Duffy Anne, Milin Robert, Grof Paul
Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
BMC Psychiatry. 2009 Feb 6;9:4. doi: 10.1186/1471-244X-9-4.
The purpose of the study was to determine the effectiveness and tolerability of quetiapine as a maintenance treatment preventing against relapse or recurrence of acute mood episodes in adolescent patients diagnosed with bipolar disorder.
Consenting patients meeting DSM-IV lifetime criteria for a bipolar disorder and clinically appropriate for maintenance treatment were enrolled in a 48-week open prospective study. After being acutely stabilized (CGI-S < or = 3 for 4 consecutive weeks), patients were started or continued on quetiapine and other medications were weaned off over an 8-week period. Quetiapine monotherapy was continued for 40-weeks and other mood stabilizers or antidepressants were added if clinically indicated. A neurocognitive test battery assessing the most reliable findings in adult patients was administered at fixed time points throughout the study to patients and matched controls.
Of the 21 enrolled patients, 18 completed the 48-week study. Thirteen patients were able to be maintained without relapse or recurrence in good quality remission on quetiapine monotherapy, while 5 patients required additional medication to treat impairing residual depressive and/or anxiety symptoms. According to symptom ratings and global functioning scores, the quality of remission for all patients was very good.Neurocognitive test performance over treatment was equivalent to that of a matched control group of never ill adolescents. Quetiapine was generally well tolerated with no serious adverse effects.
This study suggests that a proportion of adolescent patients diagnosed with bipolar disorder can be successfully maintained on quetiapine monotherapy. The good quality of clinical remission and preserved neurocognitive functioning underscores the importance of early diagnosis and effective stabilization.
D1441L00024.
本研究旨在确定喹硫平作为维持治疗药物，预防双相情感障碍青少年患者急性情绪发作复发或再发的有效性和耐受性。
符合双相情感障碍DSM-IV终身诊断标准且临床适合维持治疗的患者，被纳入一项为期48周的开放性前瞻性研究。在急性症状稳定后（连续4周临床总体印象量表评分（CGI-S）≤3），患者开始服用喹硫平或继续服用，其他药物在8周内逐渐停用。喹硫平单药治疗持续40周，如有临床指征则添加其他心境稳定剂或抗抑郁药。在研究的固定时间点，对患者和匹配的对照组进行一套神经认知测试，以评估成年患者中最可靠的结果。
21名入组患者中，18名完成了48周的研究。13名患者仅使用喹硫平单药治疗即可维持良好的缓解状态，无复发或再发，而5名患者需要额外药物治疗残留的抑郁和/或焦虑症状。根据症状评分和整体功能评分，所有患者的缓解质量都非常好。治疗期间的神经认知测试表现与从未患病的青少年匹配对照组相当。喹硫平总体耐受性良好，无严重不良反应。
本研究表明，一部分诊断为双相情感障碍的青少年患者可以通过喹硫平单药治疗成功维持病情。良好的临床缓解质量和保留的神经认知功能强调了早期诊断和有效稳定治疗的重要性。
D1441L00024
