摘要
背景:双相情感障碍是一种高误诊率的精神疾病,常被误诊为抑郁症、精神分裂症、焦虑症、强迫症和人格障碍等精神疾病,导致临床症状不能有效控制,病情呈反复发作趋势,故近年来双相情感障碍的误诊问题越来越引起精神科医生的重视。目的:了解双相情感障碍在门诊的误诊情况,并分析其误诊原因,指导临床医师加强对双相情感障碍的识别,尽量避免或减少其误诊和漏诊。方法:纳入专家门诊确诊为双相情感障碍的患者,了解其在门诊的就诊及误诊和漏诊情况,通过比较误诊组(包含漏诊者)和确诊组的临床资料进一步分析导致误诊和漏诊的可能原因。结果:双相情感障碍在专家门诊就诊患者中占31.5%。符合本研究入组标准的共有177例,其中误诊组136例(76.8%),确诊组41例(23.2%),误诊为抑郁症者最多(70.6%)。误诊组患者首次发作更多的表现为抑郁发作(χ~2=5.206,p=0.023),并且病程中抑郁发作次数更多(Z=-2.268,p=0.023);误诊组起病至首次治疗的时间较短(Z=-2.612,p=0.009)、而起病至确诊时间更长(Z=-3.685,p<0.001),总病程更长(Z=-3.274,p=0.001),并且住院治疗的患者更多(χ~2=4.539,p=0.033),住院次数也更多(Z=-2.164,p=0.031);误诊组伴有精神病性症状更多(χ~2=11.74,p=0.001),尤其抑郁发作时(χ~2=7.63,p=0.006),共病的发生率更高(χ~2=5.23,p=0.022);误诊组HCL-32评分更低(t=-2.564,p=0.011)。误诊组诊断为其他特定的双相及相关障碍的患者较确诊组多(11.0%v.4.9%),并且误诊组最近发作情况表现为抑郁发作的患者较多(78.7%v.65.9%)。结论:门诊双相情感障碍患者的误诊率高,常被误诊为抑郁症。误诊组患者首次发作更多的表现为抑郁发作,病程中抑郁发作次数更多,伴有精神病性症状更多,共病的发生率更高,并且患者对自身躁狂或轻躁狂发作情况明显认识不足,导致早期难以明确诊断,确诊所需时间更长,住院比率更高,住院次数更多。临床医生应提高对双相情感障碍的识别,避免或减少双相情感障碍的误诊和漏诊。
Background： Bipolar disorder is a mental illness with a high misdiagnosis rate and commonly misdiagnosed as other mental disorders including depression, schizophrenia, anxiety disorders, obsessive-compulsive disorders, and personality disorders, resulting in the mistreatment of clinical symptoms and increasing of recurrent episodes. Aims： To understand the reasons for misdiagnosis of bipolar disorder in an outpatient setting in order to help clinicians more clearly identify the disease and avoid diagnostic errors. Methods： Data from an outpatient clinic included two groups： those with a confirmed diagnosis of bipolar disorder （CD group） and those who were misdiagnosed （i.e. those who did in fact have bipolar disorder but received a different diagnoses and those without bipolar disorder who received a bipolar diagnosis [MD group]）. Information between these two groups was compared. Results： There were a total of 177 cases that met the inclusion criteria for this study. Among them, 136 cases （76.8%） were in the MD group and 41 cases （23.2%） were in the CD group. Patients with depression had the most cases of misdiagnosis （70.6%）. The first episode of the patients in the MD group was more likely to be a depressive episode （x2=5.206, p=0.023） and these patients had a greater number of depressive episodes during the course of the disease （Z=-2.268, p=0.023）; the time from the onset of the disease to the first treatment was comparatively short （Z=-2.612, p=0.009） in the group with misdiagnosis; the time from the onset of disease to a confirmed diagnosis was longer （Z=-3.685, p〈0.001）; the overall course of disease was longer （Z=-3.274, p=0.001）; there were more inpatients for treatment （x2=4.539, p=0.033）; and hospitalization was more frequent （Z=-2.164, p=0.031）. The group with misdiagnosis had more psychotic symptoms （x2=11.74, p= 0.001）; particularly when depression occurred （x2=7.63, p= 0.006）, and the incidence of comorbidity was higher （x2=5.23, p=0.022）. The HCL-32 rating was lower in the misdiagnosis group （t=-2.564, p=0.011）. There were more patients diagnosed with bipolar and other related disorders in the misdiagnosis group than in the confirmed diagnosis group （11.0% v. 4.9%） and there were more patients in the MD group diagnosed with depressive episodes who had a recent episode （78.7% v. 65.9%）. Conclusions： The rate of misdiagnosis of patients with bipolar receiving outpatient treatment was quite high and they often received a misdiagnosis of depression. In the misdiagnosis group the first episode tended to manifest as a depressive episode. In this group there were also a greater number of depressive episodes over the course of illness, accompanied by more psychotic symptoms and a higher incidence of comorbidity. Moreover, these patients apparently lacked insight into their own mania and hypomania symptoms, resulting in difficulties in early diagnosis, longer time needed to confirm the diagnosis, higher rate of hospitalization, and greater number of hospitalizations.
出处
《上海精神医学》
CSCD
2018年第2期93-101,共9页
Shanghai Archives of Psychiatry
基金
Shanghai Mental Health Center affiliated to the Shanghai Jiao Tong University project(project code:2016-YJ-12)
Shanghai Mental Health Center affiliated to the Shanghai Jiao Tong University project(project code:2014-YL-04)
National Key Technology Research and Development Program(project code:2012BAI01B04)
