Vieta Eduard, Rosa Adriane R
Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain.
World J Biol Psychiatry. 2007;8(1):4-11. doi: 10.1080/15622970601083280.
The episodic and chronic nature of bipolar disorder usually requires long-term treatment in all patients, yet there is an unmet need for well-tolerated and clinically effective maintenance therapy with enhanced patient adherence. Few well-tolerated treatment options are currently available that are both effective in all phases of bipolar disorder and prevent recurrence of episodes. Lithium has well-established efficacy in the prevention of further manic episodes and may also be effective in the prevention of depression and suicide, but safety is a concern due to narrow therapeutic window. For valproate and carbamazepine, data appear much less compelling. Lamotrigine has shown to be effective for long-term prevention of depressive episodes. Controlled studies suggest that atypical antipsychotics may also have mood-stabilizing properties and might become standard for long-term therapy in the new future. The role of psychoeducation in improving adherence to medication in long-term treatment and overall patient outcomes is also crucial.
双相情感障碍的发作性和慢性性质通常要求所有患者都接受长期治疗，然而，目前仍未满足对耐受性良好且临床有效的维持治疗的需求，这种治疗还需提高患者的依从性。目前几乎没有耐受性良好的治疗选择，既能在双相情感障碍的所有阶段都有效，又能预防发作的复发。锂盐在预防进一步的躁狂发作方面具有公认的疗效，在预防抑郁和自杀方面可能也有效，但由于治疗窗狭窄，安全性令人担忧。丙戊酸盐和卡马西平的数据似乎说服力要小得多。拉莫三嗪已被证明对长期预防抑郁发作有效。对照研究表明，非典型抗精神病药物可能也具有心境稳定特性，在未来可能会成为长期治疗的标准药物。心理教育在长期治疗中提高药物依从性和改善患者总体预后方面的作用也至关重要。
