Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China.
Neuropsychiatr Dis Treat. 2013;9:575-80. doi: 10.2147/NDT.S42473. Epub 2013 Apr 26.
Although quetiapine has often been used as monotherapy or adjunctive therapy in bipolar disorder, there is very limited clinical evidence regarding prescribing practices for quetiapine as maintenance treatment for bipolar disorder.
We reviewed the inpatient and outpatient records of 175 Chinese patients who received treatment with quetiapine for bipolar disorder both during and following hospitalization. We compared patients treated with high-dose (>300 mg/day) and low-dose (≤300 mg/day) quetiapine during the acute treatment phase and in the subsequent 6 months of maintenance treatment, with assessments at months 1, 3, and 6. Multifactor logistic regression analysis was performed to identify factors associated with quetiapine dosage.
The proportion of patients receiving combination therapy of quetiapine and a mood stabilizer as acute and maintenance treatment was 99.4% and 84.6%, respectively. The mean dose of quetiapine when used for acute treatment in the 175 patients was 395.7 mg/day. The following factors were found to be independently associated with use of high-dose quetiapine: male gender (odds ratio [OR] 2.712, 95% confidence interval [CI] 1.372-5.362, P < 0.01), a manic or mixed episode (OR 2.786, 95% CI 1.362-5.699, P < 0.01), and psychotic features (OR 2.658, 95% CI 1.318-5.361, P < 0.01). In the subsequent 6 months, the mean dose of quetiapine prescribed steadily decreased to 375.0 mg/day, 330.6 mg/day, and 293.7 mg/day at months 1, 3, and 6. The main factors associated with high-dose quetiapine in maintenance treatment were male gender (month 1, OR 2.761; month 3, OR 2.583; month 6, OR 2.686; P < 0.01) and a manic or mixed episode (month 1, OR 2.626; month 3, OR 2.334; P < 0.01).
Higher doses of quetiapine (>300 mg/day) are more likely to be prescribed to patients who are male, those who are experiencing a manic or mixed episode, and those who have psychotic features during acute treatment of bipolar disorder. For patients who remain clinically stable during the subsequent months, the quetiapine dose should be adjusted according to patient gender and the most recent type of episode experienced.
喹硫平常用于双相情感障碍的单药或辅助治疗，但有关喹硫平作为双相情感障碍维持治疗的处方实践的临床证据非常有限。
我们回顾了 175 名接受喹硫平治疗的中国双相情感障碍住院和门诊患者的病历。我们比较了在急性治疗期和随后 6 个月的维持治疗期间接受高剂量（>300mg/天）和低剂量（≤300mg/天）喹硫平治疗的患者，并在第 1、3 和 6 个月进行评估。采用多因素逻辑回归分析识别与喹硫平剂量相关的因素。
接受喹硫平联合心境稳定剂作为急性和维持治疗的患者比例分别为 99.4%和 84.6%。175 例患者急性治疗时喹硫平的平均剂量为 395.7mg/天。以下因素与使用高剂量喹硫平独立相关：男性（比值比[OR]2.712，95%置信区间[CI]1.372-5.362，P<0.01）、躁狂或混合发作（OR 2.786，95%CI 1.362-5.699，P<0.01）和精神病特征（OR 2.658，95%CI 1.318-5.361，P<0.01）。在随后的 6 个月中，喹硫平的处方剂量逐渐降至 375.0mg/天、330.6mg/天和 293.7mg/天，分别在第 1、3 和 6 个月。维持治疗中与高剂量喹硫平相关的主要因素是男性（第 1 个月，OR 2.761；第 3 个月，OR 2.583；第 6 个月，OR 2.686；P<0.01）和躁狂或混合发作（第 1 个月，OR 2.626；第 3 个月，OR 2.334；P<0.01）。
在双相情感障碍急性治疗期间，男性、出现躁狂或混合发作以及存在精神病特征的患者更有可能接受高剂量（>300mg/天）喹硫平治疗。对于在随后几个月内临床稳定的患者，应根据患者性别和最近经历的发作类型调整喹硫平剂量。
