误诊为其他精神障碍的双相障碍患者的临床分析

Analysis on clinical features of bipolar disorder patients who were misdiagnosed as other mental disorders

目的:分析误诊为其他精神障碍的双相障碍(BD)患者的临床资料。方法:收集2012年至2015年在本中心门诊和住院治疗的BD患者的一般人口学资料及临床资料;应用心境障碍问卷(MDQ)对入组者症状进行评估,根据既往是否曾被误诊,将入组者分为误诊组及首诊即确诊组;分析误诊的影响因素及本次发作入院前用药规范程度。结果:共104例患者入组,首诊确诊组23例,误诊组81例。误诊为抑郁障碍44例,焦虑障碍3例,精神分裂症16例,抑郁障碍合并焦虑障碍1例,抑郁障碍合并精神分裂症6例,抑郁障碍合并焦虑障碍及精神分裂症1例,其他精神障碍10例。误诊组MDQ评分明显高于首诊确诊组(P<0.05);多元Logistic回归分析显示,误诊的相关影响因素是MDQ中的第1项“您感到非常好或非常开心,这种特别开心、兴奋而带来麻烦”阳性、抑郁发作次数、轻躁狂发作次数(P<0.05或P<0.01);本次“抑郁发作”患者中47.8%用药不符合治疗指南,影响本次情绪发作治疗用药规范程度的因素是“最近一次发作极性”、“抑郁发作次数”和“躁狂发作次数”(P均<0.05)。结论:BD较容易被误诊为抑郁障碍、精神分裂症;MDQ中第1项阳性、抑郁发作次数、轻躁狂发作次数与误诊为抑郁障碍相关;抑郁发作的患者更易受到不符合指南的治疗方案;应用MDQ筛查有助于降低误诊的风险。

Objective:To analyze the clinical features of bipolar disorder(BD)patients who were misdiagnosed as other mental disorders.Method:General demographic data and clinical data were collected from 2012 to 2015 in outpatients and inpatients with BD in our center.The symptoms of the participants were assessed by the Mood Disorder Questionnaire(MDQ),and the participants were divided into the misdiagnosed group and the properly-diagnosed group according to whether they had been misdiagnosed in the past.The factors influencing the misdiagnosis and the degree of medication standardization before the admission of this episode were analyzed.Results:104 patients were enrolled.23 patients were in the properly-diagnosed group and 81 were misdiagnosed as depression(n=44),anxiety disorder(n=3),schizophrenia(n=16),depression combined with anxiety disorder(n=1),depression combined with schizophrenia(n=6),depression combined with anxiety disorder and schizophrenia(n=1)and other mental disorders(n=10).MDQ score in the misdiagnosed group was obviously higher than that in the properly-diagnosed group(P<0.05).Multiple Logistic regression analysis showed that the association with MDQ item 1"very happy and excited and causing trouble for the happiness"positive,the number of depressive episodes,the number of hypomanic episodes were statistically significant(P<0.05 or P<0.01).The patients in depressive episode accounted for the highest proportion(47.8%)for receiving the unproper treatment.The guidline-concordance of treatment were associated with the type of current episode,the number of depressive episodes and manic episodes(all P<0.05).Conclusion:BD is more likely to be misdiagnosed as unipolar depression and schizophrenia.Application of MDQ item 1 positive,the number of depressive episodes and hypomanic episodes are related to being misdiagnosed as unipolar depression.Patients with depressive episode are more likely to accept treatment options that do not meet the guidelines and applying MDQ screening helps to reduce the risk of misdiagnosis.