Al Jurdi Rayan K, Marangell Lauren B, Petersen Nancy J, Martinez Melissa, Gyulai Laszlo, Sajatovic Martha
Department of Psychiatry, Baylor College of Medicine, Houston, Texas, USA.
Am J Geriatr Psychiatry. 2008 Nov;16(11):922-33. doi: 10.1097/JGP.0b013e318187135f.
This study compares prescription patterns between young adults and elderly with bipolar disorder who achieved a recovery status during the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD).
STEP-BD is a multicenter National Institute of Mental Health-funded project designed to evaluate the longitudinal outcome of patients with bipolar disorder. The STEP-BD study involved extensive assessment across multiple domains including demographic data, diagnosis, symptom severity, treatment, and clinical status. Patients achieved "recovered" status when they experienced eight consecutive weeks without significant symptoms.
The authors analyzed data of all subjects who achieved a recovered status at least once in their participation.
The authors compared treatment regimes and doses among young participants with middle age (N = 3,364), 20-59 years old, and older participants 60 and above (N = 246).
Of the 3,615 STEP-BD participants who had a lifetime diagnosis of bipolar subtypes I or II, 67.6% (N = 2442) achieved a recovered status during their participation. A total of 78.5% (N = 193) of older patients recovered compared with 66.8% of the younger cohort. On average, participants who reached a recovered status took 2.05 medications with no difference between age groups. Lithium was prescribed to 37.8% of younger patients compared with only 29.5% of older participants. The mean dosages taken by younger and older patients differed significantly only for lithium, valproate, and risperidone with elderly individuals prescribed lower daily dosages. Significant reduction in lithium dosing was observed among individuals aged 50 and older and among individuals 60 and older for valproate. Although valproate was more often prescribed, 42.1% of recovered bipolar elder achieved recovery with lithium alone compared with only 21.3% of the younger cohort.
This data shows recovery is achievable in the elderly though more than one medication is often needed regardless of age.
本研究比较了在双相情感障碍系统治疗强化项目（STEP - BD）中达到康复状态的双相情感障碍青年人和老年人的处方模式。
STEP - BD是一项由美国国立精神卫生研究所资助的多中心项目，旨在评估双相情感障碍患者的纵向结局。STEP - BD研究涉及多个领域的广泛评估，包括人口统计学数据、诊断、症状严重程度、治疗和临床状态。当患者连续八周没有明显症状时，即达到“康复”状态。
作者分析了所有至少有一次达到康复状态的受试者的数据。
作者比较了年龄在20 - 59岁的中年参与者（N = 3364）和60岁及以上的老年参与者（N = 246）之间的治疗方案和剂量。
在3615名终生诊断为双相I型或II型亚型的STEP - BD参与者中，67.6%（N = 2442）在参与研究期间达到了康复状态。老年患者中共有78.5%（N = 193）康复，而年轻队列中的康复率为66.8%。平均而言，达到康复状态的参与者服用2.05种药物，各年龄组之间无差异。37.8%的年轻患者使用了锂盐，而老年参与者中只有29.5%使用。年轻患者和老年患者服用的平均剂量仅在锂盐、丙戊酸盐和利培酮方面存在显著差异，老年人的每日剂量较低。在50岁及以上的个体以及60岁及以上的个体中，观察到锂盐剂量显著降低，丙戊酸盐也是如此。尽管丙戊酸盐的处方更为常见，但42.1%康复的双相情感障碍老年患者仅通过锂盐就实现了康复，而年轻队列中这一比例仅为21.3%。
这些数据表明，老年人也可以实现康复，不过无论年龄大小，通常都需要不止一种药物。
