双相障碍住院患者临床特征及诊治相关因素的回顾性研究

A retrospective study of clinical features and factors related with diagnosis-treatment in inpatients with bipolar disorder

【摘要】目的了解双相障碍住院患者的临床特征及诊断、治疗等相关因素。方法采用回顾性调查方法，对2009年1～12月于北京安定医院抑郁症治疗中心治疗的全部双相障碍住院患者进行资料收集，内容包括发病年龄、确诊年龄等人口学资料以及既往诊断、治疗等临床指标。结果共收集450例双相障碍患者的资料。平均首次发病年龄为（23．25土7．11）岁，58．7％首次发病在25岁之前，确诊年龄为（29．12±5．94）岁。全部患者中，63．8％既往首次发作为抑郁发作，61．6％的患者曾被误诊，误诊前两位疾病分别是重性抑郁发作和精神分裂症。443例（98．4％）双相障碍患者因疾病复发而住院，复发原因主要为不依从服药（55．8％）和治疗不规范（24．8％）。患者发作次数与用药种类的卡方检验显示，患者发作次数越少，用药种类越少；发作次数≤2次者用药种类与其他发作次数者相比差异有统计学意义（x2=19．155，P=0．004）。结论双相障碍住院患者发病年龄早，首发症状多为抑郁发作。双相障碍误诊率高，复发率高，治疗依从性差。发作次数少的患者合并治疗药物种类相对较少。

Objective To investigate the clinical features and factors related with diagnosis and treatment in inpatients with bipolar disorder. Methods All inpatients with bipolar disorder who has been hospitalized in Depression Center of Beijing Anding Hospital from Jan 2009 to Dec 2009 were enrolled in the study. Retrospective investigation was used to collect the clinical information including age of onset, age of diagnosis, diagnosis, therapeutic effects and so on. Results 450 inpatients with bipolar disorder were enrolled. The average age of onset was 23.25 _＋ 7.11 years old. 58.7% of patients with bipolar disorder experienced the first episode before the age of 25. The average age of diagnosis was 29.12 -＋5.94 years old. The first onset in 63.8% of bipolar inpatients was depressive episode. 61.5% of bipolar patients have been misdiagnosed, and the top two misdiagnosis were major depression and schizophrenia. 443 （98.4%） bipolar inpatients were rehospitalized because of recurrence, and the main causes of recurrence were noncompliance （55.8%） and nonstandard treatment （24.8%）. Chi-square test showed that the fewer the frequency of episode was, the fewer the categroy of drug combination was. Number of medication in inpatients with less than 2 episodes was significantly lower than that in inpatients with more episodes （X2 = 14. 977, P = 0. 002 ）. Conclusion Patients with bipolar disorder often onset early and the depressive episode is the most common first episode. Bipolar disorder is a disease with high misdiagnosis rate, high recurrence rate and poor treatment compliance. Patients with less episodes usually have less categories of drug combination.