上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

首次躁狂发作患者不同亚型临床特征分析

周儒白 1，洪武 1，赵国庆 1，黄佳 1，粟幼嵩 1，王勇 1，胡莺燕 1，曹岚 1，苑成梅 1，彭代辉 1，吴志国 1，#br# 汪作为 2，邢梦娟 1，陈俊 1，方贻儒 1   

  1. 1. 上海交通大学医学院附属精神卫生中心心境障碍科，上海 200030；2. 上海市虹口区精神卫生中心，上海 200083
  • 出版日期:2017-04-28 发布日期:2017-05-04
  • 通讯作者: 方贻儒，电子信箱：yirufang@aliyun.com。陈俊，电子信箱：doctorcj2010@gmail.com。
  • 作者简介:周儒白（1991—），女，博士生；电子信箱：zhourubai@foxmail.com。
  • 基金资助:

    国家自然科学基金（91232719，81201056，81301159）；上海市卫生系统优秀人才培养项目（XYQ2011014）；上海市科委医学引导类项目（12401906200）；国家临床重点专科—上海市精神卫生中心（卫生部医政司2011-873）；“十二五”国家科技支撑项目（2012BAI01B04）

Comparative study of clinical features between different subtype bipolar patients with first mania episode

ZHOU Ru-bai1, HONG Wu1, ZHAO Guo-qing1, HUANG Jia1, SU You-song1, WANG Yong1, HU Ying-yan1, CAO Lan1, YUAN Cheng-mei1, PENG Dai-hui1, WU Zhi-guo1, WANG Zuo-wei2, XING Meng-juan1, CHEN Jun1, FANG Yi-ru1   

  1. 1.Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; 2.Shanghai Hongkou District Mental Health Centre, Shanghai 200083, China
  • Online:2017-04-28 Published:2017-05-04
  • Supported by:

    National Natural Science Foundation of China, 91232719, 81201056, 81301159; Shanghai Health Bureau Excellent Young Talents Program, XYQ2011014; Shanghai Committee of Science and Technology, 12401906200; National Key Clinical Disciplines at Shanghai Mental Health Center, OMA-MH, 2011-873; National Key Technology Research & Development Program of the Ministry of Science and Technology of China in the “12th Five-year Plan”, 2012BAI01B04

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摘要：

目的 ·比较首次躁狂发作患者不同亚型的临床特征，为双相障碍的筛查和早期识别提供新思路。方法 ·依托于中国双相躁狂临床路径调研数据库，研究对象为 2012年11月—2013年1月中国26个精神卫生服务机构的门诊或住院的双相障碍患者，比较首次躁狂发作患者中目前为轻躁狂（Ⅰ组）、不伴精神病性症状的躁狂发作（Ⅱ组）、伴精神病性症状的躁狂发作（Ⅲ组）及混合状态（Ⅳ组）4种亚型的临床特征。结果 ·双相障碍首次躁狂发作患者不同亚型在躁狂症状群及焦虑等多项临床症状的分布上存在显著差异。进一步将Ⅰ、Ⅲ、Ⅳ组与Ⅱ组进行比较，发现Ⅱ组的典型躁狂症状群分布显著高于其他亚型，Ⅳ组、Ⅰ组及Ⅲ组的焦虑相关症状显著高于Ⅱ组。Logistic回归分析提示，比平日更善辩或诙谐、坐卧不宁可能有利于预测轻躁狂，年龄较小、首次发作类型为躁狂可能有利于预测伴精神病性躁狂，年龄较大、民族为少数民族、坐卧不宁可能有利于预测混合状态。结论 ·首次躁狂发作患者不同亚型表现出不同的临床特征；分析亚型特征有利于双相障碍的早期识别。

关键词: 双相障碍, 躁狂发作, 临床亚型, 临床特征

Abstract:

 Objective · To compare the clinical features between different subtype bipolar patients with first mania episode, and to contribute to early identification of bipolar disorder. Methods · This study was based on the database named as National Bipolar Mania Pathway Survey (BIPAS). From November 2012 to January 2013, bipolar patients from 26 mental health facilities in China were enrolled in current study. The clinical features were compared between mania patients of different subtypes, including hypomania (group Ⅰ), mania without psychotic symptoms (group Ⅱ), mania with psychotic symptoms (group Ⅲ ) and mixed state (group Ⅳ ). Results · There was significant difference in the percentage of clinical symptoms between different subtype bipolar patients with first mania episode, especially the mania and anxiety related symptoms. Group Ⅰ , Ⅲ , Ⅳ were further compared with group Ⅱ , which was considered as the typical bipolar disorder. The results showed that the mania related symptoms was significantly higher in group Ⅱ , but anxiety related symptoms was significantly higher in group Ⅰ , Ⅲ , Ⅳ . Moreover, Logistic regression analysis revealed that more eloquent or humor and unusually restless could be in favor of the diagnosis of hypomania; younger and mania or hypomania as first episode might be in favor of the diagnosis of mania with psychotic symptoms; older, national minorities and unusually restless could be in favor of the diagnosis of mixed state. Conclusion · The clinical features between different subtype bipolar patients with first mania episode are various, and analysis of the clinical features can contribute to early identification of bipolar disorder.

Key words:  bipolar disorder, mania, subtype, clinical features