双相情感障碍临床高危患者的临床特征分析

doi:10.13481/j.1671-587X.20250422

Abstract

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

CLC Number:

R749.4

Shengmin ZHANG,Xinyu MENG,Yingzhen XU,Jingwen SUN,Zhikang MAO,Shuzhe ZHOU,Tianhang ZHOU,Yilin YUAN,Chenmei XIE,Xinrui ZHAO,Yantao MA,Hong MA,Xin YU,Lili GUAN. Clinical characteristics analysis on clinical high-risk patients with bipolar disorder[J].Journal of Jilin University(Medicine Edition), 2025, 51(4): 1061-1071.

Figures/Tables 5

Tab.1

Tab.2

Clinical characteristics of subjects in three groups"

Variable	HC group(n=32)	CHR-BD group(n=43)	BD group(n=33)	F	P
Symptom
HAMD-17 [M (P25, P75)]	1.0 (0.0, 3.0)	15.0 (12.0, 20.0)^*	14.0 (7.5, 20.0)^*	-	<0.001
YMRS [M (P25, P75)]	0.0 (0.0, 0.0)	6.0 (3.0, 11.0)^*	5.0 (1.0, 13.0)^*	-	<0.001
SDS [M (P25, P75)]	0.3 (0.3, 0.4)	0.7 (0.6, 0.8)^*	0.6 (0.5, 0.8)^*	-	<0.001
SAS [M (P25, P75)]	29.0 (26.0, 32.5)	56.0 (48.0, 63.0)^*	54.0 (43.5, 70.0)^*	-	<0.001
MDQ [M (P25, P75)]	0.5 (0.0, 2.0)	8.0 (6.0, 10.0)^*	9.0 (6.5, 11.0)^*	-	<0.001
HCL-32 [M (P25, P75)]	6.5 (3.3, 13.0)	22.0 (16.0, 24.0)^*	22.0 (18.5, 24.5)^*	-	<0.001
PQ-16
Positive symptoms items score [M (P25, P75)]	1.0 (0.0, 2.0)	6.0 (4.0, 10.0)^*	8.0 (5.0, 10.0)^*	-	<0.001
Pain level score [M (P25, P75)]	0.0 (0.0, 0.8)	7.0 (4.0, 12.0)^*	8.0 (3.0, 13.0)^*	-	<0.001
TEMPS-A total (x±s)	4.8±3.4	21.6±6.7^*	21.6±8.6^*	75.268	<0.001
Cyclothymic [M (P25, P75)]	1.0 (0.0, 2.0)	9.0 (6.0, 11.0)^*	9.0 (7.0, 11.0)^*	-	<0.001
Depressive [M (P25, P75)]	0.0 (0.0, 1.0)	5.0 (4.0, 7.0)^*	5.0 (2.5, 7.0)^*	-	<0.001
Irritable[ [M (P25, P75)]	0.0 (0.0, 0.0)	3.0 (1.0, 4.0)^*	2.0 (0.0, 4.5)^*	-	<0.001
Hyperthymic [M (P25, P75)]	2.0 (1.0, 3.0)	3.0 (1.0, 5.0)^*	4.0 (2.0, 6.0)^*	-	0.010
Anxious [M (P25, P75)]	0.0 (0.0, 1.0)	2.0 (1.0, 3.0)^*	3.0 (1.0, 3.0)^*	-	<0.001
Neurocognition
C-BCt total standard T-score (x±s)	54.5±5.9	54.1±7.9	54.3±2.6	0.026	0.975
Connection test standard T-score [M (P25, P75)]	49.0 (47.3, 50.0)	49.0 (46.0, 50.0)	49.0 (48.0, 50.0)	-	0.853
Symbol coding standard T-score (x±s)	55.7±10.1	55.6±9.7	55.8±9.3	0.003	0.997
Continuous operation standard T-score [M (P25, P75)]	49.0 (48.0, 52.0)	51.0 (49.0, 52.0)	51.0 (48.0, 52.0)	-	0.364
Digit span standard T-score [M (P25, P75)]	55.5 (53.0, 56.0)	54.0 (50.0, 57.0)	55.0 (48.0, 59.0)	-	0.825
Global functioning
GAF current (x±s)	92.0±4.6	59.9±14.7^*	67.8±12.8^*△	68.536	<0.001
Highest in the past year [M (P25, P75)]	92.5 (91.0, 98.0)	87.0 (78.0, 91.0)^*	83.0 (79.0, 88.0)^*	-	<0.001
Lowest in the past year (x±s)	84.3±8.7	47.4±15.5^*	39.9±15.2^*△	98.304	<0.001

