Clinical Characteristics Differences In Patients With Bipolar Affective Disorder At Different Onset Age

Research background: Bipolar affective disorder is a frequently occurring and common disease with a high recurrence rate and severe damage to social functions,which affects a large number of people in the world,it has always been a hot spot in psychiatric clinical research.The clinical characteristics of patients with bipolar affective disorder are heterogeneous,many researchers have conducted research on their clinical characteristics from different aspects,hoping to provide useful information and help for the recognition,diagnosis,treatment and prognosis of bipolar affective disorder.At present,the impact of the age of onset on bipolar affective disorder has been widely concerned by mental health workers.Whether the age of onset is a classification indicator of bipolar affective disorder and whether early onset bipolar affective disorder is a subtype with more homogeneous clinical characteristics has been controversial.At present,there are more studies on the age of onset of bipolar affective disorder abroad,but less in China.Research objective: By comparing and analyzing the clinical characteristics of patients with bipolar affective disorder at different onset ages,this paper explores the differences in clinical characteristics of patients with bipolar affective disorder at different onset ages,hoping to provide some useful information and help for mental health workers to further understand bipolar affective disorder.Research methods: It was a retrospective study,a total of 1671 patients with bipolar affective disorder who were hospitalized in research unit from January 1,2012 to December 31,2012 were selected.Self-compiled patient information questionnaire(including general socio-demographic information and clinical characteristic information),collecting general socio-demographic information and clinical characteristics of patients through the combined approach of consulting the hospital electronic medical record system and patient medical record files,the number of follow-up visits and hospitalizations within 5 years after the diagnosis of the enrolled patients was investigated by checking the electronic medical record system.Combined with the research experience of foreign scholars,patients with bipolar affective disorder are divided into three groups according to the age of onset: the early onset group with age of onset ≤ 21 years,the middle onset group with age of onset between 21 and 34 years old,and the late onset group with age of onset ≥ 34 years.Chi-square test and Kruskal-Wallis test and other statistical analysis methods were used to compare and analyze the differences in the socio-demographic and clinical characteristics of the three groups of patients with early onset,middle onset and late onset.Research results:1 Socio-demographic characteristics:1.1 There was a statistically significant difference in gender(χ2=14.10,P=0.00),of which male patients(59.64%)account for a higher proportion of early onset patients,while the ratio of male to female in middle onset and late onset bipolar affective disorder is approximately1:1.1.2 The years of education,marital status,and occupational status reflected the patient’s prognosis and future social adaptability,all of which had statistical significant(p < 0.05).In terms of years of education,the proportion of patients with years of education > 9years: middle onset > early onset > late onset(33.73% > 26.91% > 19.07%);In terms of marital status,the proportion of unmarried patients: early onset > middle onset > late onset(17.82% > 7.35% > 1.47%);in terms of occupational status,the proportion of non-employed patients: early onset > middle onset and late onset(18.83 % > 16.19%,12.96%).2 clinical characteristics:2.1 There was a statistically significant difference in the type of first onset(χ2=9.04,P=0.01).Among the patients with early onset and late onset bipolar affective disorder,depression was used as the first onset type,while the ratio of hypomania or mania first onset type to depression first onset type was about 1:1 in patients with middle onset bipolar affective disorder.2.2 The incidence of psychotic symptoms in patients with bipolar affective disorder was higher in early onset(60.24%)and middle onset(57.34%)than in late onset(42.05%),there were significant differences(χ2=36.35,P < 0.00).2.3 The incidence of suicidal ideation/behavior in patients with early onset bipolar affective disorder was higher than that in patients with middle onset and late onset bipolar affective disorder(40.36% >33.56% > 31.78%),with statistically significant difference(χ2=10.21,P=0.01).2.4 In terms of the incidence of comorbidity physical disease,late onset > middle onset > early onset(40.96% vs 49.58% vs 57.95%),there was a statistically significant difference(χ2=30.07,P < 0.00).2.5 In terms of the number of re-hospitalizations within 5 years after enrollment(reflecting recurrence),early onset > middle onset and late onset,there was a statistically significant difference(χ2=18.64,P < 0.00).2.6 There was a statistically significant difference in the overall course of disease,of which the early onset and middle onset > late onset(χ2=14.58,P < 0.00).2.7 There was a significant statistical difference in the number of outpatient visits within 5 years after enrollment(responsing treatment compliance)(χ2=5.26,P < 0.01),of which early onset > late onset,while there was no statistical difference between the early onset,middle onset and middle onset,late onset.Research conclusion: Patients with early onset bipolar affective disorder have a high rate of unmarried,high rate of unemployment,shorter years of education,it reflected that the patients with early onset had more serious social function damage and poor social adaptability.Most of the patients with early onset bipolar affective disorder were male,with psychotic symptoms and a high incidence of suicidal ideation/behavior.The treatment compliance of patients with early onset bipolar affective disorder was relatively good,but the overall course ofdisease was longer and the disease recurrence was relatively poor,which indirectly responsed that patients with early onset bipolar affective disorder were more complicated,more prone to relapse and had a poor prognosis.Patients with late onset bipolar affective disorder had the highest incidence of comorbidity physical disease,and the prognosis and social adaptability were relatively good.