Rapport Daniel, Kaplish Dheeraj, McGrady Angele, McGinnis Ronald, Whearty Kary, Thomas Manju, Fine Thomas
RAPPORT, KAPLISH, MCGRADY, MCGINNIS, WHEARTY, THOMAS, and FINE: Department of Psychiatry, University of Toledo, Toledo, OH.
J Psychiatr Pract. 2015 Sep;21(5):351-8. doi: 10.1097/PRA.0000000000000102.
Bipolar spectrum disorders are associated with symptomatic and functional disability in many patients. Other studies have examined predictors of outcome with variable results. The goal of this retrospective study was to identify medications associated with a minimum of 12 consecutive months of symptomatic, functional, and syndromal remission.
The charts of 121 patients with confirmed bipolar disorder were reviewed. Data on medical regimen and demographic and adherence factors were gathered using standardized data collection sheets approved by the University of Toledo Institutional Review Board. The criterion for improvement was set at 12 consecutive months of Clinical Global Impressions Improvement ratings of ≤2, which is a far higher standard of syndromal and functional remissions than the usual 8 consecutive weeks used by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision.
In this sample of 121 patients, 43.8% achieved a minimum of 12 consecutive months of remission, whereas 56.2% did not. When bipolar disorder was divided into its subtypes, 45.5% of our cohort were diagnosed with bipolar I disorder, 27.3% were diagnosed with bipolar II disorder, and 27.3% were diagnosed with bipolar disorder, not otherwise specified. Of the 55 patients with bipolar I disorder, 27 remitted and 28 did not. Of the 33 patients with bipolar II disorder, 12 remitted and 21 did not. Of the 33 patients with bipolar disorder, not otherwise specified, 14 remitted and 19 did not. The treatment regimen that was most closely associated with remission was a combination of atypical antipsychotics (primarily aripiprazole), mood stabilizers (primarily lamotrigine), and an antidepressant. In addition, the patients who achieved remission were more likely to be adherent to medication and with appointments.
The chart review showed that 12 consecutive months of symptomatic remission was achieved in our clinic in 43.8% of patients with bipolar disorder when they were treated with tailored medication regimens. The remainder (56.2%) failed to achieve 12 consecutive months of remission based on real-time Clinical Global Impressions Improvement ratings. The combination of an atypical antipsychotic, a mood stabilizer, and an antidepressant was highly correlated with 1-year remission.
双相谱系障碍在许多患者中与症状性及功能性残疾相关。其他研究已对预后的预测因素进行了检验，但结果各异。这项回顾性研究的目的是确定与至少连续12个月的症状、功能及综合征缓解相关的药物。
对121例确诊为双相情感障碍的患者病历进行回顾。使用经托莱多大学机构审查委员会批准的标准化数据收集表收集有关治疗方案、人口统计学及依从性因素的数据。改善的标准设定为临床总体印象改善评分连续12个月≤2，这是一种比《精神疾病诊断与统计手册》第4版修订版通常使用的连续8周更高的综合征及功能缓解标准。
在这个121例患者的样本中，43.8%的患者实现了至少连续12个月的缓解，而56.2%的患者未实现。当将双相情感障碍分为不同亚型时，我们队列中的45.5%被诊断为双相I型障碍，27.3%被诊断为双相II型障碍，27.3%被诊断为未另行说明的双相情感障碍。在55例双相I型障碍患者中，27例缓解，28例未缓解。在33例双相II型障碍患者中，12例缓解，21例未缓解。在33例未另行说明的双相情感障碍患者中，14例缓解，19例未缓解。与缓解最密切相关的治疗方案是联用非典型抗精神病药物（主要是阿立哌唑）、心境稳定剂（主要是拉莫三嗪）及一种抗抑郁药。此外，实现缓解的患者更有可能坚持服药并按时就诊。
病历回顾显示，在我们的诊所中，当双相情感障碍患者接受量身定制的治疗方案时，43.8%的患者实现了连续12个月的症状缓解。根据实时临床总体印象改善评分，其余（56.2%）患者未实现连续12个月的缓解。非典型抗精神病药物、心境稳定剂及抗抑郁药的联用与1年缓解高度相关。
