关键词: 双相情感障碍, 临床高危, 前驱期, 临床特征, 躁狂

Abstract:

Objective To compare the differences in clinical characteristics among the patients at clinical high risk for bipolar disorder （CHR-BD）， the patients with bipolar disorder （BD）， and the healthy controls （HC） at low risk， and to provide the basis for the diognasis and treatment of CHR-BD. Methods For the first time， the BD risk criteria and prospective structured assessment tools were jointly used in outpatients aged 16-30 years， and 43 CHR-BD patients were included to ensure the accuracy of the assessment. Meanwhile， 33 BD patients and 32 HC subjects were also enrolled. The clinical symptoms， neurocognitive function， and global functional levels of the subjects in the three groups were evaluated using observer-rated and self-rated tools. The CHR-BD and BD groups were combined， and Logistic regression analysis was used to identify the independent influencing factors related to diagnostic status； Pearson or Spearman correlation analysis was used to analyze the correlations between the global functional levels and the symptoms or neurocognitive characteristics of the patients in CHR-BD and BD groups. Results There were statistically significant differences in the scores of symptom and global functional level scales among HC， CHR-BD， and BD groups （P<0.05）. Compared with HC group， the scores of mood symptoms （anxiety， depression， and mania/hypomania）， psychotic symptoms， total affective temperament questionnaire scores， and some dimensions （cyclothymic， depressive， irritable， and anxious temperaments） in CHR-BD and BD groups were significantly increased （P<0.001）， while the global functional levels were significantly decreased （P<0.001）. Compared with BD group， the lowest global functional level score in the past year in CHR-BD group was significantly increased （P=0.022）， while the current global functional level score was significantly decreased （P=0.005）. No significant differences were observed in neurocognitive function scores among the three groups （P>0.05）. The lowest global functional level score in the past year was an independent influencing factor for BD diagnosis ［odds ratio （OR）=0.952， 95% confidence interval（CI）：0.917-0.988，P=0.010］. In both CHR-BD and BD patients， the current global functional levels were negatively correlated with depressive （r=-0.417， P=0.005； r=-0.617， P<0.001） and anxiety symptoms （r=-0.360， P=0.018； r=-0.506， P=0.003）. In BD patients， the current global functional level was negatively correlated with lifetime manic/hypomanic symptoms （r=-0.360， P=0.039）， psychotic symptoms （r=-0.502， P=0.003）， and affective temperament scores （r=-0.479， P=0.005）， while the lowest global functional level in the past year was negatively correlated with lifetime manic/hypomanic symptoms （r=-0.391， P=0.024）. Conclusion CHR-BD patients share similar mood symptom characteristics with BD patients， and their global functional levels are negatively correlated with depressive and anxiety symptoms. BD patients exhibit worse lowest global functional levels in the past year， and their global functional levels are negatively correlated with manic/hypomanic symptoms.

Key words: Bipolar disorder, Clinical high risk, Prodromal stage, Clinical characteristics, Mania