第一型與第二型雙極症臨床表徵及生活品質之比較

Comparison of Clinical Features and Quality of Life between Sufferers of Bipolar I and Bipolar II Disorders

10.6225/JEBN.4.4.307

陳惠君(Hui-Chun Chen)；吳羿諠(Yi-Syuan Wu)；許民憲(Min-Hsien Hsu)；高靖雯(Jing-Wen Kao)；陳秀蘭(Shiou-Lan Chen)；陸汝斌(Ru-Band Lu)

雙極症 ； 第一型雙極症 ； 第二型雙極症 ； 自殺危險 ； 生活品質 ； bipolar disorder ； bipolar I disorder ； bipolar II disorder ； suicidal risk ； quality of life

實證護理

4卷4期（2008 / 12 / 01）

307 - 317

繁體中文

雙極症(Bipolar Disorder, BD)為與自殺死亡最具關聯性的精神疾病之一(Raja & Azzoni, 2004)。相關的研究雖不少，但研究結果仍有許多不一致的結果及有待進一步證實的地方。第一型雙極症(Bipolar IDisorder, BPI)與第二型雙極症(Bipolar II Disorder, BPII)為較常見且嚴重的兩種亞型，有關兩者臨床表徵的差異，尤其是對BPII的瞭解仍相當有限，結果亦不一致，尤其亞洲族群的相關資料更顯缺乏。本研究將針對國人BPI與BPII的各種臨床表徵進行比較，分析國人兩亞型疾患的差異與關聯性，並進一步探討國人此兩種亞型BD在臨床表徵上的差異及可能的原因，並嘗試探討未來可能發展的方向，以供日後臨床實務之參考。本研究採縱貫性病程追蹤24週，評估病患的情緒症狀、自殺危險及生活品質；社會人口學變項及服藥狀況亦做記錄。符合收案標準並同意加入本研究者共114人，納入資料分析者共93人：BPI 48人，BPII 45人。本研究發現，BPII患者延遲治療的時間較BPI長，病程中容易有殘存憂鬱症狀、疾病容易復發且其憂鬱期多為混合型憂鬱；而BPII患者的服藥遵從性較差，從本研究中流失率亦較高。追蹤期間，BPII患者在特定疾病狀態下有較高的自殺危險，其心理層面生活品質持續呈現顯著受損情況。建議臨床工作者應該更加重視BPII的惡性化病程與高度自殺危險，及早提供患者合宜的治療策略與復健計劃。

Bipolar disorder (BD) is the most common psychiatric condition associated with suicide. However, related literature on this disorder remains limited and related findings remain controversial. Despite past research findings, current theories are relatively pessimistic regarding prognoses for the soft form of BD due to its intensely chronic depressive features. However, distinctions between bipolar subgroups, especially bipolar II, have not been well studied in Asian populations and crucial factors affecting clinical outcomes remain unclear. Ninety-three patients (48 bipolar I and 45 bipolar II) were followed prospectively over a 24 week period and evaluated in this study. We investigated symptomatic severity, suicidal risk, and quality of life across the mood state of each subject. Socio-demographic information, prescribed medications and drug compliance were also recorded. We found that bipolar II (BPII) patients experience a longer duration between onset and treatment, more prominently mixed depression, higher ASIQ scores in the acute stage, poorer psychological QoL and lower prescription drug compliance during the follow up period than bipolar I (BPI) patients. Through multiple linear regression models, three specific illness variables were found to be associated strongly with mental life satisfaction. We concluded that BPII disorder may be a severe chronic subtype of BPI with special malignancy. It is hoped that the present article will bring attention to the markedly impaired psychological QoL faced by BPII patients and that specific illness variables related to BPI and BPII that affect clinical outcomes will be more clearly delineated in the future.