双相I型障碍首次躁狂发作患者对安慰剂的反应。

Chengappa K N, Tohen M, Levine J, Jacobs T, Thase M E, Sanger T M, Kupfer D J

Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Special Studies Center at Mayview State Hospital, PA 15213-2593, USA.

Bipolar Disord. 2000 Dec;2(4):332-5. doi: 10.1034/j.1399-5618.2000.020407.x.

BACKGROUND

The first episode of an illness may respond differently to any treatment compared to multiple episodes of the same illness. This study details the treatment response of six first-episode manic patients who participated in a previously reported study of 139 subjects comparing olanzapine to placebo in bipolar I mania (Tohen M, Sanger TM, McElroy SL, Tollefson GD, Chengappa KNR, Daniel DG. Olanzapine versus placebo in the treatment of acute mania. Am J Psychiatry 1999; 156: 702-709).

METHODS

Six first-episode subjects participated in a 3-week double-blind, random assignment, parallel group, placebo-controlled study of olanzapine for bipolar mania. The Young Mania Rating Scale (Y-MRS), Clinical Global Impression, and Hamilton Depression ratings were administered weekly. Lorazepam as rescue medication was permitted for the first 10 days.

RESULTS

Five subjects were randomized to placebo and one to olanzapine. Two subjects (40%) with psychotic mania (who also had their first-illness episode) were assigned to placebo and responded with greater than 50% reduction in the Y-MRS score and also remitted in 3 weeks. Another placebo-assigned subject had a 46% reduction in the Y-MRS scores, and two placebo-assigned subjects worsened. The olanzapine-assigned subject had a 44% reduction in the Y-MRS score. In contrast, 34 of 69 (48.6%) multiple-episode olanzapine subjects responded and 14 of 61 (23.0%) of placebo-treated subjects did.

CONCLUSIONS

This preliminary data set suggest there may be differences in treatment response between first-illness episode versus multi-episode bipolar manic subjects. Larger numbers of subjects with these illness characteristics are needed to either confirm or refute this suggestion.

背景

与同一种疾病的多次发作相比，疾病的首次发作可能对任何治疗的反应都有所不同。本研究详细介绍了6例首次发作的躁狂症患者的治疗反应，这些患者参与了之前一项对139名受试者进行的研究，该研究比较了奥氮平与安慰剂治疗双相I型躁狂症的效果（托亨M、桑格TM、麦克尔罗伊SL、托勒夫森GD、程帕KNR、丹尼尔DG。奥氮平与安慰剂治疗急性躁狂症。《美国精神病学杂志》1999年；156: 702 - 709）。

方法

6例首次发作的受试者参与了一项为期3周的双盲、随机分组、平行组、安慰剂对照的奥氮平治疗双相躁狂症的研究。每周进行杨氏躁狂量表（Y - MRS）、临床总体印象和汉密尔顿抑郁评分。在前10天允许使用劳拉西泮作为急救药物。

结果

5名受试者被随机分配到安慰剂组，1名被分配到奥氮平组。2名患有精神病性躁狂症（也是首次发病）的受试者被分配到安慰剂组，Y - MRS评分降低超过50%，且在3周内病情缓解。另一名被分配到安慰剂组的受试者Y - MRS评分降低了46%，还有两名被分配到安慰剂组的受试者病情恶化。被分配到奥氮平组的受试者Y - MRS评分降低了44%。相比之下，69例多次发作的奥氮平受试者中有34例（48.6%）有反应，安慰剂治疗的61例受试者中有14例（23.0%）有反应。