雙相情感障礙症首次發病後12個月內復發者之特徵：初報

Characteristics of Patients with Recurrent Bipolar Disorder within 12 Months after First-onset Mania: A Prospective Study

10.29478/TJP.200603.0006

鐘國軒(Kuo-Hsuan Chung)；黃意霖(Yi-Lin Huang)；陳喬琪(Chiao-Chicy Chen)；蔡尚穎(Shang-Ying Tsai)

首次發病 ； 雙相情感障礙症 ； 復發 ； 發病年齡 ； new-onset ； bipolar disorder ； recurrence ； age at onset

台灣精神醫學

20卷1期（2006 / 03 / 01）

53 - 61

繁體中文

目的：東西方雙相情感障礙症(bipolar disorder)患者之臨床特徵不同，例如：如國內雙相情感障礙症患者物質濫用率並未如西方嚴重。本研究乃在探討有何特徵可能與東方人雙相情感障礙症患者復發有關。方法：收集符合bipolar I disorder，manic or mixed episode(DSM-IV)之患者，以前瞻性追蹤，每4個月會談評估其每週的症狀與服藥狀況，追蹤至第12個月，依據復發型態區分為復發躁症、復發鬱症與未復發共三組加以比較。結果：共收集男性15位、女性26位，收案當時平均25.6歲。一年內再復發者共22位佔53.7%，其中14.7%(N=6)為復發躁症，39.0%(N=16)為復發鬱症者。合併物質濫用者與不配合藥物治療者均僅1位(2.4%)。就各臨床變項加以分析，三組間僅「發病年齡」有顯著差異(p=0.029)，復發躁症組平均發病於17.5歲、復發鬱症組於25.9歲、未復發組於21.6歲。結論：即使低物質濫用率及良好的藥物順服性，仍有高於半數個案復發，且復發鬱症為多數。復發型態可能受發病年齡影響，越年輕發病者越易復發躁症。

Objective: Studies in Western countries have revealed that substance/alcohol abuse is the main risk factor for recurrence in patients with bipolar disorder after first-onset mania. This study investigated the characteristics of Taiwanese patients with recurrent bipolar disorder who had a relatively low prevalence of substance/alcohol abuse. Methods: Patients with bipolar disorder were recruited for participation in this prospective study after first-onset mania during the period from 2000 to 2002. The SCID-P (Structured Interview for DSM-Ⅲ-R-Patient Version) and LIFE (Longitudinal Interval Follow-up Evaluation) were used to evaluate the clinical status at 4-month intervals during the ensuing 12 months. Results were compared among patients with recurrence of manic episode, recurrence of depressive episode, and those without recurrence. Results: Fifteen male and twenty-six female patients, with mean age of 25.6 years were included in this study. Twenty-two patients (53.7%) had recurrent affective episode during the 12-month follow-up period, including 6(14.7%) patients with recurrence of manic episode, and 16(39.0%) patients with recurrence of depressive episode. Only one (2.4%) patient had substance abuse and poor compliance. Comparison of clinical variables among the three groups showed significant difference in age of onset (p=0.029) among the three groups with a mean age of 17.5 years in the manic episode group, 25.9 years in the depressive episode group and 21.6 years in patients without recurrence. Conclusion: More than a half of new-onset bipolar patients had recurrent episodes despite the low prevalence of substance abuse and good compliance. Patients with onset at younger age had a higher risk for recurrence of mania.

