双相障碍的药物治疗与精神科住院风险。
Pharmacological treatment and risk of psychiatric hospital admission in bipolar disorder.
机构信息
Erik Joas, MSc, Alina Karanti, MD, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Jie Song, MSc, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Guy M. Goodwin, FMedSci, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Paul Lichtenstein, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Mikael Landén MD, PhD, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Erik Joas, MSc, Alina Karanti, MD, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Jie Song, MSc, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Guy M. Goodwin, FMedSci, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Paul Lichtenstein, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Mikael Landén MD, PhD, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
出版信息
Br J Psychiatry. 2017 Mar;210(3):197-202. doi: 10.1192/bjp.bp.116.187989. Epub 2017 Jan 19.
Clinical trials have examined the efficacy of drugs to prevent relapse in patients with bipolar disorder, however, their design often limits generalisation to routine clinical practice.To estimate the effectiveness of drugs used for maintenance treatment in bipolar disorder.We used national registers to identify 35 022 individuals diagnosed with bipolar disorder and information on lithium, valproate, carbamazepine, lamotrigine, quetiapine and olanzapine treatment from 2006 to 2009. The main outcome was psychiatric hospital admissions. We used stratified cox regression to compare periods on and off medication within the same individual.Medication with lithium, valproate, lamotrigine, olanzapine and quetiapine was associated with reduced rates of admission to hospital. Lithium was more effective than quetiapine and olanzapine. The effects of specific drugs depended on the polarity of the mood episode.Our findings complement results from randomised controlled trails, but suggest that lithium is more effective than both quetiapine and olanzapine in routine clinical practice.
临床试验已经研究了药物预防双相情感障碍患者复发的疗效，但它们的设计往往限制了对常规临床实践的推广。为了评估双相情感障碍维持治疗中使用的药物的疗效。我们使用国家登记册来确定 2006 年至 2009 年间诊断为双相情感障碍的 35022 个人以及锂、丙戊酸、卡马西平、拉莫三嗪、喹硫平和奥氮平治疗的信息。主要结果是精神病院入院率。我们使用分层 cox 回归来比较同一患者用药和停药期间的情况。锂、丙戊酸、拉莫三嗪、奥氮平和喹硫平的治疗与住院率降低有关。锂比喹硫平和奥氮平更有效。特定药物的作用取决于情绪发作的极性。我们的发现补充了随机对照试验的结果，但表明在常规临床实践中，锂比喹硫平和奥氮平更有效。
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