南京地区1028例双相情感障碍患者冲动攻击行为及其影响因素分析

Impulsive-aggressive behavior and its influencing factors in 1028 patients with bipolar affective disorder in Nanjing

目的分析双相情感障碍患者冲动攻击行为影响因素,为制订有效的干预措施、减少双相情感障碍患者冲动攻击行为提供借鉴资料。方法以2021年1月至2022年6月南京市某专科医院明确诊断为双相情感障碍的患者为研究对象,采用修订版外显攻击行为量表(MOAS)评估其冲动攻击行为状况,收集患者的人口学资料(性别、年龄、受教育程度、居住模式)、疾病特征(起病形式、疾病分类、初/复发、发病前应激事件、自知力)及生理学检查指标[肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、脑电地形图],通过单因素、多因素Logistic回归分析以上各项是否双相情感障碍患者冲动攻击行为影响因素。结果双相情感障碍患者1028例,有冲动攻击行为194例(18.87%)。多因素Logistic回归分析显示疾病分类(OR=0.163)、初/复发(OR=1.972)、发病前应激事件(OR=2.115)、自知力(OR=2.980)、CK(OR=1.355)、脑电地形图(OR=2.395)是双相情感障碍患者冲动攻击行为的影响因素。结论双相情感障碍患者冲动攻击行为发生风险高,双相障碍I型、复发、发病前有应激事件、自知力损伤、CK>上限值、脑电地形图异常会增加双相情感障碍患者冲动攻击行为,可针对双相情感障碍患者个体情况提前采取有效干预措施以减少冲动攻击行为。

Objective To analyze the influencing factors of impulsive-aggressive behavior in patients with bipolar affective disorder,and to provide reference for formulating effective intervention measures and reducing impulsive-aggres-sive behavior in patients with bipolar affective disorder.Methods The patients diagnosed with bipolar affective disorder at a specialized hospital in Nanjing City from January 2021 to June 2022 were selected as the subjects,and the Modified Overt Aggression Scale(MOAS)was used to evaluate their impulsive-aggressive behavior.The demographic data(gender,age,education level,and living pattern),disease characteristics(onset form,disease classification,initial/recurrence,pre-onset stress events,and insight),and biological examination indicators[creatine kinase(CK),creatine kinase isoen-zyme(CK-MB),and brain electrical activity mapping]of patients were collected.Univariate and multivariate Logistic re-gression analysis were used to analyze the influencing factors of impulsive-aggressive behavior in patients with bipolar affec-tive disorder.Results Among the 1028 patients with bipolar affective disorder,194(18.87%)had impulsive-aggressive behavior.Multivariate Logistic regression analysis showed that disease classification(OR=0.163),initial/recurrence(OR=1.972),pre-onset stress events(OR=2.115),insight(OR=2.980),CK(OR=1.355),and brain electrical activity mapping(OR=2.395)were influencing factors of impulsive-aggressive behavior in patients with bipolar affective disorder.Conclusions Patients with bipolar affective disorder have a high risk of impulsive-aggressive behavior.Bipolar disorder type I,recurrence,pre-onset stress events,insight impairment,CK>upper limit,and abnormal brain electrical activity mapping will increase the impulsive-aggressive behavior of patients with bipolar affective disorder.Effective intervention measures can be taken in advance to reduce impulsive-aggressive behavior according to the individual situation of patients with bipolar affective disorder.