伴精神病性症状抑郁症患者人口学及临床特征

Abstract

目的比较伴与不伴精神病性症状抑郁症患者的人口学及临床特点。方法数据来源于"中国双相障碍患者诊断评估服务研究"项目,将来自全国13个研究中心的1172例抑郁症患者,根据有无精神病性症状,分为伴精神病性症状组和不伴精神病性症状组,采用自制调查问卷收集患者社会人口学及临床特征方面的资料,比较两组差异,并分析抑郁症患者伴精神病性症状的影响因素。结果 13.3%(156/1172)的抑郁症患者伴有精神病性症状。与不伴精神病性症状组相比,伴精神病性症状的抑郁症患者起病早,年龄小,更多已婚,既往抑郁发作次数多,因精神疾病住院次数多,抑郁发作频繁,更多患者伴非典型特征、有周期性或季节性特点、伴自杀观念及精神障碍家族史(均P<0.05)。多因素logistic回归分析显示,起病年龄(OR=0.972,95%CI:0.957～0.987)、抑郁发作频繁(OR=2.099,95%CI:1.233～3.573)、伴非典型特征(OR=1.937,95%CI:1.277～2.939)、伴自杀观念(OR=1.654,95%CI:1.147～2.385)与抑郁症患者伴精神病性症状相关(均P<0.05)。结论伴精神病性症状的抑郁症患者具有起病年龄早、抑郁发作频繁、更常伴非典型特征、伴自杀观念的特点。

Objective To compare the clinical features and its influencing factors between the major depressive disorder(MDD) patients with and without psychotic symptoms. Methods The data was obtained from the Diagnostic Assessment Service for People with Bipolar Disorders in China, which was initiated by the Chinese Society of Psychiatry(CSP) and conducted in 13 major psychiatric hospitals or the psychiatric units of general hospitals. According to the presence of psychotic symptoms, the MDD patients were classified as psychotic and non-psychotic depression groups.The socio-demographic and clinical characteristic differences between the two groups and the risk factors for psychotic symptoms were analyzed. Results Among the 1172 MDD patients, 156(13.3%) had psychotic symptoms. Compared to the non-psychotic MDD patients, the psychotic depression patients were younger, had earlier age of onset, higher marriage rate and family history of psychiatric disorders. In addition, the psychotic depression patients tended to have higher number of depressive episodes, higher rate of admissions and higher rate of suicide ideation(P <0.05). However,their psychotic symptoms were atypical. In multiple logistic regression analyses, the early age of onset(OR=0.972,95%CI:0.957～0.987), frequent depressive episodes(OR=2.099,95%CI:1.233～3.573), atypical features(OR=1.937,95%CI:1.277 ～2.939), and suicide ideation(OR =1.654,95% CI:1.147 ～2.385) were correlated with psychotic symptoms in depression patients. Conclusion MDD patients with an early age of onset, frequent depressive episodes, depressive episodes with atypical features, and depressive episodes with suicide ideation are more likely to have psychotic symptoms.