Izlaganje sa skupa
BIPOLAR DISORDER: THE IMPORTANCE OF CLINICAL ASSESSMENT IN IDENTIFYING PROGNOSTIC FACTORS - AN AUDIT. Part 1: An analysis of potential prognostic factors
Norma Verdolini
; School of Specialization in Psychiatry, Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
Jonathon Dean
; School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital Gonville and Caius College, Cambridge, UK
Sandro Elisei
; Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
Roberto Quartesan
; Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
Rashid Zaman
; Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy ; South Essex Partnership University Foundation Trust, Bedfordshire Centre for Mental Health Research in association with the University of Cambridge, Department of Psychiatry, University of Cambridge, UK
Mark Agius
; South Essex Partnership University Foundation Trust, Bedfordshire Centre for Mental Health Research in association with the University of Cambridge, Department of Psychiatry, University of Cambridge, UK ; Clare College Cambridge, The University of Cambridge, Cambridge, UK
Sažetak
Background: Prognostic factors of bipolar disorder must be identified to assist in staging and treatment, and this may be done
primarily during the initial psychiatric assessment. In fact, most of the prognostic factors, which determine disease outcome, could
be detected from simple but often-unrecorded questions asked during the psychiatric clinic visit.
Methods: We collected data from the clinical notes of 70 bipolar outpatients seen at the initial psychiatric assessment clinic
about socio-demographic and clinical factors to determine whether various factors had relevance to prevalence, prognosis, or
outcome.
Results: The sample comprised 16 bipolar I (22.9%) and 54 bipolar II (77.1%) outpatients; a psychiatric comorbidity was noted
in 26 patients (37.1%). 60.9% (42 patients) reported anxiety features and 12 patients (17.6%) were noted to have obsessivecompulsive
characteristics. Percentages reported in our results are of the sample for which the data was available. Anhedonia is a
depressive feature that was present in most of the population where this data was available (92.2%, 59 patients) and 81.8% (54
patients) reported suicidal thoughts during a depressive episode. 74.6% (47 patients) had a family history of bipolar disorder,
depression, suicide or psychosis. 27 patients (39.7%) reported current alcohol use and 14 patients (22.6%) current illicit drug use.
A comparison between 10 prognostic factors found that only the correlations between current illicit drug use/previous illicit drug
use (χ2=11.471, P<0.001), current alcohol use/previous alcohol use (χ2=31.510, P<0.001) and current illicit drug use/anxiety
(χ2=5.094, P=0.022) were statistically significant; the correlation between previous illicit drug use/previous alcohol use (χ2=5.071,
P=0.023) and previous alcohol use/family history (χ2=4.309, P=0.037) were almost statistically significant. 17 patients (24.3%) of
the 70 bipolar patients were assigned to a care coordinator; we have evaluated the possible differences between the patients with or
without a care coordinator on the basis of the presence of 10 possible prognostic factors and found no statistically significant
differences between these two groups of patients.
Conclusions: We have identified several trends in our patients with bipolar disorder that agree with previous research. Our
sample suggested that the assignation of a care coordinator is not done on a clinical basis. In our sample, some patients were found
not to have information available so we suggest that a questionnaire to remind clinicians of potentially useful information would be
helpful to aid in prognostication. In particular, specific features of the disease, like family history, age at onset, and features of
depressive episodes may be highlighted as our sample suggests that these are often unrecorded when not known or negative.
Ključne riječi
bipolar affective disorder; prognostic factors
Hrčak ID:
265733
URI
Datum izdavanja:
5.11.2014.
Posjeta: 181 *