Feifel David, Galangue Barbara, Macdonald Kai, Cobb Patrice, Dinca Ana, Becker Olga, Cooper J, Hadley Allison
All from the Department of Psychiatry, University of California San Diego Medical Center, San Diego, California.
Innov Clin Neurosci. 2011 Jan;8(1):29-35.
When treating acute bipolar mania, the speed of onset of anti-manic effects is crucial. Quetiapine and divalproex ER are widely used agents to treat acute mania. Rapid dose administration regimens for divalproex ER and for quetiapine have been described. We conducted a naturalistic, head-to-head, pilot study comparing the efficacy and safety of rapidly titrated divalproex ER and quetiapine in acutely manic inpatients, with the primary outcome being improvement within the first seven days.
Thirty consenting bipolar patients with acute mania (Young Mania Rating Scale >17 ) needing hospitalization due to acute mania were randomized to receive rapidly loaded divalproex ER (30mg/kg/day) or rapidly titrated quetiapine (200mg Day 1, raised by 200mg/day up to 800mg as tolerated). Assessments were made on Day 1 (baseline), Day 3, Day 7, Day 14, and Day 21 and included Young Mania Rating Scale, Clinical Global Impressions-Severity, Clinical Global Impressions-Improvement, and Montgomery-Asberg Depression Rating Scale. Raters but not patients or treating physicians were blinded (single-blinded study).
Subjects in both treatment groups exhibited significant and rapid improvement in their mania starting at Day 3 with few significant adverse effects; however, there were no significant differences in the degree or rate of improvement between the two treatment groups in any of the efficacy or adverse effects scales.
RESULTS of this small study indicate that rapid-dose administration of both quetiapine and divalproex ER produce rapid improvement in acute mania within the first seven days and both seem to be well tolerated.
在治疗急性双相躁狂时，抗躁狂效应的起效速度至关重要。喹硫平和丙戊酸缓释片是治疗急性躁狂的常用药物。已有关于丙戊酸缓释片和喹硫平的快速给药方案的描述。我们进行了一项自然对照、直接比较的初步研究，比较快速滴定的丙戊酸缓释片和喹硫平在急性躁狂住院患者中的疗效和安全性，主要结局是在前七天内病情改善。
30名因急性躁狂需要住院治疗的双相情感障碍急性躁狂患者（青年躁狂评定量表>17），同意参与研究，随机接受快速负荷剂量的丙戊酸缓释片（30mg/kg/天）或快速滴定的喹硫平（第1天200mg，根据耐受情况每天增加200mg直至800mg）。在第1天（基线）、第3天、第7天、第14天和第21天进行评估，评估内容包括青年躁狂评定量表、临床总体印象-严重程度、临床总体印象-改善情况以及蒙哥马利-阿斯伯格抑郁评定量表。评分者实施盲法（单盲研究），患者和治疗医生不设盲。
两个治疗组的受试者在第3天开始时躁狂症状均有显著且快速的改善，且几乎没有显著的不良反应；然而，在任何疗效或不良反应量表中，两个治疗组之间的改善程度或改善速度均无显著差异。
这项小型研究的结果表明，喹硫平和丙戊酸缓释片的快速给药在头七天内均可使急性躁狂症状快速改善，且二者似乎耐受性良好。
