Findling Robert L, McNamara Nora K, Gracious Barbara L, Youngstrom Eric A, Stansbrey Robert J, Reed Michael D, Demeter Christine A, Branicky Lisa A, Fisher Kathryn E, Calabrese Joseph R
Department of Psychiatry, Case Western Reserve University School of Medicine, USA.
J Am Acad Child Adolesc Psychiatry. 2003 Aug;42(8):895-901. doi: 10.1097/01.CHI.0000046893.27264.53.
Lithium carbonate (Li) or divalproex sodium (DVPX) may be effective for some juveniles with bipolar disorder. Many youths with bipolar disorder do not respond to DVPX or Li monotherapy. An open-label study was conducted to examine the effectiveness of combination DVPX and Li therapy with youths diagnosed with bipolar disorder.
Patients meeting DSM-IV criteria for bipolar I or bipolar II disorder, ages 5 to 17 years, were treated prospectively for up to 20 weeks with DVPX + Li. Assessments included the Young Mania Rating Scale (YMRS), Children's Depression Rating Scale-Revised (CDRS-R), and the Children's Global Assessment Scale (CGAS). The a priori definition of clinical remission utilized included four contiguous weekly ratings of YMRS </=12.5, CDRS-R </=40, CGAS >/=51, clinical stability, and no evidence of mood cycling.
Ninety patients (66 males, 24 females) were treated. Significant improvement (p <.0001) in all outcome measures was observed by week 8 as well as at the end of study. The mean time in study was 11.3 weeks. Forty-seven percent (n = 42) met a priori criteria for remission.
Symptoms of mania and depression in juvenile bipolar disorder may be safely and effectively treated acutely with DVPX + Li.
碳酸锂（Li）或丙戊酸钠（DVPX）可能对一些患有双相情感障碍的青少年有效。许多患有双相情感障碍的青少年对DVPX或Li单一疗法无反应。开展了一项开放性研究，以检验DVPX与Li联合治疗对诊断为双相情感障碍的青少年的有效性。
符合DSM-IV标准的5至17岁双相I型或双相II型障碍患者，接受DVPX + Li前瞻性治疗长达20周。评估包括青年躁狂评定量表（YMRS）、儿童抑郁评定量表修订版（CDRS-R）和儿童总体评定量表（CGAS）。临床缓解的先验定义包括YMRS连续四周评分≤12.5、CDRS-R≤40、CGAS≥51、临床稳定性且无情绪波动证据。
90名患者（66名男性，24名女性）接受了治疗。在第8周以及研究结束时，所有结局指标均有显著改善（p <.0001）。研究的平均时长为11.3周。47%（n = 42）符合缓解的先验标准。
青少年双相情感障碍的躁狂和抑郁症状可用DVPX + Li进行安全有效的急性治疗。
