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目的:了解以抑郁为首次发作的双相障碍患者的临床特征。方法:本研究纳入参加双相障碍临床路径调研的、以抑郁为首次发作的双相障碍患者共1 600例，描述人群的一般人口学资料、疾病相关信息，以及第1次躁狂发作患者的症状学特点。采用单因素方差分析比较综合医院和专科医院就诊患者临床特征，采用卡方检验对目前为第1次轻躁狂/躁狂发作时的症状学表现与复发躁狂的症状学表现进行比较。结果:首次抑郁发作到第1次轻躁狂/躁狂发作的平均时间为3.63年；从第1次轻躁狂/躁狂发作到双相躁狂诊断平均1.83年，其中仅有45.4%（728例）首次发作即被诊断；从首次抑郁发作到双相障碍诊断平均为5.45年；专科医院和综合医院就诊的双相障碍患者在既往抑郁发作次数（n F=7.119， n P=0.008）、既往发作总次数（n F=3.980， n P=0.046）的差异有统计学意义；在目前为第1次躁狂发作的患者中排在前3位的症状分别是心境高涨（83.0%，215例）、活动增多（81.5%，211例）、语量增多（79.9%，207例）；与复发性躁狂相比，首次躁狂发作的患者出现比平日更合群（χ2=13.277，n P<0.01）、比平日更善辩或诙谐（χ2=10.665，n P=0.001）症状的频率高，出现使用精神活性物质增多症状（χ2=3.990，n P=0.046）的频率低。n 结论:以抑郁为首次发作的双相障碍患者确诊所需时间长，首次躁狂发作不易识别，就诊于综合医院的患者抑郁发作更频繁，首次躁狂发作与复发性躁狂症状表现有差异。“,”Objective:To investigate the clinical characteristics of bipolar disorder patients who present with depressive symptoms at their first episode.Methods:A total of 1 600 bipolar disorder patients with the first episode of depression who participated in the clinical pathway survey of bipolar disorder were included in this study. Demographic data, clinical phenotype, and symptomatic characteristics when they presented with their first mania were described. One-way analysis of variance was applied to compare the clinical characteristics between patients who visited the general hospitals and the ones who visited the mental health centers, and chi-square test was applied to compare symptomatology of patients at the first hypomania/mania episode and their mania relapse.Results:The average time from the first depressive episode to the first hypomanic/manic episode was 3.63 years. It took an average of 1.83 years from the first hypomanic/manic episode to the diagnosis of bipolar mania, and only 45.4% (728 cases) were diagnosed as bipolar disorder when they presented with depression at their first episode; It was an average of 5.45 years from the first depressive episode to the diagnosis of bipolar disorder; There were statistically significant differences in the number of previous depressive episodes (n F=7.119, n P=0.008) and the total number of previous episodes (n F=3.980, n P=0.046) between bipolar disorder patients seen in the mental health centres and general hospitals. The top three symptoms of the first manic episode were mood elation (83%, 215 cases); increased activity (81.5%, 211 cases); increased speech (79.9%, 207 cases). Compared with recurrent manic episodes, patients at their first manic episode were more likely to report more gregarious (χ2=13.277, n P<0.01), eloquent/humorous (χ2=10.665,n P=0.001), and less likely to report excessive use of psychoactive substances (χ2=3.990,n P=0.046).n Conclusions:It takes a long time for the diagnosis of bipolar disorder who presents with the depressive mood in their first episode. The first manic episode is not easy to identify, and the patients treated in general hospitals have more frequent depressive episodes, while the first manic episode shows some different symptoms from the recurrent manic episodes.