双相障碍Ⅰ型与Ⅱ型患者首次抑郁发作前驱期症状特点研究

A study of prodromal symptoms before first-episode depression in patients with bipolar disorder Ⅰ and bipolar disorder Ⅱ

目的探讨双相Ⅰ型与双相Ⅱ型障碍患者首次抑郁发作前驱期症状特点的差异性。方法纳入102例缓解期的双相障碍患者(其中BD-Ⅰ型组57例,BD-Ⅱ型组45例),采用双相情感障碍前驱期症状回顾性量表(BPSS-R),评估两组患者首次抑郁发作前驱期症状特点。结果两组第一次疾病发作类型比较差异有统计学意义(P<0.01),BD-Ⅰ型组较BD-Ⅱ型组抑郁发作前驱期持续时间短(P<0.05)。首次抑郁发作前,BD-Ⅰ型组最常出现的前驱症状包括抑郁情绪、兴趣及愉悦感降低、失眠、学习/工作能力下降等,BD-Ⅱ型组最常出现的前驱症状包括抑郁情绪、兴趣及愉悦感降低、焦虑或紧张等。在首次抑郁发作的前驱期症状中,BD-Ⅰ型组较BD-Ⅱ型组更易出现易激惹或生气,疲劳、精力减退,发脾气、很难控制愤怒,情绪频繁波动、不稳定,过度兴奋,话多,精力过剩、活动过多,过分自信,创造性增加相关症状(P<0.05);BD-Ⅱ型组较BD-Ⅰ型组更易出现焦虑或紧张,抑郁情绪,敏感多疑、被害妄想相关症状(P<0.05)。结论双相障碍患者首次抑郁发作前均存在前驱期症状,且BD-Ⅰ型患者与BD-Ⅱ型患者在持续时间及躁狂相关症状方面存在差异性。

Objective To explore the difference of prodromal symptoms before first-episode depression in patients with bipolar disorder Ⅰ and bipolar disorder Ⅱ. Methods A total of 102 patients with bipolar disorder were selected and divided into BD-Ⅰ group（ patients with bipolar disorder Ⅰ,57 cases） and BD-Ⅱ group（ patients with bipolar disorder Ⅱ,45 cases）. They were assessed with Bipolar Prodrome Symptom Scale-Retrospective（ BPSS-R）. Results There existed significant difference on types of first-onset of the disorder between two groups（ P〈0. 01）. The duration of prodrome before depression in BD-Ⅰ group was significantly shorter than that in BD-Ⅱ group（ P〈0. 05）. Before first-episode depression,the most frequent prodromal symptoms in BD-Ⅰ group were depressive mood,interest and pleasure reducing,insomnia,decreased ability in learning/working; and depressive mood,interest and pleasure reducing,anxiety or tension in BD-Ⅱ group. Ⅰn the prodromal symptoms before firstepisode depression,there were more irritability/anger,fatigue/reduced energy,losing temper/hard to control anger,frequent mood swing,superexitation,being talkative,excess of energy,self-assertiveness,creativity increase in BD-Ⅰ group compared with those in BD-Ⅱ group（ P〈0. 05）; there were more anxiety/tension,depressive mood,being sensitive/suspicious in BD-Ⅱ group compared with those in BD-Ⅰ group（ P〈0. 05）. Conclusions There are prodromal symptoms in patients with bipolar disorder before first-episode depression,and there exist differences in duration and manic related symptoms between patients with bipolar disorder Ⅰ and bipolar disorder Ⅱ.