残留症状对缓解期双相情感障碍患者心理社会功能的影响

Impact of residual symptoms on psychosocial function of patients with euthymic bipolar disorder

目的探讨残留症状对缓解期双相情感障碍患者心理社会功能的影响。方法采用横断面研究,选取2019年11月至2020年12月就诊于河北医科大学第一医院门诊的81例纳入符合ICD-10诊断的缓解期双相情感障碍患者,对其进行人口统计学调查,采用24项汉密尔顿抑郁量表(HAMD)、轻躁狂量表(HCL-32)、汉密尔顿焦虑量表(HAMA)测量双相情感障碍患者的残留情绪症状,采用霍普金斯词汇学习测验-修订版(HVLT-R)、简易视觉空间记忆测验-修订版(BVMT-R)、连线测试A(TMT-A)部分实验、数字广度测试评估残留的认知症状,使用功能大体评定量表(GAF)评估心理社会功能。根据功能大体评定量表评分将患者分为GAF=9组(27例)和GAF<9组(54例)。采用SPSS 22.0统计软件对数据进行分析。结果GAF<9组的女性[40.7%(22/54)]明显多于GAF=9组[33.3%(9/27)],受教育年限[12.00(9.00,13.00)年]明显少于GAF<9组[16.00(12.00,16.00)年],无职业者[40.7%(22/54)]明显多于GAF=9组[18.5%(5/27)],抗精神病药物使用剂量[(10.48±5.40)mg]明显高于GAF=9组[(7.99±5.65)mg],HAMD评分[6.00(3.75,10.00)分]明显高于GAF=9组[3.00(0,6.00)分],BVMT-RT1评分[4.00(1.00,8.00)分]明显低于GAF=9组[6.00(3.00,10.00)分],BVMT-RDR评分[7.50(3.00,11.25)分]明显低于GAF=9组[11.00(8.00,12.00)分],DST评分[14.00(12.00,16.00)分]低于GAF=9组[15.00(13.00,18.00)分]。两组患者的性别、受教育年限、婚姻、职业、吸烟、饮酒、既往史、心境稳定剂、抗抑郁药、苯二氮䓬类药物的使用、HAMD评分、DST评分、BVMT-RT1评分、BVMT-RDR评分比较,差异均有统计学意义(P<0.05)。双相情感障碍患者缓解期的整体功能与受教育年限(r=-0.34,95%CI:-0.53~-0.12,P<0.01)、HAMD评分(r=0.37,95%CI:0.16~0.56,P<0.01)、BVMT-RT1评分(r=-0.23,95%CI:-0.41~-0.02,P=0.04)、BVMT-RDR评分(r=-0.24,95%CI:-0.45~-0.02,P=0.03)、数字广度测验总分(r=-0.23,95%CI:-0.42~-0.01,P=0.04)、抗精神病药物(r=0.23,95%CI:0.02~0.44,P=0.04)之间存在显著的相关性。缓解期的双相情感障碍患者残留抑郁症状(χ^(2)=5.33,OR=1.58,95%CI:1.07~2.33,P=0.02)、使用抗精神药物(χ^(2)=4.77,OR=1.37,95%CI:1.03~1.82,P=0.03)是其心理社会功能损害的危险因素;受教育年限长是其保持良好心理社会功能的保护因素(χ^(2)=5.31,OR=0.34,95%CI:0.14~0.85,P=0.02)。结论缓解期双相情感障碍患者心理社会功能的损害危险因素包括残留抑郁症状、使用抗精神病药物,保护因素包括受教育年限长。

Objective To explore the impact of residual symptoms on psychosocial function of patients with euthymic bipolar disorder.Methods A cross-sectional study was conducted.A total of 81 patients with euthymic bipolar disorder diagnosed by ICD-10,who were admitted to the outpatient clinic of the First Hospital of Hebei Medical University from November 2019 to December 2020,were enrolled in this study.The demographic survey was conducted.The residual mood symptoms were measured by Hamilton Depressive Scale 24 items(HAMD-24),Hypomania Check List(HCL-32)and Hamilton Anxiety Scale(HAMA).Hopkins Verbal Learning Test revised(HVLT-R),Brief Visuospatial Memory Test revised(BVMT-R),Trail Making Test A(TMT-A)and Digit span task(DST)were used to assess the residual cognitive symptoms.The Global Assessment Function(GAF)was used to evaluate the psychosocial function.The patients were divided into two groups according to the score of GAF:high social function group(GAF=9)with 27 cases and low social function group(GAF<9)with 54 cases.All the data were analyzed by SPSS 22.0.Results Compared with the GAF=9 group,the GAF<9 group had more female[40.7%(22/54)vs 33.3%(9/27)],lower level of education[12.00(9.00,13.00)vs 16.00(12.00,16.00)],more unemployed[40.7%(22/54)vs 18.5%(5/27)],higher dosage of antipsychotics[(10.48±5.40)vs(7.99±5.65)]mg,higher HAMD score[6.00(3.75,10.00)vs 3.00(0,6.00)],lower BVMT-RT1 score[4.00(1.00,8.00)vs 6.00(3.00,10.00)],lower BVMT-RDR score[7.50(3.00,11.25)vs 11.00(8.00,12.00)]and lower DST score[14.00(12.00,16.00)vs 15.00(13.00,18.00)].The differences in gender,education,marriage,profession(χ^(2)=9.00,P=0.03),smoking history,drinking history,past history,the use of mood stabilizers,antidepressant,benzodiazepines,the score of HAMD,DST,BVMT-RT1,BVMT-RDR were statistical significant(P<0.05).The overall function of patients with euthymic bipolar disorder was correlated with education level(r=-0.34,95%CI=-0.53--0.12,P<0.01),HAMD(r=0.37,95%CI=0.16-0.56,P<0.01),BVMT-RT1(r=-0.23,95%CI=-0.41--0.02,P=0.04),BVMTRDR(r=-0.24,95%CI=-0.45--0.02,P=0.03),DST(r=-0.23,95%CI=-0.42--0.01,P=0.04)and the use of antipsychotics(r=0.23,95%CI=0.02-0.44,P=0.04).In patients with euthymic bipolar disorder,the residual depressive symptoms(χ^(2)=5.33,OR=1.58,95%CI=1.07-2.33,P=0.02)and the use of antipsychotics(χ^(2)=4.77,OR=1.37,95%CI=1.03-1.82,P=0.03)were the risk factors of psychosocial function impairment,and high level of education was a protective factor(χ^(2)=5.31,OR=0.34,95%CI=0.14-0.85,P=0.02).Conclusions The risk factors of psychosocial function impairment in patients with euthymic bipolar disorder include residual depressive symptoms and use of antipsychotics.The protective factor for maintaining psychosocial function in patients with euthymic bipolar disorder is high level of education.