Swann A C
University of Texas, Houston Medical Scholl, USA.
Encephale. 2001 May-Jun;27(3):277-9.
To determine predictive factors for response to mood stabilising treatment in manic episodes and to determine the mood stabilising properties of divalproex.
For predictive factors, 179 subjects in 3 parallel groups (divalproex, lithium, placebo) were evaluated over a period of 21 days by using structured interviews conducted by the clinician (SADS-C) and by nursing staff (ADRS). For the follow-on study, 372 stabilised patients were randomised to three groups: divalproex, lithium or placebo.
The presence of depressive symptoms was associated with poor response to lithium, and patients with manic episodes with depressive symptoms or with rapid cycling exhibited good response to divalproex, while classical manic episodes showed good response to lithium and divalproex, and dysphoric or irritable manic episodes responded well to divalproex but not to lithium. A high number of both manic and depressive prior episodes is predictive of poor response to lithium and favourable response to divalproex. The effects of depressive and manic episodes appear to be independent and do not correlate with the duration of the illness or age at onset. Divalproex was superior to placebo in preventing all types of episodes, whether or not relapse was depressive or manic, and it was also superior to lithium in preventing depressive episodes.
Specific features of the disease history and of the semiology of individual episodes help predict therapeutic response to mood stabilisers.
确定躁狂发作时对心境稳定剂治疗反应的预测因素，并确定丙戊酸镁的心境稳定特性。
对于预测因素，通过临床医生进行的结构化访谈（SADS-C）和护理人员进行的访谈（ADRS），在21天的时间里对3个平行组（丙戊酸镁、锂盐、安慰剂）中的179名受试者进行评估。对于后续研究，将372名病情稳定的患者随机分为三组：丙戊酸镁、锂盐或安慰剂。
抑郁症状的存在与对锂盐反应不佳相关，伴有抑郁症状或快速循环发作的躁狂发作患者对丙戊酸镁表现出良好反应，而典型躁狂发作对锂盐和丙戊酸镁均表现出良好反应，烦躁或易激惹性躁狂发作对丙戊酸镁反应良好但对锂盐无反应。既往有大量躁狂和抑郁发作史可预测对锂盐反应不佳及对丙戊酸镁反应良好。抑郁发作和躁狂发作的影响似乎是独立的，且与病程或起病年龄无关。丙戊酸镁在预防所有类型发作方面优于安慰剂，无论复发是抑郁性还是躁狂性，在预防抑郁发作方面也优于锂盐。
疾病史和个体发作症状学的特定特征有助于预测对心境稳定剂的治疗反应。
