首次躁狂发作患者不同亚型临床特征分析
Comparative study of clinical features between different subtype bipolar patients with first mania episode

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。
： 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