关键词: 双相情感障碍, 双相I型, 首发躁狂, 复发, 影响因素分析, 随访研究

Abstract: Background　Due to complex clinical symptoms，bipolar Ⅰ disorder （BP-Ⅰ） is easily misdiagnosed or underdiagnosed，and difficult to treat，and has relatively high recurrence. The recurrence may occur often even in some cases with standardized treatment. Frequent recurrence of BP-Ⅰ can damage patients' social function significantly. However，to the best of our knowledge，there are few studies on the recurrence of BP-Ⅰ based on the long-term follow-up with the first-episode mania patients. Objective　To explore the recurrence of first-episode mania in BP-Ⅰ over a 7-year follow-up period and its influencing factors. Methods　Both outpatients and inpatients with BP-Ⅰ and first-episode mania were recruited from Mental Health Center of Hebei Province between October 2011 and October 2013. Divided into low recurrence group and high recurrence group according to the number of recurrences. The collected patients' data at the first episode cover the following aspects：（1）demographic characteristics，including gender，age，body mass index，marital status，occupation and education level; （2）psychological cognitive level，including results of Wisconsin Card Sorting Test，Stroop Color-Word Association Test（Stroop） and Social Support Rating Scale; （3）disease characteristics，including family mental health history，prevalence of stressful life events before the onset，prevalence of aggressive characteristics and psychotic symptoms，Young Mania Rating Scale score; （4）treatment details，including treatment in both acute and maintenance phases. The 7-year follow-up data were also collected，including the recurrence within the first year，single manic episodes and psychotic symptoms，the prevalence of psychotic symptoms，depressive episodes，manic episodes，and the proportion of maintenance treatment times in total number of episodes，medication adherence assessed by the Medication Adherence Scale，and functional level assessed by the Global Assessment of Functioning （GAF） at the last follow-up in the seventh year. Results　A total of 147 patients were enrolled in this program，and 101 of them who completed the follow-up were finally included，including 45 with recurrence <4 times（low recurrence group） and 56 with recurrence ≥4 times（high recurrence group）. Stroop interference ensues （SIE） in the low recurrence group was lower than that in the high recurrence group（P<0.05）. Low recurrence group had higher prevalence of receiving treatment in the maintenance phase（P<0.05）. Low recurrence group had lower recurrence rate，higher prevalence of manic episodes，and higher proportion of maintenance treatment times in total number of episodes within the first follow-up year （P<0.05）. Unconditional binary logistic regression analysis indicated that manic episode was significantly associated with the number of recurrent episodes（OR=0.170，P<0.05）. Conclusion　Low recurrence rate was noted in BP-Ⅰ patients with first-episode mania who had relatively good executive function after the first onset，received treatment in the maintenance phase，had only manic episodes after treatment for the first onset，and a higher proportion of maintenance treatment times in total number of episodes. Those who relapsed within the first year after remission had a higher rate of later recurrence. Manic episodes were found to be associated with the recurrence. The recurrent outcome of those with single manic episodes was better than that of those with alternating manic-depressive episodes.

Key words: Bipolar disorder, Bipolar disorder-Ⅰ, First-episode of mania, Recurrence, Root cause analysis, Follow-up studies