Rucci Paola, Frank Ellen, Kostelnik Bryan, Fagiolini Andrea, Mallinger Alan G, Swartz Holly A, Thase Michael E, Siegel Lori, Wilson Dorothy, Kupfer David J
Department of Psychiatry, Western Psychiatric Institite and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
Am J Psychiatry. 2002 Jul;159(7):1160-4. doi: 10.1176/appi.ajp.159.7.1160.
Lifetime rates of suicide attempts among patients with bipolar I disorder were compared to rates during a 2-year period of intensive treatment with pharmacotherapy and with one of two adjunctive psychosocial interventions.
Subjects entered the study during an acute mood episode. Subjects were treated with primarily lithium pharmacotherapy and with either psychotherapy specific to bipolar disorder, which included help in regularizing daily routines, or nonspecific, intensive clinical management involving regular visits with empathic clinicians. Data on prior suicide attempts were obtained retrospectively from interviews with the NIMH-Life-Chart method. Data on suicide attempts during the clinical trial were collected systematically throughout the protocol.
The rate of suicide attempts was 1.05 per 100 person-months before patients entered the trial. Patients experienced a threefold reduction in the rate of suicide attempts during the acute treatment phase (until the patient achieved stabilization, defined by completion of 4 weeks during which the patient had a mean score of < or =7 on the 17-item Hamilton Depression Rating Scale and < or =7 on the Bech-Rafaelsen Mania Scale) and a 17.5-fold reduction during maintenance treatment. Poisson loglinear regression analysis modeling the relationship between the observed rates and the three protocol stages (pretreatment, acute, and maintenance) showed that the reductions were significant in the acute and maintenance phases, compared with the pretreatment phase. No patient with one or more suicide attempts before entering the trial attempted suicide during the protocol.
A treatment program in a maximally supportive clinical environment can significantly reduce suicidal behavior in high-risk patients with bipolar I disorder.
将双相I型障碍患者的终身自杀未遂率与接受药物治疗及两种辅助心理社会干预之一进行强化治疗的两年期间的自杀未遂率进行比较。
受试者在急性情绪发作期间进入研究。受试者主要接受锂盐药物治疗，并接受双相情感障碍特异性心理治疗（包括帮助规范日常活动）或非特异性强化临床管理（包括定期与富有同理心的临床医生就诊）。既往自杀未遂数据通过采用美国国立精神卫生研究所生活图表法进行访谈回顾性获取。临床试验期间的自杀未遂数据在整个方案中系统收集。
在患者进入试验前，自杀未遂率为每100人月1.05次。患者在急性治疗阶段（直至患者达到稳定，定义为在17项汉密尔顿抑郁量表上平均得分≤7且在贝克-拉法尔森躁狂量表上平均得分≤7持续4周）自杀未遂率降低了三倍，在维持治疗期间降低了17.5倍。对观察到的发生率与三个方案阶段（治疗前、急性和维持）之间关系进行建模的泊松对数线性回归分析表明，与治疗前阶段相比，急性和维持阶段的降低具有显著性。在进入试验前有一次或多次自杀未遂的患者在方案期间均未自杀。
在最大支持性临床环境中的治疗方案可显著降低双相I型障碍高危患者的自杀行为。
