Revicki Dennis A, Matza Louis S, Flood Emuella, Lloyd Andrew
Center for Health Outcomes Research, The MEDTAP Institute at United BioSource Corporation, Bethesda, Maryland 20814, USA. Dennis.Revicki@united biosource.com
Pharmacoeconomics. 2005;23(6):583-94. doi: 10.2165/00019053-200523060-00005.
Bipolar disorder is a chronic psychiatric disorder with a variable course and significant impact on patients' social, occupational, and general functioning and wellbeing. Although there are effective pharmaceutical and psychosocial interventions for patients with bipolar disorder, many patients receive poor-quality care. Prospective longitudinal studies demonstrate that less than half of bipolar disorder patients have a good long-term response to treatment, long-term outcome is highly variable, and many patients do not fully recover. There is substantial evidence that bipolar disorder is associated with significant impairment to functioning and wellbeing.However, few clinical trials comparing treatments for bipolar disorder have incorporated health-related quality-of-life (HR-QOL) assessments. Existing studies suggest that, while treatment improves HR-QOL, there is limited evidence for differences between the mood stabilisers in terms of HR-QOL outcomes. Additional clinical trials are needed to evaluate patient-reported outcomes associated with the most frequently used pharmacological treatments to determine whether there are meaningful differences between treatments. There are challenges in measuring HR-QOL in patients with acute mania, and future studies should assess the psychometric qualities of HR-QOL instruments in these and other bipolar disorder patients. HR-QOL outcome data may be useful in informing psychiatrists, patients and patient family members of the effects of treatment for bipolar disorder on patients' everyday lives, functioning and wellbeing.
双相情感障碍是一种慢性精神疾病，病程多变，对患者的社交、职业及整体功能和幸福感有重大影响。尽管有针对双相情感障碍患者的有效药物和心理社会干预措施，但许多患者接受的护理质量较差。前瞻性纵向研究表明，不到一半的双相情感障碍患者对治疗有良好的长期反应，长期预后差异很大，许多患者无法完全康复。有大量证据表明，双相情感障碍与功能和幸福感的显著损害有关。然而，很少有比较双相情感障碍治疗方法的临床试验纳入与健康相关的生活质量（HR-QOL）评估。现有研究表明，虽然治疗可改善HR-QOL，但关于心境稳定剂在HR-QOL结果方面的差异，证据有限。需要更多的临床试验来评估与最常用药物治疗相关的患者报告结局，以确定不同治疗方法之间是否存在有意义的差异。在急性躁狂症患者中测量HR-QOL存在挑战，未来的研究应评估这些患者及其他双相情感障碍患者中HR-QOL工具的心理测量质量。HR-QOL结局数据可能有助于告知精神科医生、患者及其家属双相情感障碍治疗对患者日常生活、功能和幸福感的影响。
