Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, NIH, Bethesda, MD, USA.
J Affect Disord. 2013 Jan 10;144(1-2):160-4. doi: 10.1016/j.jad.2012.05.039. Epub 2012 Aug 17.
Despite lithium's clinical efficacy in treating mania in bipolar disorder (BD), studies evaluating early improvement and subsequent treatment response are sparse. This study investigated whether early improvement (within one week) to lithium monotherapy predicted later response and remission in individuals with BD mania.
BD-I patients (n=46) experiencing a manic episode received lithium monotherapy for four weeks (initial dose: 600mg/d, adjusted to therapeutic levels); individuals experiencing a mixed episode, rapid cyclers, previous non-responders to lithium, and those with current drug abuse/dependence were excluded. Symptoms were rated using the Young Mania Rating Scale (YMRS) at baseline and at Days 7, 14, 21, and 28.
Thirty-three percent of the total sample responded to lithium within the first week of treatment, defined as a ≥50% decrease from baseline YMRS scores; 63% responded by study endpoint. In addition, 39% of the total sample showed early improvement (at least 20% decrease in YMRS scores) after one week of treatment. In this group, 79% responded to lithium by study endpoint. Among those showing less than 20% improvement at Week 1, only 23% responded to lithium by study endpoint.
History of episodes sequence was not assessed.
Early improvement in response to lithium monotherapy in subjects with BD mania predicted later response and remission. Most patients who did not show early improvement in response to lithium during the first week of treatment showed no response after one month. The findings provide a valuable clinical tool for early identification of those patients most likely to benefit from lithium in clinical practice.
尽管锂在双相情感障碍（BD）躁狂症的治疗中具有临床疗效，但评估早期改善和随后治疗反应的研究却很少。本研究旨在探讨 BD 躁狂症患者接受锂单药治疗后早期改善（一周内）是否能预测其后续反应和缓解。
接受锂单药治疗四周的 BD-I 患者（n=46）经历了躁狂发作（初始剂量：600mg/d，调整至治疗水平）；排除混合发作、快速循环、既往对锂无反应和目前药物滥用/依赖的患者。在基线和第 7、14、21 和 28 天使用 Young 躁狂评定量表（YMRS）评定症状。
在治疗的第一周内，总样本中有 33%的患者对锂有反应，定义为 YMRS 评分较基线下降≥50%；63%的患者在研究结束时出现反应。此外，总样本中有 39%的患者在治疗一周后出现早期改善（YMRS 评分至少下降 20%）。在这组患者中，79%的患者在研究结束时对锂有反应。在第 1 周显示改善幅度小于 20%的患者中，只有 23%的患者在研究结束时对锂有反应。
未评估发作序列的历史。
BD 躁狂症患者接受锂单药治疗后早期改善反应预测了后续反应和缓解。在锂治疗的第一周内没有显示早期改善反应的大多数患者在一个月后没有反应。这些发现为临床实践中早期识别最有可能从锂治疗中获益的患者提供了有价值的临床工具。
