Llorca P-M, Camus V, Courtet P, Gourion D, Lukasiewicz M, Coulomb S
Service de psychiatrie B, CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
Encephale. 2013 Jun;39(3):212-23. doi: 10.1016/j.encep.2013.04.010. Epub 2013 May 30.
The objectives were to assess the characteristics of patients with bipolar disorder (BD) and to evaluate the prescribing practices.
MONTRA is a quantitative survey conducted between December 2010 and February 2011. Data were extracted by the psychiatrists from the medical files of BD patients seen on four consecutive days of consulting.
Four hundred and thirty-nine psychiatrists included 2529 patients (inpatients, n=319; outpatients from mental clinics, n=1090; outpatients consulting in private practice, n=1020). In the total patient population (mean age: 47 years; women, 58%), BD was distributed as follows: BD type I, 56%; BD type II, 40%; other types of BD, 4%; rapid cyclers, 10%. The prevalence of psychiatric comorbidities was high (anxiety disorders, 48%; abuse and dependence on toxic substances, 17 and 10% respectively), 36% of the patients had a history of suicide attempt and the risk of suicide, when assessed, was 6%. In about half the patients (48%), the polarity of the initial bipolar episode was of the depressive type (versus 39% for the manic/hypomanic type). Outpatients were globally independent and did not require assistance in the management of their disease or its treatment whereas the social and professional lives of inpatients were negatively affected by their condition. Based on the psychiatrist's declarations, 39 to 50% of the outpatients were symptom-free, 36 to 40% were in the intercurrent phase with residual symptoms, 11 to 17% presented either a manic or depressive acute BP episode, and 3 to 4% were in a mixed state; among inpatients, 52% presented an acute episode either manic or depressive, 38% were in the intercurrent phase and 9% were in a mixed state. In the symptomatic patients from the total population (61%), the most prevalent symptoms were depressive and corresponded to acute symptoms (patients with a depressive episode, 14%) or residual symptoms (patients in the intercurrent phase, 27%). The predominant depressive polarity was observed in both hospitalized and outpatients. The pharmacological treatment of BD included polytherapy in 73% of the patients. In the manic episodes (n=126), the patients were treated with a Mood Stabilizer (MS, 56%) or an atypical antipsychotic (AAP, 52%) in association. In the depressive episodes (n=342), the patients received an antidepressant drug associated with a MS or an AAP (70%). In symptom-free or symptomatic intercurrent periods (n=1943), the patients were treated with a MS (49-58%) or an AAP (37-49%), in association.
BD patients evaluated in our survey were in majority diagnosed with BD type I, associated with considerable comorbidity. In the symptomatic patients, the most prevalent symptoms, either acute or residual, were of the depressive type. In the majority of the patients, whatever the clinical status, polytherapy was prescribed for the BD.
本研究旨在评估双相情感障碍（BD）患者的特征，并评价其处方用药情况。
MONTRA是一项于2010年12月至2011年2月间开展的定量调查。数据由精神科医生从连续四天就诊的BD患者病历中提取。
439名精神科医生纳入了2529例患者（住院患者319例；精神科门诊患者1090例；私人执业门诊患者1020例）。在全部患者群体中（平均年龄47岁；女性占58%），BD的分布如下：I型BD占56%；II型BD占40%；其他类型BD占4%；快速循环型占10%。精神科合并症的患病率较高（焦虑症48%；药物滥用和依赖分别为17%和10%），36%的患者有自杀未遂史，评估时自杀风险为6%。约半数患者（48%）首发双相情感发作的极性为抑郁型（躁狂/轻躁狂型为39%）。门诊患者总体上能够自理，在疾病管理或治疗方面无需帮助，而住院患者的社会和职业生活受到病情的负面影响。根据精神科医生的报告，39%至50%的门诊患者无症状，36%至40%处于伴有残留症状的间歇期，11%至17%出现躁狂或抑郁急性双相情感发作，3%至4%处于混合状态；住院患者中，52%出现躁狂或抑郁急性发作，38%处于间歇期，9%处于混合状态。在全部有症状的患者（61%）中，最常见的症状为抑郁，包括急性症状（抑郁发作患者占14%）或残留症状（间歇期患者占27%）。住院患者和门诊患者中均以抑郁极性为主。BD的药物治疗中73%的患者采用联合治疗。在躁狂发作患者（n = 126）中，使用心境稳定剂（MS，56%）或非典型抗精神病药物（AAP，52%）联合治疗。在抑郁发作患者（n = 342）中，患者接受与MS或AAP联合使用的抗抑郁药物（70%）。在无症状或有症状的间歇期（n = 1943），患者接受MS（49 - 58%）或AAP（37 - 49%）联合治疗。
在我们的调查中评估的BD患者多数被诊断为I型BD，合并症较多。在有症状的患者中，无论是急性还是残留症状，最常见的是抑郁型。在大多数患者中，无论临床状态如何，BD均采用联合治疗。
