双相障碍与复发性抑郁障碍患者前驱症状临床特点分析

摘要

目的 分析双相障碍与复发性抑郁障碍患者前驱症状的临床特点.方法 采用双相障碍前驱症状回顾性量表对74例双相障碍患者(双相障碍组)和37例复发性抑郁障碍患者(复发性抑郁障碍组)询问自我报告的前驱症状,并针对39个症状进行结构性访谈.结果 (1)68例(91.9％,68/74)双相障碍患者和36例(97.3％,36/37)复发性抑郁障碍患者报告首次发作之前存在前驱症状;(2)双相障碍组较复发性抑郁障碍组患者描述的精神病性症状多见(t=-3.761,P=0.001);(3)双相障碍组较复发性抑郁障碍组患者发生过度高兴/极度兴奋[16例(21.6％,16/74)与2例(5.4％,2/37),x2=5.269,P=0.022]、话多[19例(25.7％,19/74)与3例(8.1％,3/37),x2=5.370,P=0.020]、思维很快/跳跃思维[17例(23.0％,17/74)与3例(8.1％,3/37),x2=4.168,P=0.041]、精力过剩/活动过多[18例(24.3％,18/74)与1例(2.7％,1/37),x2=8.777,P=0.003]、过分自信[14例(18.9％,17/74)与0,x2=8.514,P=0.002]和情绪频繁波动/情绪不稳定[38例(51.4％,38/74)与8例(24.3％,8/37),x2=10.537,P=0.001]的情况多见.结论 双相障碍和复发性抑郁障碍患者表现出不同的前驱症状,而有助于双相障碍患者的早期识别和早期干预.%Objective To explore the differences of prodromal symptoms between bipolar disorder (BD) and recurrent major depressive disorder (RMDD).Methods We used the Bipolar Prodrome Symptom Interview and Scale-Retrospective to investigate 74 BD patients and 37 RMDD patients,which included open questions and semi-structured questions about the 39 prodromal symptoms to the first full depressive episode.Results (1) Most of BD patients (91.9％,68/74) and RMDD patients (97.3％,36/37) could recognize their prodromal symptoms.(2) BD patients reported more psychotic symptoms than RMDD patients (t=-3.761,P=0.001).(3) Compared with RMDD patients,more BD patients reported prodromal symptoms,overly cheerful/happy/on top of the world(16 cases (21.6％,16/74) vs.2 cases (5.4％,2/37),x2=5.269,P=0.022),overly talkative (19 cases (25.7％,19/74) vs.3 cases (8.1％,3/37),x2=5.370,P=0.020),racing thoughts or jumping from one thought to another (17 cases (23.0％,17/74) vs.3 cases (8.1％,3/37),x2=4.168,P=0.041),extremely energetic or active (18 cases (24.3％,18/74) vs.1 cases (2.7％,1/37),x2=8.777,P=0.003),overly self confident (14 cases (18.9％,17/74)vs.0,x2=8.514,P=0.002),and frequent mood swings/lability (38 cases (51.4％,38/74) vs.8 cases (24.3％,8/37),x2=10.537,P=0.001),and these symptoms were more likely to be a part of the bipolar prodromal symptoms.Conclusions BD patients and RMDD patients represent different prodromal symptoms,which could promote early identification and early intervention of BD.