presence of severe and SRD events during the year prior to index episode onset was then determined.Results. More manic than cycling and unipolar subjects experienced SRD events during 8- and 20-week pre-onset periods, and severe events during 20-week pre-onset periods. Controlling for age and prior number of episodes left most findings unchanged. An earlier finding of more manic subjects with SRD events in an 8-week pre-onset versus control period was also replicated.Conclusions. It appears that manic onsets are influenced by stressful life events, especially those involving SRD, in a unique manner compared to onsets of other types of bipolar and unipolar episodes. Onset of bipolar cycling episodes, in contrast, seems to be relatively unaffected by SRD or severe life events. These findings refine the hypothesis that SRD may precipitate onset of affective episodes to be specific to manic onsets.