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.