Lenox R H, Newhouse P A, Creelman W L, Whitaker T M
Department of Psychiatry, University of Vermont College of Medicine, Burlington 05405.
J Clin Psychiatry. 1992 Feb;53(2):47-52.
While lithium is effective in treating the majority of bipolar patients during a manic episode, the addition of neuroleptic during the early phase of treatment has been common clinical practice in inpatient settings. In an earlier open study, we demonstrated the utility of the short-acting benzodiazepine lorazepam as an adjunct to lithium for the clinical management of manic agitation.
We now present data from a randomized, double-blind clinical study of lorazepam versus haloperidol in 20 hospitalized patients with a DSM-III-R diagnosis of bipolar disorder who were being treated concomitantly with lithium. Patients were rated using the Mania Rating Scale, Brief Psychiatric Rating Scale, Physician Global Impression Scale, and side effects scales. Data were analyzed using standard group comparisons and survival analysis.
There was no evidence for a significant difference between the two treatment groups in the magnitude of or time to response (5.0 +/- .82 days for haloperidol; 6.5 +/- .93 days for lorazepam). Of the patients who were terminated from the protocol early, nonresponse was the primary reason in the lorazepam group while side effects were the reason in the haloperidol group.
Lorazepam may offer an efficacious and safe alternative to haloperidol as an adjunctive treatment to lithium in the clinical management of the early phase of manic agitation in a subgroup of bipolar patients.
虽然锂盐在治疗大多数双相情感障碍患者躁狂发作时有效，但在住院环境中，在治疗早期加用抗精神病药物是常见的临床做法。在一项早期的开放性研究中，我们证明了短效苯二氮䓬类药物劳拉西泮作为锂盐辅助药物用于躁狂激越临床管理的效用。
我们现在展示一项随机、双盲临床研究的数据，该研究对比了劳拉西泮与氟哌啶醇对20例诊断为双相情感障碍（DSM-III-R标准）且正在接受锂盐治疗的住院患者的疗效。使用躁狂评定量表、简明精神病评定量表、医生整体印象量表和副作用量表对患者进行评分。采用标准组间比较和生存分析对数据进行分析。
没有证据表明两个治疗组在反应程度或反应时间上存在显著差异（氟哌啶醇组为5.0±0.82天；劳拉西泮组为6.5±0.93天）。在提前退出方案的患者中，劳拉西泮组的主要原因是无反应，而氟哌啶醇组的原因是副作用。
对于双相情感障碍患者亚组躁狂激越早期阶段的临床管理，劳拉西泮作为锂盐的辅助治疗，可能是氟哌啶醇的一种有效且安全的替代药物。
