Fornaro Michele, De Berardis Domenico, Koshy Ann Sarah, Perna Giampaolo, Valchera Alessandro, Vancampfort Davy, Stubbs Brendon
New York Psychiatric Institute, Columbia University, New York, NY, USA.
National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", Teramo, Italy.
Neuropsychiatr Dis Treat. 2016 Mar 31;12:719-35. doi: 10.2147/NDT.S100846. eCollection 2016.
Uncertainty exists regarding the prevalence and clinical features associated with the practice of polypharmacy in bipolar disorder (BD), warranting a systematic review on the matter.
Three authors independently searched major electronic databases from inception till September 2015. Articles were included that reported either qualitative or quantitative data about the prevalence and clinical features associated with polypharmacy in adult cases of BD.
The operative definitions of polypharmacy adopted across varying studies varied, with concomitant use of two or more psychotropic medications or use of four or more psychotropic medications at once being the most common and the most reliable, respectively. Regardless of type or current mood episode polarity of BD, prevalence rates up to 85% and 36% were found using the most permissive (two or more medications at once) and the most conservative (four or more) operative definitions for polypharmacy, respectively. Point prevalence prescription rates of one or more antidepressant or antipsychotic as part of a polypharmacy regimen occurred in up to 45% or 80% of the cases, respectively, according to the most permissive definition of polypharmacy. In contrast, lithium prescription rates ranged from 13% to 33% in BD patients receiving polypharmacy according to conservative and permissive definitions, possibly suggesting a reduced need for augmentation of combination strategies for those cases of BD with a favorable lifetime lithium response and/or long-lasting treatment as well as less likelihood of lithium response over the time most severe cases possibly exposed to a more complex polypharmacy overall.
"Apples and oranges" bias; publication bias for most recently introduced compounds.
Polypharmacy is common among people with BD across varying type and mood episode phases of illness. Special population, including BD patients at high risk of familial load for suicidal behavior, solicit further research as well as the plausible "protective" role of lithium toward polypharmacy in BD. The PROSPERO registration number is CRD42014015084.
双相情感障碍（BD）中多药联用的患病率及临床特征存在不确定性，因此有必要对此进行系统综述。
三位作者独立检索了从数据库建立至2015年9月的主要电子数据库。纳入的文章需报告有关BD成年患者中多药联用的患病率及临床特征的定性或定量数据。
不同研究采用的多药联用的操作定义各不相同，同时使用两种或更多种精神药物或一次性使用四种或更多种精神药物分别是最常见和最可靠的定义。无论BD的类型或当前情绪发作极性如何，使用最宽松的（一次性使用两种或更多种药物）和最保守的（四种或更多种）多药联用操作定义时，患病率分别高达85%和36%。根据最宽松的多药联用定义，在多药联用方案中，分别有高达45%或80%的病例开具了一种或更多种抗抑郁药或抗精神病药的时点患病率处方。相比之下，根据保守和宽松定义，接受多药联用的BD患者中锂盐的处方率在13%至33%之间，这可能表明对于那些有良好的终生锂盐反应和/或长期治疗的BD病例，增强联合治疗策略的需求降低，并且随着时间推移，大多数重症病例可能总体上暴露于更复杂的多药联用中，锂盐反应的可能性也较小。
“风马牛不相及”偏倚；对最新引入化合物的发表偏倚。
在BD患者不同类型和情绪发作阶段中，多药联用很常见。特殊人群，包括有自杀行为家族负荷高风险的BD患者，需要进一步研究，以及锂盐对BD中多药联用可能的“保护”作用。国际前瞻性系统评价注册库登记号为CRD42014015084。
