Goldberg Joseph F, Brooks John O, Kurita Keiko, Hoblyn Jennifer C, Ghaemi S Nassir, Perlis Roy H, Miklowitz David J, Ketter Terence A, Sachs Gary S, Thase Michael E
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA.
J Clin Psychiatry. 2009 Feb;70(2):155-62. doi: 10.4088/jcp.08m04301. Epub 2009 Feb 10.
Many patients with bipolar disorder receive multi-drug treatment regimens, but the distinguishing profiles of patients who receive complex pharmacologies have not been established.
Prescribing patterns of lithium, anticonvulsants, antidepressants, and antipsychotics were examined for 4,035 subjects with bipolar disorder (DSM-IV) immediately prior to entering the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Subjects were recruited for participation across 22 centers in the United States between November 1999 and July 2005. The quality receiver operating characteristic (ROC) method was used to develop composite profiles of patients receiving complex regimens (p < .01 for all iterations).
Use of 3 or more medications occurred in 40% of subjects, while 18% received 4 or more agents. Quality ROC analyses revealed that subjects had a 64% risk for receiving a complex regimen (> or = 4 medications) if they had (1) ever taken an atypical antipsychotic, (2) > or = 6 lifetime depressive episodes, (3) attempted suicide, and (4) an annual income > or = $75,000. Complex polypharmacy was least often associated with lithium, divalproex, or carbamazepine and most often associated with atypical antipsychotics or antidepressants. Contrary to expectations, a history of psychosis, age at onset, bipolar I versus II subtype, history of rapid cycling, prior hospitalizations, current illness state, and history of alcohol or substance use disorders did not significantly alter the risk profiles for receiving complex regimens.
Complex polypharmacy involving at least 4 medications occurs in approximately 1 in 5 individuals with bipolar disorder. Use of traditional mood stabilizers is associated with fewer cotherapies. Complex regimens are especially common in patients with substantial depressive illness burden and suicidality, for whom simpler drug regimens may fail to produce acceptable levels of response.
clinicaltrials.gov Identifier: NCT00012558.
许多双相情感障碍患者接受多种药物治疗方案，但接受复杂药物治疗的患者的特征尚未明确。
在4035名双相情感障碍（DSM-IV）患者即将进入双相情感障碍系统治疗强化项目（STEP-BD）之前，对他们使用锂盐、抗惊厥药、抗抑郁药和抗精神病药的处方模式进行了检查。1999年11月至2005年7月期间，在美国22个中心招募了研究对象。采用质量接受者操作特征（ROC）方法来确定接受复杂治疗方案患者的综合特征（所有迭代的p<0.01）。
40%的研究对象使用了3种或更多药物，18%的研究对象使用了4种或更多药物。质量ROC分析显示，如果患者有以下情况，则接受复杂治疗方案（≥4种药物）的风险为64%：（1）曾服用非典型抗精神病药；（2）一生中≥6次抑郁发作；（3）有自杀企图；（4）年收入≥75000美元。复杂的联合用药最不常与锂盐、丙戊酸或卡马西平相关，最常与非典型抗精神病药或抗抑郁药相关。与预期相反，精神病病史、发病年龄、双相I型与II型亚型、快速循环病史、既往住院史、当前疾病状态以及酒精或物质使用障碍病史并未显著改变接受复杂治疗方案的风险特征。
约五分之一的双相情感障碍患者使用了至少4种药物的复杂联合用药。使用传统心境稳定剂时联合使用其他药物的情况较少。复杂治疗方案在有严重抑郁疾病负担和自杀倾向的患者中尤为常见，对于这些患者，简单的药物治疗方案可能无法产生可接受的疗效。
clinicaltrials.gov标识符：NCT00012558。