Tab.2

Tab.3

Tab.4

Tab.5

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Variable	HC group(n=32)	CHR-BD group(n=43)	BD group(n=33)	F/χ²	P
Age [year, M (P25, P75)]	23.0 (22.3, 24.0)	21.0 (19.0, 25.0)	22.0 (18.5, 25.5)	-	0.265
Gender [n (%)]				1.062	0.588
Male	10 (31.2)	9 (20.9)	9 (27.3)
Female	22 (68.8)	34 (79.1)	24 (72.7)
Ethnicity[n (%)]				1.487	0.564
Han	30 (93.8)	37 (86.0)	28 (84.8)
Others	2 (6.2)	6 (14.0)	5 (15.2)
Years of education (year, x±s)	17.0±1.8	14.6±3.0^*	14.8±2.8^*	8.419	<0.001
Education[n (%)]				17.419	0.002
High school	1 (3.1)	10 (23.3)	9 (27.3)
College/bachelor’s degree	14 (43.8)	25 (58.1)	19 (57.5)
Master’s degree or above	17 (53.1)	8 (18.6)	5 (15.2)
Current occupation[n (%)]				11.476	0.012
Full-time employed	3 (9.4)	15 (34.8)	8 (24.2)
On campus students	29 (90.6)	26 (60.5)	21 (63.7)
Unemployed/semi-unemployed	0 (0.0)	2 (4.7)	4 (12.1)
Smoking history[n (%)]				3.109	0.247
No	31 (96.9)	37 (86.0)	28 (84.8)
Yes (including former smokers)	1 (3.1)	6 (14.0)	5 (15.2)
Drinking history[n (%)]				6.421	0.107
Never	18 (56.2)	16 (37.2)	9 (27.3)
Sometimes	14 (43.8)	26 (60.5)	23 (69.7)
Always	0 (0.0)	1 (2.3)	1 (3.0)
Family history of mental disorders[n (%)]				22.544	<0.001
Negative	32 (100.0)	27 (62.8)	19 (57.6)
Positive	0 (0.0)	16 (37.2)	14 (42.4)

Variable	β	SE	OR (95%CI)	Wald χ²	P
Age	0.028	0.053	1.028(0.926-1.142)	0.267	0.606
Years of education	0.022	0.080	1.022(0.874-1.196)	0.075	0.785
HAMD-17	-0.047	0.032	0.954(0.896-1.016)	2.117	0.146
YMRS	-0.008	0.024	0.992(0.947-1.039)	0.121	0.728
SDS	-2.277	1.690	0.103(0.004-2.817)	1.815	0.178
SAS	0.004	0.021	1.004(0.964-1.045)	0.031	0.860
MDQ	0.129	0.080	1.138(0.963-1.332)	2.612	0.106
HCL-32	0.087	0.050	1.091(0.990-1.204)	3.068	0.080
PQ-16 positive symptoms items score	-0.056	0.067	0.946(0.829-1.079)	0.684	0.408
PQ-16 pain level score	0.001	0.036	1.001(0.933-1.074)	0.001	0.981
TEMPS-A total	-0.001	0.032	0.999(0.939-1.063)	0.001	0.972
GAF current	0.041	0.018	1.042(1.006-1.078)	5.363	0.021
GAF highest in the past year	0.003	0.021	1.003(0.962-1.046)	0.025	0.873
GAF lowest in the past year	-0.033	0.017	0.967(0.936-1.000)	3.934	0.047

Variable	β	SE	OR (95%CI)	Wald χ²	P
HAMD-17	-0.003	0.057	0.997 (0.891-1.116)	0.002	0.963
SDS	-2.174	2.722	0.114 (0.001-23.586)	0.638	0.424
MDQ	-0.006	0.102	0.994 (0.813-1.214)	0.004	0.950
HCL-32	0.093	0.067	1.098 (0.963-1.251)	1.959	0.162
GAF current	0.049	0.026	1.050 (0.998-1.106)	3.565	0.059
GAF lowest in the past year	-0.049	0.019	0.952 (0.917-0.988)	6.569	0.010

Variable	CHR-BD group (n=43)		BD group (n=33)
	r	P	r	P
GAF-Current
HAMD-17	-0.501	0.001	-0.843	<0.001
YMRS	0.262	0.090	-0.141	0.435
SDS	-0.417	0.005	-0.617	<0.001
SAS	-0.360	0.018	-0.506	0.003
MDQ	0.168	0.282	-0.128	0.477
HCL-32	0.079	0.615	-0.360	0.039
PQ-16-positive symptoms items score	-0.249	0.107	-0.502	0.003
PQ-16-pain level score	0.279	0.070	-0.367	0.036
TEMPS-A total	0.114	0.465	-0.479	0.005
C-BCT total standard T-score	0.021	0.896	-0.267	0.134
GAF-highest in the past year
MDQ	-0.099	0.529	0.220	0.219
HCL-32	-0.143	0.361	0.067	0.713
TEMPS-A Total	0.032	0.839	-0.232	0.194
GAF-lowest in the past year
MDQ	0.035	0.824	-0.391	0.024
HCL-32	-0.110	0.481	-0.176	0.328
TEMPS-A total	-0.122	0.437	-0.062	0.733

Clinical characteristics analysis on clinical high-risk patients with bipolar disorder

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