Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
CNS Neurosci Ther. 2012 Mar;18(3):243-9. doi: 10.1111/j.1755-5949.2011.00257.x. Epub 2011 Jun 7.
The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) was funded as part of a National Institute of Mental Health initiative to develop effectiveness information about treatments, illness course, and assessment strategies for severe mental disorders. STEP-BD studies were planned to be generalizable both to the research knowledge base for bipolar disorder and to clinical care of bipolar patients. Several novel methodologies were developed to aid in illness characterization, and were combined with existing scales on function, quality of life, illness burden, adherence, adverse effects, and temperament to yield a comprehensive data set. The methods integrated naturalistic treatment and randomized clinical trials, which a portion of STEP-BD participants participated. All investigators and other researchers in this multisite program were trained in a collaborative care model with the objective of retaining a high percentage of enrollees for several years. Articles from STEP-BD have yielded evidence on risk factors impacting outcomes, suicidality, functional status, recovery, relapse, and caretaker burden. The findings from these studies brought into question the widely practiced use of antidepressants in bipolar depression as well as substantiated the poorly responsive course of bipolar depression despite use of combination strategies. In particular, large studies on the characteristics and course of bipolar depression (the more pervasive pole of the illness), and the outcomes of treatments concluded that adjunctive psychosocial treatments but not adjunctive antidepressants yielded outcomes superior to those achieved with mood stabilizers alone. The majority of patients with bipolar depression concurrently had clinically significant manic symptoms. Anxiety, smoking, and early age of bipolar onset were each associated with increased illness burden. STEP-BD has established procedures that are relevant to future collaborative research programs aimed at the systematic study of the complex, intrinsically important elements of bipolar disorders.
双相障碍系统治疗强化研究（STEP-BD）是作为美国国立精神卫生研究所（NIMH）的一项计划的一部分而资助的，旨在获取有关严重精神障碍的治疗、疾病进程和评估策略的有效性信息。STEP-BD 研究计划既具有普遍性，可应用于双相障碍的研究知识库，也可应用于双相患者的临床护理。开发了几种新的方法学来帮助疾病特征描述，并与现有关于功能、生活质量、疾病负担、依从性、不良反应和气质的量表相结合，生成了一个综合数据集。该方法整合了自然主义治疗和随机临床试验，部分 STEP-BD 参与者参与了后者。该多中心项目的所有研究者和其他研究人员都接受了合作护理模式的培训，目的是在几年内保留高比例的入组者。STEP-BD 的文章提供了关于影响结果的风险因素、自杀、功能状态、康复、复发和照顾者负担的证据。这些研究结果提出了质疑，即广泛实践的在双相抑郁中使用抗抑郁药，以及尽管使用联合策略，但双相抑郁的反应较差。特别是，关于双相抑郁特征和病程（疾病更为普遍的一极）以及治疗结果的大型研究得出结论，附加心理社会治疗而不是附加抗抑郁药，可产生优于单独使用心境稳定剂的结果。大多数双相抑郁患者同时存在临床上显著的躁狂症状。焦虑、吸烟和双相障碍发病年龄较早，均与疾病负担增加相关。STEP-BD 已建立了相关程序，可应用于未来旨在系统研究双相障碍复杂的、本质重要的要素的合作研究计划。
