双相障碍的难治性：定义和基于证据的治疗。
Refractoriness in bipolar disorder: definitions and evidence-based treatment.
机构信息
3rd Department of Psychiatry, Aristotle University of Thessaloniki, Greece.
出版信息
CNS Neurosci Ther. 2012 Mar;18(3):227-37. doi: 10.1111/j.1755-5949.2011.00259.x. Epub 2011 Aug 2.
Abstract
Defining refractoriness in bipolar disorder is complex and should concern and include either every phase and pole or the disorder as a whole. The data on the treatment of refractory bipolar patients are sparse. Combination and add-on studies suggest that in acutely manic patients partial responders to lithium, valproate, or carbamazepine, a good strategy would be to add haloperidol, risperidone, olanzapine, quetiapine, or aripiprazole. Adding oxcarbazepine to lithium is also a choice. There are no reliable data concerning the treatment of refractory bipolar depressives and also there is no compelling data for the maintenance treatment of refractory patients. It seems that patients stabilized on combination treatment might do worse if shifted from combination. Conclusively there are only limited and sometimes confusing data on the treatment of refractory bipolar patients. Further focused research is necessary on this group of patients.
摘要
定义双相情感障碍的难治性是复杂的，应该关注并包括每个阶段和极性，或整个疾病。难治性双相情感障碍患者的治疗数据稀少。联合和附加研究表明，在急性躁狂患者中，锂、丙戊酸或卡马西平部分反应者，一个好的策略是添加氟哌啶醇、利培酮、奥氮平、喹硫平或阿立哌唑。加用奥卡西平到锂也是一种选择。关于难治性双相情感障碍抑郁患者的治疗，目前尚无可靠数据，也没有针对难治性患者维持治疗的确凿数据。似乎从联合治疗转为单一治疗的患者病情可能会恶化。总而言之，难治性双相情感障碍患者的治疗数据有限，有时令人困惑。对于这组患者，需要进一步有针对性的研究。
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