Ghaemi S Nassir, Hsu Douglas J, Thase Michael E, Wisniewski Stephen R, Nierenberg Andrew A, Miyahara Sachiko, Sachs Gary
Department of Psychiatry at Emory University in Atlanta, Georgia 30322, USA.
Psychiatr Serv. 2006 May;57(5):660-5. doi: 10.1176/ps.2006.57.5.660.
This study assessed patterns of psychopharmacological treatment for bipolar disorder.
Intake treatment data were examined for the first 500 patients in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study (1998 to 1999). Diagnoses were assessed by using the Structured Clinical Interview for DSM-IV mood modules. Data on treatments were obtained by interviewing patients during the initial psychiatric examination.
Of the 500 participants, 73.6 percent had bipolar I disorder, 23.0 percent had bipolar II disorder, and 3.4 percent had bipolar disorder not otherwise specified. Upon examination, 63.4 percent were euthymic, 24.6 percent were depressed, and 12.0 percent were experiencing manic, hypomanic, or mixed states. Standard mood stabilizers (lithium, valproate, or carbamazepine) were the most commonly prescribed class of drugs that participants were taking at intake (71.9 percent). The next most common class of agents was antidepressants (40.6 percent), followed by novel anticonvulsants (31.8 percent), second-generation neuroleptics (27.2 percent), and benzodiazepines (25.0 percent). Eleven percent of patients were treated with standard mood stabilizer monotherapy. These prescribing patterns were further analyzed by subtype of illness and compared with patterns in other clinical and community settings.
In a large, well-characterized cross-sectional analysis of prescription patterns in the U.S. psychiatric academic setting, patients with bipolar disorder were primarily treated with standard mood stabilizers, followed by moderate use of antidepressants, novel anticonvulsants, and second-generation neuroleptics. Results can be useful in understanding the current clinical standard of care, as well as in guiding research studies toward areas in which there is a relative absence of evidence to inform clinical practice. Studies of longitudinal prescribing patterns in bipolar disorder are also needed.
本研究评估了双相情感障碍的心理药物治疗模式。
对双相情感障碍系统治疗强化项目（STEP - BD）研究（1998年至1999年）中的前500名患者的入院治疗数据进行了检查。使用DSM - IV情绪模块的结构化临床访谈对诊断进行评估。通过在初次精神检查期间对患者进行访谈来获取治疗数据。
在500名参与者中，73.6%患有双相I型障碍，23.0%患有双相II型障碍，3.4%患有未特定说明的双相情感障碍。经检查，63.4%处于心境正常状态，24.6%处于抑郁状态，12.0%处于躁狂、轻躁狂或混合状态。标准心境稳定剂（锂盐、丙戊酸盐或卡马西平）是参与者入院时最常服用的药物类别（71.9%）。其次最常见的药物类别是抗抑郁药（40.6%），然后是新型抗惊厥药（31.8%）、第二代抗精神病药（27.2%）和苯二氮䓬类药物（25.0%）。11%的患者接受标准心境稳定剂单药治疗。这些处方模式按疾病亚型进一步分析，并与其他临床和社区环境中的模式进行比较。
在美国精神病学学术环境中进行的一项大规模、特征明确的处方模式横断面分析中，双相情感障碍患者主要接受标准心境稳定剂治疗，其次是适度使用抗抑郁药、新型抗惊厥药和第二代抗精神病药。研究结果有助于理解当前的临床护理标准，并指导研究针对相对缺乏证据以指导临床实践的领域。还需要对双相情感障碍的纵向处方模式进行研究。
