Bipolar Clinic and Research Programs, 50 Staniford St, 5th Floor, Boston, MA 02114, USA.
J Clin Psychiatry. 2010 Feb;71(2):194-200. doi: 10.4088/JCP.09m05019yel.
Benzodiazepines are widely prescribed to patients with bipolar disorder, but their impact on relapse and recurrence has not been examined.
We examined prospective data from a cohort of DSM-IV bipolar I and II patients who achieved remission during evidence-guided naturalistic treatment in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study (conducted in the United States between 1999 and 2005). Risk for recurrence among individuals who did or did not receive benzodiazepine treatment was examined using survival analysis. Cox regression was used to adjust for clinical and sociodemographic covariates. Propensity score analysis was used in a confirmatory analysis to address the possible impact of confounding variables.
Of 1,365 subjects, 349 (25.6%) were prescribed a benzodiazepine at time of remission from a mood episode. After adjusting for potential confounding variables, the hazard ratio for mood episode recurrence among benzodiazepine-treated patients was 1.21 (95% CI, 1.01-1.45). The effects of benzodiazepine treatment on relapse remained significant after excluding relapses occurring within 90 days of recovery, or stratifying the sample by propensity score, a summary measure of likelihood of receiving benzodiazepine treatment. In an independent cohort of 721 subjects already in remission at study entry, effects of similar magnitude were observed.
Benzodiazepine use may be associated with greater risk for recurrence of a mood episode among patients with bipolar I and II disorder. The prescribing of benzodiazepines, at a minimum, appears to be a marker for a more severe course of illness.
苯二氮䓬类药物被广泛用于治疗双相情感障碍患者，但它们对复发和再发的影响尚未得到研究。
我们研究了在双相情感障碍系统治疗增强计划（STEP-BD）研究中接受证据导向的自然治疗达到缓解的 DSM-IV 双相 I 型和 II 型患者的前瞻性数据（在美国，1999 年至 2005 年进行）。使用生存分析检查未接受苯二氮䓬类药物治疗和接受苯二氮䓬类药物治疗的个体的复发风险。使用 Cox 回归调整临床和社会人口统计学协变量。在确认性分析中使用倾向评分分析来解决混杂变量的可能影响。
在 1365 名受试者中，349 名（25.6%）在心境发作缓解时被处方苯二氮䓬类药物。在调整潜在混杂变量后，苯二氮䓬类药物治疗患者心境发作复发的风险比为 1.21（95%CI，1.01-1.45）。在排除缓解后 90 天内发生的复发或根据倾向评分分层样本（接受苯二氮䓬类药物治疗的可能性的综合衡量标准）后，苯二氮䓬类药物治疗对复发的影响仍然显著。在已经在研究入组时缓解的 721 名独立队列中，观察到类似幅度的效果。
苯二氮䓬类药物的使用可能与双相 I 型和 II 型障碍患者心境发作再发的风险增加相关。苯二氮䓬类药物的处方至少似乎是疾病更严重病程的标志物。
