Michalak Erin E, Murray Greg, Young Allan H, Lam Raymond W
Division of Mood Disorders, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
CNS Drugs. 2008;22(5):389-406. doi: 10.2165/00023210-200822050-00003.
Bipolar disorder is a complex, chronic psychiatric condition characterized by recurring episodes of depressive illness and mania or hypomania. Although the manic or hypomanic episodes define the disorder, recent research has shown that depressive symptoms predominate over manic symptoms in the majority of patients, and that bipolar depression accounts for much of the significant morbidity and mortality associated with bipolar disorder. Given these findings, there has been a recent upsurge of interest in furthering our understanding of the burden of depression in bipolar disorder. At the same time, increasing scientific attention is now being paid to expanding the measurement of outcome in bipolar disorder to encompass broader indicators of response, one of which is the assessment of quality of life (QOL). In this review, we provide a summary of the current knowledge about QOL in the depressive phase of bipolar disorder, and the effects of pharmacological treatment interventions for bipolar disorder upon QOL. It appears that QOL is poorer in bipolar disorder than in other mood disorders and anxiety disorders, but that schizophrenia might compromise QOL more severely than bipolar disorder. Existing data also suggest that, for patients with bipolar disorder, QOL is negatively associated with depression, both as a cross-sectional mood state and perhaps also as a feature of the patient's course. Despite its clinical and public health importance, bipolar depression has only recently started to receive the attention it warrants in clinical trials, and many important questions about its optimal pharmacological management remain to be answered. There is also a paucity of information about the impact of pharmacological interventions on QOL in bipolar depression. To our knowledge, only two clinical trials to date have specifically examined the impact of medications on QOL in patients with bipolar depression. A small number of other studies have examined the effects of depressive symptoms on QOL in patients who are experiencing manic or mixed episodes. Nonetheless, QOL appears to be a meaningful and important indicator of outcome and recovery in this patient population, and one that warrants further scientific interest and energy.
双相情感障碍是一种复杂的慢性精神疾病，其特征为抑郁发作与躁狂或轻躁狂发作反复出现。尽管躁狂或轻躁狂发作定义了该疾病，但最近的研究表明，在大多数患者中，抑郁症状比躁狂症状更为突出，并且双相抑郁是双相情感障碍相关的大部分严重发病和死亡的原因。鉴于这些发现，最近人们对进一步了解双相情感障碍中抑郁负担的兴趣激增。与此同时，越来越多的科学关注正投向扩大双相情感障碍的疗效测量范围，以纳入更广泛的反应指标，其中之一就是生活质量（QOL）评估。在本综述中，我们总结了目前关于双相情感障碍抑郁期生活质量的知识，以及双相情感障碍药物治疗干预对生活质量的影响。双相情感障碍患者的生活质量似乎比其他情绪障碍和焦虑障碍患者更差，但精神分裂症可能比双相情感障碍更严重地损害生活质量。现有数据还表明，对于双相情感障碍患者，生活质量与抑郁呈负相关，无论是作为横断面情绪状态，还是可能作为患者病程的一个特征。尽管双相抑郁具有临床和公共卫生重要性，但它直到最近才开始在临床试验中得到应有的关注，关于其最佳药物治疗的许多重要问题仍有待解答。关于药物干预对双相抑郁患者生活质量的影响的信息也很匮乏。据我们所知，迄今为止只有两项临床试验专门研究了药物对双相抑郁患者生活质量的影响。其他一些研究则考察了抑郁症状对处于躁狂或混合发作期患者生活质量的影响。尽管如此，生活质量似乎是该患者群体疗效和康复的一个有意义且重要的指标，值得进一步的科学关注和投入。
