Busch Alisa B, Frank Richard G, Sachs Gary, Normand Sharon-Lise T
McLean Hospital, Belmont, MA, USA.
Psychopharmacol Bull. 2009;42(1):35-49.
Second-generation antipsychotics offer more choice in antimanic pharmacologic treatment. Unclear though is whether they are expanding antimanic treatment, replacing mood stabilizers, or if/which patient characteristics influence prescribing choices. We studied the association between patient characteristics and patient-reported antimanic medication use upon entry in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD).
Observational study using STEP-BD baseline data from bipolar-I patients (N = 1,943) during years 2000-2004. Two logistic regression models (binomial and multinomial) were estimated to examine associations between patient characteristics and patient-reported drug use: 1) any antimanic medication (antipsychotic or mood stabilizer), and 2) mood stabilizer, antipsychotic monotherapy, or neither.
At study entry over 80% of participants reported receiving at least one antimanic medication; 73% a mood stabilizer specifically. In general, there was no association between study year and the odds of entering on antimanic medication. Measures of psychiatric severity or complexity were more likely to be associated with differences in the drugs used; co-occurring medical conditions were not. Depressed states were associated with similar odds of antipsychotic monotherapy as elevated or mixed states. Compared to whites, blacks had greater odds of entering on antipsychotic monotherapy relative to a mood stabilizer.
Despite increasing pharmacotherapy options, we found no evidence that over time more patients received antimanic medication. Not all prescribing differences were consistent with the medical literature. Also, blacks were more likely to receive antipsychotic monotherapy, even after adjusting for clinical characteristics. Future research examining provider characteristics that influence prescribing is needed.
第二代抗精神病药物在抗躁狂药物治疗中提供了更多选择。然而，尚不清楚它们是在扩大抗躁狂治疗范围、取代心境稳定剂，还是患者特征（如果有/哪些）会影响处方选择。我们研究了双相情感障碍系统治疗强化项目（STEP - BD）入组时患者特征与患者报告的抗躁狂药物使用之间的关联。
使用2000 - 2004年双相I型障碍患者（N = 1,943）的STEP - BD基线数据进行观察性研究。估计了两个逻辑回归模型（二项式和多项式）以检验患者特征与患者报告的药物使用之间的关联：1）任何抗躁狂药物（抗精神病药物或心境稳定剂），以及2）心境稳定剂、抗精神病药物单药治疗或两者都不用。
在研究入组时，超过80%的参与者报告接受了至少一种抗躁狂药物；73%的人专门使用了心境稳定剂。总体而言，研究年份与开始使用抗躁狂药物的几率之间没有关联。精神疾病严重程度或复杂性的指标更可能与所用药物的差异相关；共病的医疗状况则不然。抑郁状态与抗精神病药物单药治疗的几率与躁狂发作或混合状态相似。与白人相比，黑人开始接受抗精神病药物单药治疗而非心境稳定剂的几率更高。
尽管药物治疗选择不断增加，但我们没有发现证据表明随着时间推移有更多患者接受抗躁狂药物治疗。并非所有的处方差异都与医学文献一致。此外，即使在调整临床特征后，黑人接受抗精神病药物单药治疗的可能性更大。需要进一步研究影响处方的医疗服务提供者特征。
