Estudo comparativo do fenótipo clínico de mulheres com transtorno afetivo bipolar em fase reprodutiva da vida com e sem piora pré-menstrual do humor / A comparative study of the clinical phenotype of women with bipolar affective disorder phase reproductive life with and without premenstrual worsening of mood

AUTOR(ES)
DATA DE PUBLICAÇÃO

2010

RESUMO

The impact of hormonal fluctuation during the menstrual cycle on the course of bipolar disorder in women is poorly studied. We also found many gaps in knowledge about its clinical presentation and its implications for the evolution of Bipolar Disorder, especially the association with rapid cycling and its predictive value for recurrence. Methods: Women with Bipolar Disorder (types I, II or Not Otherwise Specificated ) participants Systematic Treatment Enhancement Program for Bipolar Disorder, aged between 16 and 40, were divided into two groups: with and without reports of Premenstrual Exacerbation of Bipolar Disorder in the baseline assessment. These groups were compared to clinical features of BD, reproductive life and treatment at study entry. The time difference of recurrence between groups who were euthymic at the baseline assessment were done with survival analysis Kaplan Meiers survival curve and Cox regression models. The number of episodes between the patients who were followed for a period of one year was also compared. Results: Of 706 women who completed the questionnaire, 490 (69.4%) reported premenstrual exacerbation. At study entry, compared to those without premenstrual exacerbation, women with premenstrual exacerbation were more depressed, had more psychiatric comorbidities, mood symptoms with the use of hormonal contraceptives, irregular menstrual cycles, and were receiving less drug treatment. Women with premenstrual exacerbation also reported more mood episodes during the previous year and were more likely to state rapid cycling in the same period. In a prospective evaluation among women who started the study in euthymic mood state (premenstrual exacerbation n = 66, without premenstrual exacerbation n = 63), the premenstrual exacerbation group had a smaller time to relapse when associated subsyndromal mood states to relapse in mania, depression or mixed state. The median time to relapse of 50% of the sample was 4.5 months for women with premenstrual exacerbation, compared with 8.5 months for the group without premenstrual exacerbation (p = 0,02). The premenstrual exacerbation was also a significantly positive factor for a greater severity of depressive symptoms and elevation of mood among women with one year of follow-up. Conclusions: Women with Bipolar Disorder who reported premenstrual exacerbation had a higher psychiatric comorbidity, greater number of episodes of mood in the previous year and rapid cycling. Prospective evaluation showed a higher rate of recurrence, more states and more subsyndromal episodes, but not rapid cycling among women in the premenstrual exacerbation. Our results suggest that premenstrual exacerbation can be considered a clinical marker predictor of a worse clinical phenotype and associated with a worst disease progression in women of reproductive with bipolar affective disorder

ASSUNTO(S)

clinical evolution bipolar disorder menstruação transtorno bipolar evolução clínica menstruation women mulheres fase luteal luteal phase

ACESSO AO ARTIGO

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