Baca-Garcia Enrique, Sher Leo, Perez-Rodriguez M Mercedes, Burke Ainsley K, Sullivan Gregory M, Grunebaum Michael F, Stanley Barbara H, Mann J John, Oquendo Maria A
Molecular Imaging and Neuropathology Division, NYS Psychiatric Institute and Columbia University, New York 10032, USA.
J Affect Disord. 2009 May;115(1-2):262-8. doi: 10.1016/j.jad.2008.09.012. Epub 2008 Oct 29.
We aimed to examine the adequacy of antidepressant treatment and compliance with treatment in bipolar patients with and without alcohol use disorders (AUD). We hypothesize that the adequacy of antidepressant treatment and the compliance with treatment for those with AUD are lower than for those without AUD.
Subjects were 97 patients with current bipolar major depressive episode, 39 (40.2%) with lifetime history of AUD and 58 (59.8%) without AUD. Adequacy of antidepressant medication treatment in the 3 previous months was assessed using the Antidepressant Treatment History Form. Compliance rates were estimated.
Rates of inadequate treatment were high in all patients. Bipolar patients with AUD (74.3%) showed higher rates of inadequate antidepressant treatment than those without AUD (67.3%). The proportion of intensive treatment was higher in bipolars without AUD (15.5%) than in those with AUD (2.6%). Median compliance was similar in bipolars with and without AUD.
We lack serum medication levels to assess the compliance. We do not have data to address the possibility that the presence of AUD adversely affected prescribing practices.
Bipolars with AUD had lower rates of adequate treatment than those without AUD, but the two groups were not different in terms of self-reported treatment adherence. The finding that bipolar patients with or without comorbid AUD did not receive adequate treatment is of considerable clinical relevance. It raises the question as to whether inadequate treatment of depression contributes to the high rates of morbidity, and attempted and completed suicides in bipolar patient populations.
我们旨在研究伴有和不伴有酒精使用障碍（AUD）的双相情感障碍患者抗抑郁治疗的充分性及治疗依从性。我们假设，伴有AUD的患者抗抑郁治疗的充分性及治疗依从性低于不伴有AUD的患者。
研究对象为97例当前处于双相情感障碍重度抑郁发作的患者，其中39例（40.2%）有AUD终生史，58例（59.8%）无AUD终生史。使用抗抑郁治疗史表格评估前3个月抗抑郁药物治疗的充分性，并估算依从率。
所有患者中治疗不充分的比例都很高。伴有AUD的双相情感障碍患者（74.3%）抗抑郁治疗不充分的比例高于不伴有AUD的患者（67.3%）。不伴有AUD的双相情感障碍患者强化治疗的比例（15.5%）高于伴有AUD的患者（2.6%）。伴有和不伴有AUD的双相情感障碍患者的中位依从性相似。
我们缺乏血清药物水平来评估依从性。我们没有数据来探讨AUD的存在是否对处方行为产生不利影响。
伴有AUD的双相情感障碍患者充分治疗的比例低于不伴有AUD的患者，但两组在自我报告的治疗依从性方面没有差异。伴有或不伴有AUD共病的双相情感障碍患者均未接受充分治疗这一发现具有相当大的临床意义。这就提出了一个问题，即抑郁症治疗不充分是否导致了双相情感障碍患者群体中高发病率、自杀未遂和自杀既遂的发生率。
