Tohen Mauricio, Chengappa K N Roy, Suppes Trisha, Baker Robert W, Zarate Carlos A, Bowden Charles L, Sachs Gary S, Kupfer David J, Ghaemi S Nassir, Feldman Peter D, Risser Richard C, Evans Angela R, Calabrese Joseph R
Lilly Research Laboratories, Indianapolis, Indiana 46285, USA.
Br J Psychiatry. 2004 Apr;184:337-45. doi: 10.1192/bjp.184.4.337.
Few controlled studies have examined the use of atypical antipsychotic drugs for prevention of relapse in patients with bipolar I disorder. Aims To evaluate whether olanzapine plus either lithium or valproate reduces the rate of relapse, compared with lithium or valproate alone.
Patients achieving syndromic remission after 6 weeks'treatment with olanzapine plus either lithium (0.6-1.2 mmol/l) or valproate (50-125 microg/ml) received lithium or valproate plus either olanzapine 5-20 mg/day (combination therapy) or placebo (monotherapy), and were followed in a double-masked trial for 18 months.
The treatment difference in time to relapse into either mania or depression was not significant for syndromic relapse (median time to relapse: combination therapy 94 days, monotherapy 40.5 days; P=0.742), but was significant for symptomatic relapse (combination therapy 163 days, monotherapy 42 days; P=0.023).
Patients taking olanzapine added to lithium or valproate experienced sustained symptomatic remission, but not syndromic remission, for longer than those receiving lithium or valproate monotherapy.
很少有对照研究探讨非典型抗精神病药物在预防双相I型障碍患者复发中的应用。目的：评估与单用锂盐或丙戊酸盐相比，奥氮平联合锂盐或丙戊酸盐是否能降低复发率。
在用奥氮平联合锂盐（0.6 - 1.2 mmol/L）或丙戊酸盐（50 - 125 μg/ml）治疗6周后达到症状缓解的患者，接受锂盐或丙戊酸盐加奥氮平5 - 20 mg/天（联合治疗）或安慰剂（单药治疗），并在双盲试验中随访18个月。
对于综合征复发，复发至躁狂或抑郁的时间治疗差异无统计学意义（复发的中位时间：联合治疗94天，单药治疗40.5天；P = 0.74），但对于症状性复发有统计学意义（联合治疗163天，单药治疗42天；P = 0.023）。
与接受锂盐或丙戊酸盐单药治疗的患者相比，服用奥氮平联合锂盐或丙戊酸盐的患者症状缓解持续时间更长，但综合征缓解情况并非如此。
