Masi Gabriele, Pisano Simone, Pfanner Chiara, Milone Annarita, Manfredi Azzurra
1 Scientific Institute Stella Maris for Child Neurology and Psychiatry , Calambrone, Pisa, Italy .
J Child Adolesc Psychopharmacol. 2013 Oct;23(8):568-71. doi: 10.1089/cap.2013.0063.
Bipolar Disorders (BD) are often comorbid with disruptive behaviour disorders (DBDs) (oppositional-defiant disorder or conduct disorder), with negative implications on treatment strategy and outcome. The aim of this study was to assess the efficacy of quetiapine monotherapy in adolescents with BD comorbid with conduct disorder (CD). A consecutive series of 40 adolescents (24 males and 16 females, age range 12-18 years, mean age 14.9 ± 2.0 years), diagnosed with a clinical interview (Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children-Present and Lifetime Version [K-SADS-PL]) according to American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision (DSM-IV-TR) criteria were included. All the patients were treated with quetiapine monotherapy (mean final dose 258 ± 124 mg/day, range 100-600 mg/day). At the end-point (3 months), 22 patients (55.0%) were responders (Clinical Global Impressions-Improvement [CGI-I] score of 1 or 2 and CGI-Severity [CGI-S] ≤ 3 and improvement of at least 30% Children's Global Assessment Scale [C-GAS] during 3 consecutive months). Both CGI-S and C-GAS significantly improved (p<0.0001). Nine out of the 16 patients with suicidality (56.3%) had a reduction in this severe symptom during the follow-up. Nonresponders were more frequently males, and more frequently had an attention-deficit/hyperactivity disorder (ADHD) comorbidity. Eight patients (20.0%) experienced moderate to severe sedation and eight (20.0%) experienced increased appetite and weight gain. In these severely impaired adolescents, quetiapine monotherapy was well tolerated and effective in>50% of the patients.
双相情感障碍（BD）常与破坏性行为障碍（DBDs）（对立违抗障碍或品行障碍）共病，这对治疗策略和治疗结果具有负面影响。本研究的目的是评估喹硫平单药治疗双相情感障碍合并品行障碍（CD）青少年的疗效。纳入了连续的40名青少年（24名男性和16名女性，年龄范围12 - 18岁，平均年龄14.9±2.0岁），根据美国精神病学协会《精神疾病诊断与统计手册》第4版，修订版（DSM-IV-TR）标准，通过临床访谈（儿童情感障碍和精神分裂症量表-学龄儿童版-目前和终生版[K-SADS-PL]）进行诊断。所有患者均接受喹硫平单药治疗（平均最终剂量258±124mg/天，范围100 - 600mg/天）。在终点（3个月）时，22名患者（55.0%）为有效者（临床总体印象-改善[CGI-I]评分为1或2且临床总体印象-严重程度[CGI-S]≤3，且连续3个月儿童总体评估量表[C-GAS]改善至少达30%）。CGI-S和C-GAS均显著改善（p<0.0001）。16名有自杀倾向的患者中有9名（56.3%）在随访期间该严重症状有所减轻。无效者中男性更为常见，且更常合并注意力缺陷/多动障碍（ADHD）。8名患者（20.0%）经历了中度至重度镇静，8名患者（20.0%）出现食欲增加和体重增加。在这些严重受损的青少年中，喹硫平单药治疗耐受性良好，超过50%的患者有效。
