Persson Charlotte, Kardell Mathias, Karanti Alina, Isgren Anniella, Annerbrink Kristina, Landen Mikael
Sahlgrenska universitetssjukhuset - Psykiatri Psykos Göteborg, Sweden Sahlgrenska universitetssjukhuset - Psykiatri Psykos Göteborg, Sweden.
BipoläR- Nationella kvalitetsregistret för bipolär affektiv sjukdom - Göteborgs universitet Göteborg, Sweden National Quality Register for bipolar disorder BipoläR - University of Gothenburg Gothenburg, Sweden.
Lakartidningen. 2017 Jan 10;114:D77T.
Prescribed drug use for bipolar disorder type I and II in clinical practice Practice guidelines based on available evidence and clinical consensus are available for the treatment of bipolar disorder. We surveyed to which extent those guidelines are implemented in clinical practice in Sweden. We analysed pharmacological treatment in patients with bipolar disorder in 2015 using the national quality register for bipolar disorder (BipoläR). We compared bipolar disorder type I (BDI) with type bipolar disorder type II (BDII). The vast majority of patients were prescribed a mood stabilizer either as monotherapy or as a part of combination therapy (BDI 87%, BDII 83%, p<0.001). Whereas lithium was the most common mood stabilizer in type I (BDI 65%, BDII 40%, p<0.001), lamotrigine was the most common mood stabilizer in type II (BDI 18%, BDII 42%, p<0.001). Antidepressants were less common in BDI than BDII (35% vs. 53%, p<0.001). Antipsychotic drugs (first or second generation) were more frequently used in BDI than BDII (49% vs 35%, p<0.001). Central stimulants were rarely used (BDI 3.1%, BDII 6.6%, p<0.001). Combining a mood stabilizer with an antipsychotic drug was more common in BDI than BDII (27% vs. 12%, p<0.001), whereas combining a mood stabilizer with an antidepressant was less common in BDI than BDII (16% vs 28%, p<0.001). We conclude that most patients are prescribed mood stabilizers and that the differences between BDI and BDII are rational given the differences in clinical manifestations. The use of antidepressants is surprisingly high given the long-standing debate about the risk and effectiveness of this class in bipolar disorder.
I型和II型双相情感障碍在临床实践中的处方药使用情况 基于现有证据和临床共识的实践指南可用于双相情感障碍的治疗。我们调查了这些指南在瑞典临床实践中的实施程度。我们使用全国双相情感障碍质量登记册（BipoläR）分析了2015年双相情感障碍患者的药物治疗情况。我们将I型双相情感障碍（BDI）与II型双相情感障碍（BDII）进行了比较。绝大多数患者被开具了心境稳定剂，无论是作为单一疗法还是作为联合治疗的一部分（BDI为87%，BDII为83%，p<0.001）。虽然锂盐是I型中最常见的心境稳定剂（BDI为65%，BDII为40%，p<0.001），但拉莫三嗪是II型中最常见的心境稳定剂（BDI为18%，BDII为42%，p<0.001）。抗抑郁药在BDI中的使用比BDII中少见（35%对53%，p<0.001）。抗精神病药物（第一代或第二代）在BDI中的使用比BDII更频繁（49%对35%，p<0.001）。中枢兴奋剂很少使用（BDI为3.1%，BDII为6.6%，p<0.001）。将心境稳定剂与抗精神病药物联合使用在BDI中比BDII中更常见（27%对12%，p<0.001），而将心境稳定剂与抗抑郁药联合使用在BDI中比BDII中少见（16%对28%，p<0.001）。我们得出结论，大多数患者被开具了心境稳定剂，并且鉴于临床表现的差异，BDI和BDII之间的差异是合理的。考虑到关于这一类药物在双相情感障碍中的风险和有效性的长期争论，抗抑郁药的使用比例高得惊人。
