伴精神病性症状躁狂首发双相障碍Ⅰ型患者疾病特征及长期功能预后

Diseases features and long-term functional prognosis in first-episode manic bipolar disorder-Ⅰ patients with psychotic symptoms

目的比较伴与不伴精神病性症状躁狂首发双相障碍I型患者人口学特征、疾病特征、治疗情况,以及7年后的整体功能水平。方法纳入2011年10月至2013年10月首次躁狂发作患者147例,根据首次发作是否伴精神病性症状,分为伴精神病性症状组和不伴精神病性症状组。收集首次发作时人口学特征,社会支持评定量表(social support rating scale,SSRS)评分、精神疾病家族史、是否伴自杀行为、是否伴3级及以上危险行为、是否伴精神病性症状等疾病特征,复发情况和治疗情况。于第2年、第4年、第7年进行随访,收集复发情况、复发次数、是否伴精神病性症状、是否伴自杀或3级及以上危险行为、治疗情况等资料。第7年末次随访时采用整体功能评定量表(global assessment function,GAF)评估整体功能水平。结果101例(68.7%)患者完成7年随访。伴精神病性症状组33例(32.7%)。伴精神病性症状组与不伴精神病性症状组相比,首次发作时SSRS总分(36.85±9.81 vs.40.93±8.57)、主观支持分(21.24±5.37 vs.23.72±4.85)、客观支持分(7.27±3.10 vs.8.78±3.35)较低(P<0.05);首次发作接受治疗时,伴精神病性症状组首选抗精神病药物者比例高(60.6%vs.36.8%,P=0.024);伴精神病性症状组首次急性期治疗时间长于不伴精神病性症状组[(42.58±20.92)d vs.(35.13±14.04)d,P=0.039]。7年间伴精神病性症状组伴精神病性症状发作次数占比[0.67(0.33,0.95)vs.0.00(0.00,0.25)]、伴自杀行为的抑郁发作次数占比[0.00(0.00,1.00)vs.0.00(0.00,0.00)]、伴3级及以上危险行为躁狂发作次数占比[0.33(0.00,0.58)vs.0.00(0.00,0.33)]高于不伴精神病性症状组(P<0.05)。7年后,伴精神病性症状组GAF分低于不伴精神病性症状组(64.18±10.15 vs.68.54±9.71,P=0.039)。结论与不伴精神病性症状首发躁狂患者相比,伴精神病性症状首发躁狂患者自杀、暴力攻击行为发生率高,首次治疗时以抗精神病药物为主、急性期治疗时间长,7年后功能结局差。

Objective To compare the demographic characteristics,disease characteristics,treatment and global assessment functional 7 years between first-episode manic bipolar disorder-Ⅰpatients with or without psychotic symptoms.Methods A total of 147 patients with first episode manic from October 2011 to October 2013 were collected.According to the presence of psychotic symptoms,first episode manic patients were classified as psychotic and non-psychotic groups.At the first-episode,demographic data,social support rating scale score,family history of mental illness,whether with suicidal behavior,whether with risk behaviors of grade 3 and above,whether with psychotic symptoms and other disease characteristics,recurrence and treatment were collected.Follow-up was performed at 2,4,and 7 years by natural observation.Recurrence,recurrence frequency,whether with psychiatric symptoms,suicidal behavior and risk behaviors of grade 3 and above,treatment,were collected.At the last follow-up,Global Assessment Function(GAF)were used to evaluate functional level after 7 years.Results One hundred and one patients(68.7%)were followed up for 7 years and33 patients(32.7%)had psychotic symptoms.Compared to the non-psychotic patients with the first manic episode,the total score on Social Support Rating Scale(36.85±9.81 vs.40.93±8.57),the score on subjective support(21.24±5.37 vs.23.72±4.85)and objective support of the first episode patients(7.27±3.10 vs.8.78±3.35)in psychotic group were lower(P<0.05).At the first treatment,the proportion of patients in psychotic group who preferred antipsychotic drugs was higher(60.6%vs.36.8%,P=0.024).The duration of treatment in the first acute phase in psychotic group was longer than those in non-psychotic group[(42.58±20.92)d vs.(35.13±14.04)d,P=0.039].In 7 years,the proportion of patients in psychotic group with the proportion of the number of onset frequency with psychotic symptoms[0.67(0.33,0.95)vs.0.00(0.00,0.25)],the proportion of the number of depression episodes with suicidal behavior[0.00(0.00,1.00)vs.0.00(0.00,0.00)]and the proportion of the number of manic episodes with risk behaviors of grade 3 and above[0.33(0.00,0.58)vs.0.00(0.00,0.33)]were higher than those in non-psychotic group(P<0.05).After 7 years,the GAF score in the psychotic groups was lower than that in non-psychotic group(64.18±10.15 vs.68.54±9.71,P=0.039).Conclusion Compared to the first mania patients without psychotic symptoms,the first mania patients with psychotic symptoms have a higher incidence of suicide and violent aggressive behavior.The patients are given priority to antipsychotic drugs in the first treatment,the duration of treatment in the first acute phase were longer,the functional outcome are poorer after 7 years.