Frye Mark A, Helleman Gerhard, McElroy Susan L, Altshuler Lori L, Black David O, Keck Paul E, Nolen Willem A, Kupka Ralph, Leverich Gabriele S, Grunze Heinz, Mintz Jim, Post Robert M, Suppes Trisha
Department of Psychiatry, Mayo Mood Clinic and Research Program, Mayo Clinic, 200 First St., S.W., Rochester, MN 55901, USA.
Am J Psychiatry. 2009 Feb;166(2):164-72. doi: 10.1176/appi.ajp.2008.08030322. Epub 2008 Nov 17.
Treatment-emergent mania can have substantial negative impact on overall mood and psychosocial stability in patients receiving treatment for bipolar depression. This study examined the correlates associated with treatment-emergent mania in patients receiving adjunctive antidepressant treatment for bipolar depression.
A total of 176 adult outpatients with bipolar disorder in a 10-week trial of adjunctive antidepressant treatment for depression were categorized into three groups based on the Clinical Global Impression Scale for Bipolar Disorder: those who responded to antidepressant treatment (N=85), those who did not respond to antidepressant treatment (N=45), and those who had treatment-emergent mania or hypomania (N=46). Symptom severity was measured with the Inventory of Depressive Symptomatology and the Young Mania Rating Scale (YMRS) at baseline and bimonthly intervals. Factor analysis was used to examine correlates of treatment-emergent mania.
Baseline YMRS scores were significantly different between groups. Otherwise, there were no significant between-group differences in demographic or clinical characteristics. Factor analysis showed that a subset of the YMRS items predicted treatment-emergent mania in this sample: increased motor activity, speech, and language-thought disorder.
These data suggest that minimal manic symptoms at baseline coexisting with otherwise full syndromal bipolar depression are associated with antidepressant treatment-emergent mania or hypomania. A careful examination of motor activation, pressured speech, and racing thoughts is warranted before starting antidepressant treatment in bipolar depression.
在接受双相抑郁治疗的患者中，治疗中出现的躁狂可能会对整体情绪和心理社会稳定性产生重大负面影响。本研究探讨了接受双相抑郁辅助抗抑郁治疗的患者中与治疗中出现的躁狂相关的因素。
在一项为期10周的双相抑郁辅助抗抑郁治疗试验中，共有176名成年双相情感障碍门诊患者根据双相情感障碍临床总体印象量表被分为三组：对抗抑郁治疗有反应者（N = 85）、对抗抑郁治疗无反应者（N = 45）以及出现治疗中躁狂或轻躁狂者（N = 46）。在基线及每两个月的间隔期，使用抑郁症状量表和杨氏躁狂评定量表（YMRS）测量症状严重程度。采用因子分析来研究治疗中出现的躁狂的相关因素。
各组间基线YMRS评分存在显著差异。除此之外，在人口统计学或临床特征方面，组间无显著差异。因子分析表明，YMRS项目的一个子集可预测该样本中治疗中出现的躁狂：运动活动增加、言语增多和语言思维紊乱。
这些数据表明，在基线时存在轻微躁狂症状且同时伴有其他完全综合征性双相抑郁，与抗抑郁治疗中出现的躁狂或轻躁狂有关。在开始对双相抑郁进行抗抑郁治疗之前，有必要仔细检查运动激活、言语逼迫感和思维奔逸情况。
