雙極症 ( Bipolar Disorder, BD ) 為與自殺死亡最具關聯性的精神疾病之一（Raja and Azzoni, 2004）。相關的研究雖不少，但研究結果仍有許多不一致的結果及有待進一步證實的地方。第一型雙極症 ( Bipolar I Disorder, BPI ) 與第二型雙極症 ( Bipolar II Disorder, BPII ) 為較常見且嚴重的兩種亞型，有關兩者臨床表徵的差異，尤其是對 BPII 的瞭解仍相當有限，結果亦不一致，尤其亞洲族群的相關資料更顯缺乏。本研究將針對國人 BPI 與 BPII 的各種臨床表徵進行比較，分析國人兩亞型疾患的差異與關聯性，並進一步探討國人此兩種亞型BD在臨床表徵上的差異及可能的原因，並討論未來可能發展的方向，以供日後臨床實務之參考。

本研究採縱貫性病程追蹤 24 週，評估病患的情緒症狀、自殺危險、生活滿意度與病識感；社會人口學變項及服藥狀況亦做記錄。符合收案標準並同意加入本研究者共114人，納入資料分析者共 93 人：BPI 48 人，BPII 45 人。

本研究發現，BPII患者延遲治療的時間較 BPI 長，病程中容易有殘存憂鬱症狀、疾病容易復發且其憂鬱期多為混合型憂鬱；而 BPII 患者的病識感及服藥遵從性較差，從本研究中流失率較高。追蹤期間，BPII 患者在特定疾病狀態下有較高的自殺危險，其心理層面 QoL 持續呈現顯著受損情況。建議臨床工作者應該更加重視 BPII 的惡性化病程與高度自殺危險，及早提供患者合宜的治療策略與復健計劃。

Background:
Bipolar disorder (BD) is the most common psychiatric condition associated with suicide. However, related literature remains limited and findings are controversial. Despite past research standings, current theories regarding the prognosis are not as optimistic for the soft form of BD due to its intensely chronic depressive features. However, by far, the distinctions of bipolar subgroups, especially for bipolar II, have not been well studied in Asian populations, and the crucial factors related to clinical outcome are unclear.

Method:
Ninety-three patients (bipolar I: 48; bipolar II: 45) were prospectively followed over a 24 weeks period and evaluated in this study. We investigated the symptomatic severity, suicidal risk (the Adult Suicidal Ideation Questionnaire; ASIQ), insight of illness (the Mood Disorders Insight Scale, MDIS) and quality of life (the Short Form of World Health Organization Questionnaire on Quality of Life-Taiwan Version; WHOQOL-BREF TW) across the mood state of each recruited subject. The socio-demographic information, prescribed medications and the drug compliance were also recorded.

Results:
The results showed that bipolar II (BPII) patients have a longer duration of onset to treatment, more prominently mixed depression and residual depressive symptoms, higher ASIQ scores in the acute stage, poor psychological QoL and lower prescription during the follow up period than bipolar I patients (BPI). Through the multiple Linear Regression models, three specific illness variables (depression symptoms, ASIQ scores, and the type of BD) could strongly account for mental life satisfaction; the explainable variances were 43.6%.

Conclusion:
Overall, our results indicated that BPII disorder might be a more severe, chronic subtype, and with special malignancy in comparison with BPI. It is hoped that the present article will bring attention to the markedly impaired psychological QoL in BPII patients and that the specific illness variables relevant to BPI and BPII affecting the clinical outcome can be more clearly delineated in the future.

柯慧貞、孫苑庭、林木芬、葉宗烈、陸汝斌（2000）‧由行為抑制探討婦女焦慮與憂鬱之共病機制‧台灣精神醫學，14 (1)，13-21。
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姚開屏（2000）‧台灣版世界衛生組織生活品質問卷之發展簡介‧中華公共衛生雜誌，19 (4)，315-324。
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