Chang Kiki D, Dienes Kimberley, Blasey Christine, Adleman Nancy, Ketter Terence, Steiner Hans
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, Calif., USA.
J Clin Psychiatry. 2003 Aug;64(8):936-42. doi: 10.4088/jcp.v64n0812.
Offspring of parents with bipolar disorder, by virtue of their high-risk status for developing bipolar disorder, merit an investigation of the efficacy of treatment with mood stabilizers. Behavioral and mood difficulties in this population may represent prodromal forms of bipolar disorder. We studied the efficacy of divalproex in treating child and adolescent bipolar offspring with mood or behavioral disorders who did not yet meet criteria for bipolar I or II disorder.
We studied 24 children aged 6-18 years (mean = 11.3 years; 17 boys/7 girls) with at least 1 biological parent with bipolar disorder. Participants were diagnosed by the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia with at least 1 of the following DSM-IV disorders: major depressive disorder, dysthymic disorder, cyclothymic disorder, or attention-deficit/hyperactivity disorder. Subjects all had at least moderate affective symptoms (28-item Hamilton Rating Scale for Depression or Young Mania Rating Scale score > 12). After a 2-week washout period, subjects were treated with divalproex for 12 weeks, titrated to achieve serum levels of 50-120 micro g/mL (mean final dose = 821 mg/day; mean final serum level = 79.0 micro g/mL).
One subject discontinued after 2 weeks due to continuation of symptoms. Of the remaining 23 subjects, 18 (78%) were considered responders by primary outcome criteria ("very much improved" or "much improved" on the Clinical Global Impressions-Improvement scale). Divalproex was well tolerated with no discontinuations due to adverse effects.
Bipolar offspring with mood or behavioral disorders and at least mild affective symptoms may respond to divalproex treatment. Our study was limited by the open treatment, lack of a placebo group, and the heterogeneous nature of the sample. Controlled studies are warranted in the use of divalproex in symptomatic bipolar offspring.
双相情感障碍患者的后代因其患双相情感障碍的高风险状态，值得对心境稳定剂治疗的疗效进行研究。该人群中的行为和情绪问题可能代表双相情感障碍的前驱形式。我们研究了丙戊酸镁治疗尚未符合双相I型或II型障碍标准的患有情绪或行为障碍的儿童和青少年双相情感障碍后代的疗效。
我们研究了24名年龄在6至18岁（平均 = 11.3岁；17名男孩/7名女孩）的儿童，他们至少有1名患双相情感障碍的亲生父母。参与者通过圣路易斯华盛顿大学儿童情感障碍和精神分裂症量表进行诊断，患有以下至少1种DSM-IV障碍：重度抑郁症、恶劣心境障碍、环性心境障碍或注意力缺陷/多动障碍。所有受试者均至少有中度情感症状（28项汉密尔顿抑郁量表或杨氏躁狂量表评分>12）。在经过2周的洗脱期后，受试者接受丙戊酸镁治疗12周，滴定剂量以达到血清水平50 - 120μg/mL（平均最终剂量 = 821mg/天；平均最终血清水平 = 79.0μg/mL）。
1名受试者在2周后因症状持续而停药。在其余23名受试者中，18名（78%）根据主要结局标准被视为有反应者（临床总体印象改善量表上“非常显著改善”或“显著改善”）。丙戊酸镁耐受性良好，无因不良反应而停药的情况。
患有情绪或行为障碍且至少有轻度情感症状的双相情感障碍后代可能对丙戊酸镁治疗有反应。我们的研究受到开放治疗、缺乏安慰剂组以及样本异质性的限制。有必要进行对照研究以确定丙戊酸镁在有症状的双相情感障碍后代中的应用。
