老年情感性精神障碍的预后及其相关因素的随访研究

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

探讨老年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二版中情感性精神障碍诊断标准出院的７２例老年患者，进行为期６～７年的随访研究。并根据临床发作过程分为单相抑郁症（２１例）、双相非混合或快速循环型（２９例）、双相混合或快速循环型（１６例）和单相躁狂症（６例）四型，对所有患者进行预后的评定和相关因素的ｌｏｇｉｓｔｉｃ回归分析。结果７２例患者中，７８％复发（其中５５％于出院后一年内复发），５３％再住院，２５％自杀（其中自杀未遂２１％，自杀死亡４％），８％转为慢性病程；３５％预后良好，３３％预后一般，３２％预后较差。预后危险因素依次为临床类型、自杀、复发频率、ＬＥＳ总值、发病年龄；保护因素为住院多、ＳＳＲＳ总分高和回归社会时间长。进一步分析发现，各临床类型中的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。结论提示老年情感性精神障碍患者有三分之一左右预后较差；临床类型、自杀和复发频率等是最主要的危险因素，住院治疗是最主要的保护因素；双相混合或快速循环型的预后最差；应针?

Objective The purpose of the study was to investigate the prognosis and its relevant factors in the senile patients with affective disorders.Methods 72 patients diagnosed as senile affective disorders were followed up at 6～7 years after their discharge from hospital.They were divided into 4 groups of 21 unipolar depression,29 bipolar non-mixed or rapid cycling affective disorder,16 bipolar mixed or rapid cycling affective disorder and 6 unipolar mania.All the relevant factors were analyzed with logistic regressive analysis method.Results During 6～7 years after discharge,the prognosis of the senile affective disorders were 78% relapse,53% readmission,21% suicide,4% dead,8% shift to chronic phrase,and 32% poor prognosis.The relevant factors for prognosis included the clinical subtype,suicide,relapse frequency,life events,age of onset,readmission frequency,social support and period of living in community.The patients in bipolar mixed or rapid cycling group had significantly higher incidence of relapse,suicide and chronicity,and lower GAS scores but higher SDSS total score compared with other three groups.The prognosis assessment showed an poor prognosis for patients with bipolar mixed or rapid cycling subtype,a moderate prognosis for bipolar nonmixed or rapid cycling subtype,an 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.The hospitalization was a protective factor for suicide.Conclusion There were worse prognosis in about 1/3 of senile affective disorders for 6～7 years after discharge from hospital.The main risk factore for prognosis included the clinical subtype,suicide and relapse frequency.The main protective factor for prognosis was hospitalization.The bipolar mixed or rapid cycling subtype may be one with unfavourable prognosis in senile affective disorders.