Smith L A, Cornelius V, Warnock A, Tacchi M J, Taylor D
Medical Research Matters, Eynsham, UK.
Acta Psychiatr Scand. 2007 Jan;115(1):12-20. doi: 10.1111/j.1600-0447.2006.00912.x.
The aim of this meta-analysis was to systematically review the effectiveness of co-therapy compared with monotherapy for people with bipolar mania.
MEDLINE, Embase, Psychinfo, The Cochrane Library and reference lists of retrieved studies were searched without language restrictions for randomized controlled trials evaluating co-therapy compared with monotherapy for acute bipolar mania. Each trial was assessed for susceptibility to bias. Data on mania outcomes, withdrawals, extrapyramidal symptoms and weight were extracted and pooled effect estimates summarized as relative risks (RR) or differences in mean values (MD) where appropriate.
Eight eligible studies were included (1124 participants). Significant reductions in mania (Young Mania Rating Scale, YMRS) scores were shown for haloperidol, olanzapine, risperidone and quetiapine as co-therapy compared with monotherapy with a mood stabilizer. For atypical antipsychotics combined, the pooled difference in mean scores was 4.41 (95% CI: 2.74, 6.07). Significantly more participants on co-therapy met the response criterion (at least 50% reduction in YMRS score), RR 1.53 (1.31, 1.80). With some drugs, co-therapy decreased tolerability compared with monotherapy, and resulted in greater weight gain. There were insufficient data to compare one co-therapy regimen with another.
The addition of antipsychotic treatment to established mood-stabilizer treatment is more effective than mood-stabilizer treatment alone.
本荟萃分析旨在系统评价联合治疗对比单一疗法治疗双相躁狂症患者的有效性。
检索MEDLINE、Embase、Psychinfo、Cochrane图书馆以及检索到的研究的参考文献列表，纳入评价联合治疗对比单一疗法治疗急性双相躁狂症的随机对照试验，无语言限制。对每项试验进行偏倚易感性评估。提取关于躁狂症结局、退出研究、锥体外系症状和体重的数据，并在适当情况下将合并效应估计值总结为相对危险度（RR）或均值差异（MD）。
纳入8项符合条件的研究（1124名参与者）。与使用心境稳定剂单一疗法相比，使用氟哌啶醇、奥氮平、利培酮和喹硫平联合治疗时，躁狂症（杨氏躁狂量表，YMRS）评分显著降低。对于联合使用的非典型抗精神病药物，平均评分的合并差异为4.41（95%CI：2.74，6.07）。联合治疗中有显著更多的参与者达到反应标准（YMRS评分至少降低50%），RR为1.53（1.31，1.80）。与单一疗法相比，某些药物联合治疗降低了耐受性，并导致体重增加更多。没有足够的数据来比较一种联合治疗方案与另一种方案。
在既定的心境稳定剂治疗基础上加用抗精神病药物治疗比单独使用心境稳定剂治疗更有效。
