江西省精神病院精神科双相情感障碍患者精神及躯体共病率的调查及相关因素分析

Investigation of the psychiatric and somatic comorbidity rate of bipolar disorder patients in the psychiatric department of Jiangxi province psychiatric hospital and analysis of related factors

目的分析江西省精神病院双相情感障碍(BD)患者精神、躯体共病情况与相关影响因素。方法选取2018年1月至2020年1月于江西省精神病院精神科就诊的290例BD患者作为研究对象,采用国际神经精神科简式访谈问卷进行其他精神疾病的共病调查。依据患者提供的疾病诊断进行筛选和研究躯体疾病共病。结果290例BD患者中,共病精神疾病98例(33.79%),其中共病1种77例(78.57%),共病2种14例(14.29%),共病3种7例(7.14%)。最常见的精神科共病为共病焦虑症67例(68.37%),其次为共病物质依赖39例(39.80%)。共病躯体疾病54例(18.62%),其中共病1种38例(70.37%),共病2种12例(22.22%),共病3种4例(7.41%);最常见躯体共病为共病偏头痛39例(72.22%),其次为共病糖尿病15例(27.78%)、共病心血管疾病12例(22.22%)、共病肥胖8例(14.81%)。BD精神科共病患者与非精神科共病患者在年龄、婚姻状况、受教育程度、居住地、是否独居、职业状态、发病年龄、病程方面差异无统计学意义;精神科共病患者的女性、有吸烟史、有饮酒史、有心境障碍家族史、有焦虑症状、易激惹均高于非精神科共病患者,差异有统计学意义(P<0.05)。BD躯体共病患者与非躯体共病患者在年龄、婚姻情况、受教育程度、居住地、是否独居、职业状态、病程方面方面差异无统计学意义;BD躯体共病患者年龄、病程均长于非躯体共病患者,BD躯体共病患者发病年龄小于非躯体共病患者,BD躯体共病患者有吸烟史、有饮酒史、有心境障碍家族史、有焦虑症状、易激惹均高于非躯体共病患者,差异有统计学意义(P<0.05)。性别、饮酒史、心境障碍家族史及焦虑症状均为影响BD共病精神疾病的危险因素(P<0.05),而吸烟史、易激惹比较差异无统计学意义。年龄、吸烟史、心境障碍家族史、易激惹均为影响BD共病躯体疾病的危险因素(P<0.05),而发病年龄、饮酒史比较差异无统计学意义。结论BD与其他精神疾病和躯体疾病具有广泛共病,BD患者精神及躯体疾病共病与患者性别、年龄、饮酒、吸烟和心境障碍家族史、焦虑症状易激惹有关。在诊疗过程中,应对上述高危因素提高警惕。

Objective To analyze the psychiatric and somatic comorbidities of patients with bipolar disorder(BD)in Jiangxi provincial psychiatric hospital and related influencing factors.Methods A total of 290 BD patients who attended the Jiangxi provincial psychiatric hospital from January 2018 to January 2020 were selected as the research subjects,and the international neuropsychiatric simplified interview questionnaire was used to investigate the comorbidities of other psychiatric diseases.Screening and study of comorbidities of medical conditions based on the patient's diagnosis.Results Among the 290 patients with BD,98(33.79%)had comorbid psychiatric diseases,including 77(78.57%)of one comorbidity,14(14.29%)of two comorbidities,and seven cases(7.14%)of three comorbidities.The most common psychiatric comorbidities were comorbid anxiety disorders with 67 cases(68.37%),followed by comorbid substance dependence in 39 cases(39.80%).There were 54 cases(18.62%)of comorbid physical diseases,including 38 cases(70.37%)of 1 comorbidity,12 cases(22.22%)of 2 comorbidities,and 4 cases(7.41%)of 3 comorbidities.The most common comorbidities were comorbid migraine in 39 cases(72.22%),followed by comorbid diabetes mellitus in 15 cases(27.78%),comorbid cardiovascular disease in 12 cases(22.22%),and comorbid obesity in 8 cases(14.81%).There was no significant difference in psychiatric comorbidities and non-comorbidities in terms of age,marital status,education level,place of residence,whether they lived alone,occupational status,age of onset,and course of disease among BD patients.The proportion of women,smoking history,alcohol history,family history of mood disorders,proportion of anxiety symptoms,and irritability of patients with psychiatric comorbidities were statistically significant(P<0.05).There was no significant difference between patients with BD and non-physical comorbidities in terms of age,marital status,education level,place of residence,whether they lived alone,occupational status,and course of disease.The age and duration of BD somatic comorbidities were longer than those of non-somatic comorbidities,the age of onset of BD somatic comorbidities was younger than that of non-somatic comorbidities,and the proportion of BD somatic comorbidities with smoking history,drinking history,family history of mood disorders,anxiety symptoms,and irritability were higher than those of non-somatic comorbidities,and the differences were statistically significant(P<0.05).Gender,drinking history,family history of mood disorder and anxiety symptoms were all risk factors affecting BD comorbid psychiatric disorders(P<0.05),there was no significant difference in smoking history and irritability.Age,smoking history,family history of mood disorder,and irritability were all risk factors affecting BD comorbid physical diseases(P<0.05),there was no significant difference in age of onset and drinking history.Conclusion BD has extensive comorbidities with other psychiatric and physical diseases,and comorbidities of mental and somatic diseases in BD patients are related to gender,age,alcohol consumption,smoking,family history of mood disorders,and irritability of anxiety symptoms.During diagnosis and treatment,vigilance should be given to such high-risk factors.