双相情感障碍自知力水平与冲动攻击行为的关系及复发因素

Relationship between the level of insight and impulsive aggressive behavior in bipolar disorder and its recurrence factors

目的探讨双相情感障碍自知力水平与冲动攻击行为的关系、复发因素及预测模型的预测价值。方法回顾性选取216例双相情感障碍患者,均经治疗达痊愈标准后随访1年。收集临床资料,评估冲动攻击行为,根据评估结果分为冲动组(96例)和无冲动组(120例),比较2组自知力水平,另根据随访结果分为复发组(43例)和未复发组(173例),分析患者复发的危险因素,并构建预测模型,分析预测价值。结果216例双相情感障碍患者冲动攻击行为占44.44%。与无冲动组比,冲动组对住院认识、疾病认识、服药认识、疾病复发及求助方式认识的评分、自知力与治疗态度问卷(ITAQ)总分更低(P<0.05)。双相情感障碍患者对住院认识、疾病认识、服药认识、疾病复发及求助方式认识、ITAQ总分与Barratt冲动量表(BIS-11)、外显攻击行为量表(MOAS)评分呈负相关(P<0.05)。合并睡眠障碍、单一使用心境稳定剂、迅速停药、既往复发次数≥2次是双相情感障碍患者复发的危险因素(P<0.05)。构建预测模型,当logit(P)>9.88时,AUC值为0.873,95%CI为0.821,0.914。结论双相情感障碍患者冲动攻击行为与自知力水平低下有关,且患者复发因素包括合并睡眠障碍、单一使用心境稳定剂、迅速停药、既往复发次数≥2次等,预测模型可较准确地预测双相情感障碍复发。

Objective To explore the relationship between the level of insight and impulsive aggressive behavior in bipolar disorder,recurrence factors,and the predictive value of predictive models.Methods 216 patients with bipolar disorder were selected,and their data were retrospectively analyzed.All patients were followed up for 1 year after reaching the recovery standard after treatment.The clinical data of the patients were collected and their impulsive aggressive behavior was evaluated.The patients were divided into the impulsive group(96 cases)and the non impulsive group(120 cases)according to the evaluation results.The levels of insight in two groups were compared.The patients were divided into the recurrent group(43 cases)and the non recurrent group(173 cases)according to the followed-up results.The risk factors for patient recurrence were analyzed,and a predictive model was constructed to analyze the predictive value.Results The impulsive aggressive behavior of 216 patients with bipolar disorder accounted for 44.44%.Compared with the non impulsive group,the impulsive group had lower scores on hospital awareness,disease awareness,medication awareness,and awareness of disease recurrence and the way to seek help,as well as lower total scores of Insight and Treatment Attitudes Questionnaires(ITAQ)(P<0.05).The hospitalization awareness,disease awareness,medication awareness,awareness of disease recurrence and the way to seek help,and total scores of ITAQ of patients with bipolar disorder were negatively correlated with the scores of Barratt Impulsiveness Scale Version 11(BIS-11)and Modified Overt Aggression Scales(MOAS)(P<0.05).The risk factors for relapse in patients with bipolar disorder included combined sleep disorders,single use of mood stabilizers,rapid withdrawal of medication,and previous recurrence times≥2(P<0.05).The prediction models were constructed.When logit(P)>9.88,the area under the curve(AUC)value was 0.873,with 95%CI of 0.821 to 0.914.Conclusion Impulsive aggressive behavior in patients with bipolar disorder is related to low levels of insight.The risk factors for relapse in patients include combined sleep disorders,single use of mood stabilizers,rapid withdrawal of medication,and previous recurrence times≥2.The predictive model can accurately predict the recurrence of bipolar disorder.