Geha Mental Health Center, Petach-Tikva, Israel.
Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Bipolar Disord. 2016 Dec;18(8):684-691. doi: 10.1111/bdi.12459. Epub 2016 Dec 9.
Antipsychotic adjunctive therapy to mood stabilizers (MSs) may improve relapse prevention; however, only a few naturalistic studies, reflecting more generalizable bipolar disorder (BD) samples, support this notion. We compared the 1-year rehospitalization rates of manic patients with bipolar I disorder (BD-I) who were discharged with MS (lithium or valproate) monotherapy or with adjunctive atypical or typical antipsychotic therapy.
A total of 201 patients with BD-I who were hospitalized with manic episodes between 2005 and 2013 were retrospectively followed for 1-year rehospitalization rates according to treatment at discharge: MS monotherapy, MS with atypical antipsychotics, and MS with typical antipsychotics. Additionally, time to rehospitalization during the 1-year period after discharge was compared between treatment groups. Multivariable survival analyses adjusted for covariates known to influence rehospitalization were conducted.
Rehospitalization rates within 1 year were significantly lower in the MS with atypical antipsychotics group (6.3%) compared to the MS monotherapy group (24.3%, P=.008) and to the MS with typical antipsychotics group (20.6%, P=.02). Time to rehospitalization was significantly longer for the MS with atypical antipsychotics group (345.5 days) compared to the MS monotherapy group (315.1 days, P=.006) and to the MS with typical antipsychotics group (334.1 days, P=.02). The MS with atypical antipsychotics group had a significantly reduced adjusted risk of rehospitalization (hazard ratio=0.17, 95% confidence interval: 0.05-0.61, P=.007) compared to the MS monotherapy group.
Atypical antipsychotic adjunctive therapy to MSs may be more effective than MS monotherapy in preventing rehospitalization during the 1-year period after a BD manic episode.
抗精神病药物辅助心境稳定剂（MSs）治疗可能有助于预防复发；然而，仅有少数自然主义研究支持这一观点，这些研究反映了更具普遍性的双相障碍（BD）样本。我们比较了单相躁狂发作后出院时使用 MS（锂盐或丙戊酸盐）单药治疗或联合使用非典型或典型抗精神病药物辅助治疗的 I 型双相障碍（BD-I）躁狂患者的 1 年再住院率。
回顾性随访 2005 年至 2013 年住院治疗的 201 例单相躁狂发作的 BD-I 患者，根据出院时的治疗方法分为 MS 单药治疗、MS 联合非典型抗精神病药物治疗和 MS 联合典型抗精神病药物治疗组。比较各组患者出院后 1 年内的再住院时间。对影响再住院率的已知混杂因素进行多变量生存分析。
与 MS 单药治疗组（24.3%，P=.008）和 MS 联合典型抗精神病药物治疗组（20.6%，P=.02）相比，MS 联合非典型抗精神病药物治疗组 1 年内的再住院率显著较低（6.3%）。MS 联合非典型抗精神病药物治疗组的再住院时间（345.5 天）明显长于 MS 单药治疗组（315.1 天，P=.006）和 MS 联合典型抗精神病药物治疗组（334.1 天，P=.02）。与 MS 单药治疗组相比，MS 联合非典型抗精神病药物治疗组的再住院风险显著降低（危险比=0.17，95%置信区间：0.05-0.61，P=.007）。
与 MS 单药治疗相比，MS 联合非典型抗精神病药物治疗可能在单相躁狂发作后 1 年内预防再住院方面更有效。
