Mood Disorders Centre, Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver BC Canada V6T2A1.
J Affect Disord. 2013 Sep 5;150(2):408-14. doi: 10.1016/j.jad.2013.04.032. Epub 2013 Jun 2.
The literature on the treatment mixed episodes in Bipolar Disorder [BD] is sparse. Second generation antipsychotics [SGA] have documented efficacy in mania, but not mixed episodes. The objective of this meta-analysis was to ascertain the efficacy of SGA, either as mono- and/or adjunctive therapy, in the treatment of acute mixed episodes of BD, compared to placebo.
A MEDLINE search for English language publications of randomized controlled trials [RCTs] comparing SGA with placebo in the treatment of an acute manic/mixed episode of BD, during the period 1990-2012, was performed using the terms 'atypical antipsychotics', 'SGA', 'mixed episodes', 'dysphoric mania' and each SGA independently. 9 RCTs reporting data on 1289 mixed episode patients treated with aripiprazole, asenapine, olanzapine, paliperidone-ER, risperidone, and ziprasidone, either as monotherapy or as adjunctive therapy, versus placebo, for 3-6 weeks, were included in the meta-analysis. We extracted data on the number of patients, SGA, duration of study and mean change in mania and depression scores from baseline to endpoint. Standardized mean difference between SGA and placebo for the mean baseline-to-endpoint change in mania and depression rating scores was calculated, with a 95% confidence limit.
SGA, either alone or in combination with mood stabilizers, had superior efficacy in treating manic symptoms of mixed episodes compared to placebo (-0.41, 95% CI -0.53, -0.30; overall effect p<0.00001). SGA were equally effective for manic symptoms in mixed episodes and pure mania (p=0.99). SGA had superior efficacy in treating depressive symptoms of mixed episodes (-0.30, 95% CI -0.47, -0.13; p<0.001) compared to placebo in two trials reporting this information.
Thirteen relevant studies could not be included as data for mixed-episodes were not presented separately.
SGA are effective in treating acute mixed episodes of BD, with predominant manic symptoms. Their efficacy in treating depressed mixed episodes remains unclear.
关于双相情感障碍 [BD] 混合发作治疗的文献很少。第二代抗精神病药 [SGA] 已被证实对躁狂症有效，但对混合发作无效。本项荟萃分析的目的是确定 SGA 在治疗 BD 急性混合发作时的疗效，无论是单独使用还是作为辅助治疗，与安慰剂相比。
对 1990 年至 2012 年期间，在 MEDLINE 上使用“非典型抗精神病药”、“SGA”、“混合发作”、“抑郁性躁狂”和每个 SGA 单独的术语，搜索比较 SGA 与安慰剂治疗急性躁狂/混合发作的随机对照试验 [RCT] 的英文文献。共纳入 9 项 RCT，报告了 1289 名混合发作患者的数据，这些患者接受阿立哌唑、阿塞纳平、奥氮平、帕利哌酮 ER、利培酮和齐拉西酮治疗，无论是单独使用还是作为辅助治疗，为期 3-6 周，与安慰剂进行比较。我们从研究中提取了关于患者人数、SGA、研究持续时间以及从基线到终点时躁狂和抑郁评分的平均变化的数据。使用标准化均数差值计算 SGA 与安慰剂在从基线到终点时躁狂和抑郁评分的平均变化之间的差异，并计算 95%置信区间。
SGA 无论是单独使用还是与心境稳定剂联合使用，在治疗混合发作的躁狂症状方面均优于安慰剂（-0.41，95%CI -0.53，-0.30；总效应 p<0.00001）。SGA 对混合发作和单纯躁狂的躁狂症状同样有效（p=0.99）。在两项报告此信息的试验中，SGA 治疗混合发作的抑郁症状的疗效优于安慰剂（-0.30，95%CI -0.47，-0.13；p<0.001）。
由于未单独报告混合发作的数据，因此无法纳入 13 项相关研究。
SGA 对治疗 BD 急性混合发作有效，且主要表现为躁狂症状。它们在治疗抑郁混合发作中的疗效尚不清楚。
