Chou J C
Nathan Kline Institute, Orangeburg, New York 10962.
J Clin Psychopharmacol. 1991 Feb;11(1):3-21.
Standard and more recent advances in treatment of acute mania are reviewed with special emphasis on controlled studies. Lithium is still the drug of choice and the most common treatment for mania, but some of its limitations have become more apparent, and specific indications for its use are defined. Alternatives to lithium are recommended for psychotic, rapid cycling, severely manic, and lithium-refractory patients. Neuroleptics are effective and used commonly but carry risks of long term side effects. Substantial reduction in neuroleptic dose and duration of exposure is probably feasible in many patients. Neuroleptic-lithium combinations are popular but do not have clear advantages over treatment with a single drug in the initial treatment of acute mania. These combinations have also been associated with increased neurotoxicity. Carbamazepine, both alone and in combination with lithium, has been used increasingly over recent years. Its efficacy is comparable to lithium, but clinical features predicting responsiveness may be different for these two drugs. Carbamazepine-neuroleptic combinations offer little advantage over neuroleptics alone. Valproic acid, verapamil, clonazepam, lorazepam, benzodiazepine-neuroleptic combinations, clonidine, tryptophan, propranolol, and electroconvulsive therapy are also popular, but their effectiveness has not yet been adequately confirmed by controlled studies.
本文回顾了急性躁狂症治疗的标准方法及最新进展，特别强调了对照研究。锂盐仍然是治疗躁狂症的首选药物和最常用疗法，但它的一些局限性已变得更加明显，文中明确了其具体使用指征。对于伴有精神病性症状、快速循环发作、严重躁狂发作以及锂盐难治性的患者，推荐使用锂盐以外的其他药物。抗精神病药物有效且常用，但存在长期副作用风险。在许多患者中，大幅降低抗精神病药物剂量和缩短用药时间可能是可行的。抗精神病药物与锂盐联合使用很常见，但在急性躁狂症的初始治疗中，与单一药物治疗相比并无明显优势。这些联合用药还与神经毒性增加有关。近年来，卡马西平单独使用或与锂盐联合使用的情况越来越多。其疗效与锂盐相当，但这两种药物预测反应性的临床特征可能有所不同。卡马西平与抗精神病药物联合使用相比单独使用抗精神病药物并无多少优势。丙戊酸、维拉帕米、氯硝西泮、劳拉西泮、苯二氮䓬类与抗精神病药物联合使用、可乐定、色氨酸、普萘洛尔以及电抽搐治疗也很常用，但其有效性尚未得到对照研究的充分证实。