1. Akiskal HS,Sadock BJ,Sadock VA (eds.)(2000).Kaplan and Sadock`s Comprehensive Textbook of Psychiatry.Philadelphia:Lippincott Williams & Wilkins.
2. American Psychiatric association(1994).Diagnostic and Statistical Manual of Mental Disorder.Washington DC:DSM-Ⅳ.
3. Bellivier F,Golmard JL,Rietschel M(2003).Age at onset in bipolar I affective disorder: further evidence for three subgroups.Am J Psychiatry,160,999-1001.
4. Black D W,Winokur G,Hubert J,Narsrallah A(1988).Predictors of immediate response in the treatment of mania: the important if comorbidity.Biol Psychiatry,24,191-198.
5. Bowden CL,Calabrese JR,Sachs G(2003).A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently manic or hypomanic patients with bipolar I disorder.Arch Gen Psychiatry,60,392-400.
6. Brady KT,Sonne SC(1995).The relationship between substance abuse and bipolar disorder.J Clin Psychiatry,56(suppl 3),19-24.
7. Calabrese JR,Vieta E,El-Mallakh R(2004).Mood state at study entry as predictor of the polarity of relapse in bipolar disorder.Biol Psychiatry,56,957-963.
8. Conus P,McGorry PD(2002).First-episode mania: a neglected priority for early intervention.Aust N Z J Psychiatry,36,158-172.
9. Cusin C,Serretti A,Lattuada E,Mandelli L,Smeraldi E(2000).Impact of clinical variables on illness time course in mood disorders.Psychiatry Res,97,217-227.
10. Feinman JA,Dunner DL(1996).The effect of alcohol and substance on the course of bipolar affective disorder.J Affect Disord,37,43-49.
11. Goldberg JF,Harrow M,Grossman LS(1995).Course and outcome in bipolar affective disorder: a longitudinal follow-up study.Am J Psychiatry,152,379-384.
12. Goodwin FK(2002).Rationale for long-term treatment of bipolar disorder and evidence for long-term lithium treatment.J Clin Psychiatry,63(Suppl 10),5-12.
13. Goodwin FK,Jamison KR(1990).Manic-depressive Illness.New York:Oxford University Press.
14. Hamilton M(1960).A rating scale for depression.J Neurol Neurosurg Psychiatry,23,56-62.
15. Harrow M,Goldberg JF,Grossman LS,Meltzer HY(1990).Outcome in manic disorders: a naturalistic follow-up study.Arch Gen Psychiatry,47,665-671.
16. Keck PE,McElroy SL,Strakowski SM(1998).12-month outcome of patients with bipolar disorder following hospitalization for a manic or mixed episode.Am J Psychiatry,155,646-652.
17. Keller MB,Lavari PW,Friedman BE(1987).The longitudinal interval follow-up evaluation.Arch Gen Psychiatry,44,540-548.
18. Kessing LV,Hansen MG,Andersen PK(2004).Course of illness in depressive and bipolar disorders. Naturalistic study, 1994-1999.Br J Psychiatry,185,372-377.
19. Lam D,Wong G(1997).Prodromes, coping strategies, insight and social functioning in bipolar affective disorders.Psychol Med,27,1091-1100.
20. Lin CC,Bai YM,Hu PG,Yeh HS(1998).Substance use disorders among inpatients with bipolar disorder and major depressive disorder in a general hospital.Gen Hosp Psychiatry,20,98-101.
21. Maj M,Pirozzi R,Kemali D(1989).Long-term outcome of lithium prophylaxis in patients initially classified as complete responders.Psychopharmacology,98,535-538.
22. Mikloaitz DJ,Goldstein MJ,Nuechterlein KH(1988).Family factors and the course of bipolar affective disorder.Arch Gen Psychiatry,45,225-231.
23. Regier CA,Farmer ME,Rae DS(1990).Comorbidity of mental disorders with alcohol and other drug abuse results from the epidemiologic catchment area (ECA) study.JAMA,264,2511-2518.
24. Spitzer RL,Williams JBW,Gibbon M,First MB(1992).The structured Clinical Interview for DSM-III-R (SCID). I: history, rationale, and description.Arch Gen Psychiatry,49,624-629.
25. Staner L,Tracy A,Dramaix M(1997).Clinical and psychosocial predictors of recurrence in recovered bipolar and unipolar deporessive disorder: a one-year controlled prospective study.Psychiatry Res,69,39-51.
26. Stefos G,Bauwens F,Staner L,Pardoen D,Mendlewicz J(1996).Psychosocial predictors of major affective recurrences in bipolar disorder: a 4-year longitudinal study of patients on prophylactic treatment.Acta Psychiatr Scand,93,420-426.
27. Strakowski SM,Keck PE,McElroy SL(1998).Twelve-month outcome after a first hospitalization for affective psychosis.Arch Gen Psychiatry,55,49-55.
28. Strakowski SM,McElroy SL,Keck PE,West SA(1996).Suicidality among patients with mixed and manic bipolar disorder.Am J Psychiatry,153,674-676.
29. Strawkowski SM,Stoll AL,Tohen M(1993).The tridimensional personality questionnaire as a predictor of six-month outcome in first-episode mania.Psychiatry Res,48,1-8.
30. Tohen M,Stoll AL,Strakowski SM(1992).The McLean first-episode psychosis project: six-month recovery and recurrence outcome.Schizophrenia Bull,18,273-282.
31. Tohen M,Waternaux CM,Tsuang MT(1990).Outcome in mania: a four-year prospective follow-up of 75 patients utilizing survival analysis.Arch Gen Psychiatry,47,1106-1111.
32. Tohen M,Zarate CA,Hennen J(2003).The McLean-Harvard First-Episode Mania Study: prediction of recovery and first recurrence.Am J Psychiatry,160,2099-2107.
33. Tsai SY,Chen C,Kuo C,Lee J,Lee H,Strakowski SM(2001).15-year outcome of treated bipolar disorder.J Affect Disord,63,215-220.
34. Tsai SY,Chen CC,Yeh EK(1997).Alcohol problems and long-term psychosocial outcome in Chinese patients with bipolar disorder.J Affect Disord,46,143-150.
35. Tsai SY,Lee CH,Chen CC,Lee HC(2002).Risk factors for natural death in bipolar disorder.The 12th World Congress of Psychiatry, World Psychiatric Association,Yokohama, Japan:
36. Tsai SY,Strakowski SM,Chen CC,Lee HC(2002).Cross-cultural comparison of new-onset mania between US and Taiwan.The 12th World Congress of Psychiatry, World Psychiatric Association,Yokohama, Japan:
37. Winokur C,Coryell W,Akiskal HS,Endicott J,Keller M,Mueller T(1994).Manic-depressive (bipolar) disorder: the course in light of a prospective ten-year follow-up of 131 patients.Acta Psychiatr Scand,89,102-110.
38. Young RC,Biggs JT,Ziegler VF,Meyer DA(1978).A rating scale for mania: reliability, validity and sensitivity.Br J Psychiatry,133,429-435.
39. 蔡尚穎、陳喬琪、胡維恆、李儒卿、趙文聖、葉英堃(1996)。躁鬱症共存物質濫用：15年追蹤研究。中華精醫，7，357-363。