Brochier T, Gay C
Service Hospitalo-Universitaire de Santé Mentale et de Thérapeutique, Centre Hospitalier Sainte-Anne, Paris.
Encephale. 1991 Dec;17 Spec No 3:391-8.
Among clinical factors, the compliance amounts to 47 to 82% of the patients. Recent data contradict the classical poor response of unipolar patients to lithium. Most studies realized on bipolar patients concern bipolars type I. Bipolar patients type II often show comorbidity factors which predict poor response to lithium or carbamazepine. The clarity of mood disorders and the frequency of cyclers have a bearing on the treatment response. But hypothyroidisms described in rapid cyclers do not predict response to L. thyroxine. We should also take into account the sequence of episodes and the type of index episode. The data concerning other possible mood stabilizers are scarce. Among biological parameters, the results are very upsetting. The calcium levels, serotonin levels, the red blood cell/plasma lithium ratio essentially predict tolerance or compliance. The various psychological tests do not enable us to identify a sub-group of patients responding to lithium. The remaining difficulties in the predictive capacity enhance the importance of establishing for each patient the precise history of the illness and previous treatments.
在临床因素中,患者的依从率为47%至82%。近期数据与单相患者对锂盐反应不佳的经典观点相矛盾。大多数针对双相情感障碍患者的研究关注的是I型双相情感障碍。II型双相情感障碍患者常表现出一些共病因素,这些因素预示着对锂盐或卡马西平反应不佳。心境障碍的清晰度和发作频率对治疗反应有影响。但快速循环型患者中出现的甲状腺功能减退并不能预测对左甲状腺素的反应。我们还应考虑发作的顺序和首发发作的类型。关于其他可能的心境稳定剂的数据很少。在生物学参数方面,结果非常令人不安。钙水平、血清素水平、红细胞/血浆锂比值主要预测耐受性或依从性。各种心理测试无法使我们识别出对锂盐有反应的患者亚组。预测能力方面仍然存在的困难凸显了为每位患者建立精确的疾病史和既往治疗史的重要性。