误诊为抑郁症的双相障碍Ⅰ型患者自杀风险的危险因素分析

Risk factors to suicidal risk in misdiagnosed bipolar disorder I treated for major depressive disorder

目的探讨误诊为抑郁症的双相障碍Ⅰ型患者自杀风险的社会人口学与临床特征方面的危险因素。方法来自全国13个中心患者共1478例,收集社会人口学及临床特征等信息,通过简明国际神经精神访谈(the Mini International Neuropsychiatric Interview,MINI)5.0中文版确定诊断,其中116例被诊断为双相Ⅰ型。此116例患者采用MINI中自杀模块界定自杀风险,比较有、无自杀风险两组之间特征有无差异,通过Logistic回归分析探讨自杀风险的危险因素。结果与无自杀风险组相比,有自杀风险组发作频繁、更多伴不典型特征、自杀观念及精神病性症状、周期性或季节性、起病有诱因、更多次发病。Logistic回归分析显示,精神病性症状(OR=6.127)、伴有自杀观念(OR=3.940)及频繁发作(OR=3.283)与误诊为抑郁症的双相Ⅰ型患者自杀风险高相关(均P<0.05)。结论精神病性症状、自杀观念及频繁发作可能是误诊为抑郁症的双相Ⅰ型患者自杀风险的独立危险因素。

Objective To analyze the risk factors of socio-demographic and clinical characteristics related to suicidal risk in misdiagnosed bipolar disorder I （ BP I ） treated for major depressive disorder （MDD）. Methods A total of 1478 patients in 13 major mental health centers in China. The patients＇ socio-demographic and clinical char- acteristics were recorded. DSM-1V diagnoses were established using the Mini International Neuropsychiatric Inter- view （MINI）, 116 patients were diagnosed BP I. This 116 patients were classified with suicidal risk group and no suicidal risk group by the suicidality module of MINI. We compared socio-demographic characteristics and clinical features between the two groups. Finally, logistic regression was performed to evaluate significant risk factors associ- ated with suicidal risk. Results In comparison to the non suicidal ris.k group, the risk group had more frequent de- pressive episodes, untypical characteristics, suicidal ideation, psychotic symptoms, seasonal depressive episodes, premorbid cause, more depressive episodes. Logistic regression analysis showed that psychotic symptoms （OR = 6. 127）, suicidal ideation （ OR = 3. 940）, frequent depressive episodes （ OR = 3.283 ） were significant associated with higher Suicidal risk in BP I treated for MDD （P〈 0. 05）. Conclusions It shows that psychotic symptoms , suicidal ideation, frequent depressive episodes may be potential independent risk factors to suicide risk.