老年期情感性精神障碍预后相关因素的随访研究

A follow-up study on the prognosis and its relevant factors in senile affective disorders

目的 探讨老年期情感性精神障碍的预后及其相关因素。 方法 对符合中国精神疾病分类方案与诊断标准第 2版修订本 ( CCMD- -R)中情感性精神障碍诊断标准的 72例老年患者 ,进行为期 6～ 7年的随访、预后评定和相关因素的 Logistic回归分析。 结果 72例中 ,78%复发 (其中 55%于出院后的 1年内复发 ) ,53 %再住院 ,2 5%自杀 ,8%转为慢性病程 ;3 5%预后良好 ,3 3 %预后一般 ,3 2 %预后较差。预后危险因素依次为临床类型、自杀、复发频率、生活事件紧张总值 ;保护因素为维持治疗、住院次数多和社会支持量表总分高。各临床类型中预后以双相混合或快速循环型最差 ,双相非混合或快速循环型一般 ,单相抑郁症和躁狂症最好 ;自杀的危险因素为双相混合或快速循环型、频繁发作和自杀未遂史 ,保护因素为住院治疗。 结论 老年期情感性精神障碍患者有 1 /3左右预后较差 ,双相混合或快速循环型预后最差。临床类型、自杀和复发频率等是最主要的危险因素 ,维持治疗与住院治疗等是最主要的保护因素 ,应针对有关因素采取预防对策。

Objective To investigate the prognosis and its relevant factors in senile patients with affective disorders. Methods Seventy two patients diagnosed as senile affective disorders were followed up for 6 7 years after their discharge from the hospital. All the relevant factors were analyzed with logistic regressive analysis method. Results During the period of follow up the results of the senile affective disorders in these patients were 78% relapse, 53% readmission, 21% suicide, 4% death and 8% shift to chronic phase. 35% had good, 33% moderate and 32% poor prognosis. The relevant factors for prognosis included clinical subtype, suicide, maintenance treatment , relapse frequency, life events,readmission frequency and social support.Prognosis assessment showed a poor prognosis for patients with bipolar mixed or rapid cycling subtype, a moderate prognosis for bipolar non mixed or rapid cycling subtype, a good prognosis for unipolar depression and mania . The risk factors for suicide included bipolar mixed or rapid cycling subtype, more frequent episodes and history of suicide attempts.Hospitalization was a protective factor for suicide. Conclusions Prognosis was poor in about 1/3 of the senile affective disorders after discharge from hospital. The bipolar mixed or rapid cycling subtype may be associated with unfavourable prognosis in senile affective disorders. The main risk factors for prognosis included clinical subtype, suicide, relapse frequency and life events. The main protective factor for prognosis was maintenance treatment,social support and hospitalization.