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

摘要： 背景　双相Ⅰ型障碍（BP-Ⅰ）临床表现复杂，易漏诊、误诊，治疗困难，复发率相对较高。部分患者即使获得规范化治疗，仍会反复发作导致其社会功能受损明显。目前针对BP-Ⅰ首发躁狂患者复发情况的相关研究相对缺乏，且随访时间相对较短。目的　探讨BP-Ⅰ首发躁狂患者7年间疾病复发情况及其影响因素。方法　选取2011年10月至2013年10月在河北省精神卫生中心门诊就诊和住院的BP-Ⅰ首发躁狂患者。根据复发次数分为低复发组（复发次数<4次）和高复发组（复发次数≥4次）。收集首发BP-Ⅰ时的人口学特征：包括性别、年龄、体质指数（BMI）、婚姻、职业、受教育水平；心理认知评估情况：威斯康星卡片分类测验（WCST）、Stroop色-词关联测验（Stroop）、社会支持评定量表（SSRS）；疾病特征：阳性精神疾病家族史、发病前有无应激性生活事件、是否伴攻击特征、是否伴精神病性症状、杨氏躁狂量表（YMRS）总分；治疗情况：急性期治疗时间、接受维持期治疗情况。随访7年，收集第1年内复发情况、只有躁狂发作情况、是否伴精神病性症状，计算伴精神病性症状发作占比、抑郁发作次数占比、躁狂发作次数占比、维持治疗次数占比；第7年末次随访时采用药物依从性评定量表（MARS）评估患者对药物治疗的依从性、采用整体功能评定量表（GAF）评估患者的功能水平。结果　共入组147例，完成7年随访101例，低复发组45例，高复发组56例。低复发组干扰量正确数（SIE）低于高复发组、接受维持期治疗者比例高于高复发组（P<0.05）；低复发组中第1年内复发比例低于高复发组，只有躁狂发作者比例、维持治疗次数占比高于高复发组（P<0.05）。经二分类非条件Logistic回归分析结果显示，只有躁狂发作为复发情况的影响因素（OR=0.170，P<0.05）。结论　BP-Ⅰ首发躁狂患者首次发病后执行功能相对良好的、接受维持期治疗的、只有躁狂发作的、维持期治疗次数占总发作次数比例高的患者后期复发率低；首次发病缓解后第1年内复发的患者后期复发率高。其中只有躁狂发作为影响因素，单纯躁狂发作者的复发结局优于躁狂抑郁交替发作者。

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