Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA.
J Clin Psychiatry. 2010 Sep;71(9):1176-86; quiz 1252-3. doi: 10.4088/JCP.08m04811yel.
To evaluate the clinical correlates of and types of naturalistic treatments associated with sustained improvement/remission for at least 6 months in outpatients with bipolar disorder.
Five hundred twenty-five outpatients with bipolar disorder (77.7% bipolar I) gave informed consent, had their mood rated daily on the National Institute of Mental Health Life Chart Method for a minimum of at least 1 year, and recorded all medications. Demographics and clinical characteristics of patients with a "sustained response" (ratings of "improved" or "very much improved" on the Clinical Global Impressions-Bipolar Version for a period of at least 6 months) versus nonresponders were compared. The study was conducted from 1996 to 2002.
Of the 429 patients who were ill at study entry, 195 (45.5%) showed a sustained response; 54.5% showed no or insufficient response. A mean of 2.98 medications was given at time of improvement, which occurred after a mean of 18 months of participation in the study. Lithium and valproate were the medications most frequently prescribed at the time of improvement and had among the highest overall success rates. Equally complex regimens were employed in the nonresponders who, however, had a more adverse clinical course prior to network entry. Nonresponders were ultimately exposed to more antidepressants and antipsychotics than the sustained responders.
A mean of 1.5 years and at times highly complex medication regimens were required to achieve a sustained response for 6 months during naturalistic outpatient treatment of bipolar disorder. Delineating the clinical and biologic correlates of individual response to combination treatment is a very high clinical research priority, as is developing new treatment strategies for the large proportion of patients who fail to respond in a sustained fashion.
评估与至少 6 个月持续改善/缓解相关的门诊双相情感障碍患者的自然治疗的临床相关性和类型。
525 名门诊双相情感障碍患者（77.7%为双相 I 型）知情同意，使用国家心理健康研究所生命图表法（National Institute of Mental Health Life Chart Method）对其情绪进行每日评估，至少持续 1 年，并记录所有药物。比较“持续反应”（临床总体印象-双相版（Clinical Global Impressions-Bipolar Version）评分至少 6 个月为“改善”或“非常改善”）患者与无反应者的人口统计学和临床特征。该研究于 1996 年至 2002 年进行。
在研究开始时患有疾病的 429 名患者中，有 195 名（45.5%）表现出持续反应；54.5%的患者没有反应或反应不足。在改善时，平均给予 2.98 种药物，在参加研究后平均 18 个月出现改善。锂盐和丙戊酸盐是改善时最常开的药物，总体成功率最高。在网络进入前，非反应者具有更不利的临床过程，因此采用了同样复杂的治疗方案。然而，非反应者最终暴露于更多的抗抑郁药和抗精神病药。
在自然门诊治疗双相情感障碍期间，要达到 6 个月的持续缓解，需要平均 1.5 年的时间，有时还需要非常复杂的药物治疗方案。阐明个体对联合治疗的反应的临床和生物学相关性是一个非常高的临床研究重点，因为对于大多数未能持续反应的患者，需要开发新的治疗策略。
