Golden Julia C, Goethe John W, Woolley Stephen B
The Institute of Living, Hartford, CT, USA.
The Institute of Living, Hartford, CT, USA; New York Medical College, USA.
J Affect Disord. 2017 Oct 15;221:6-10. doi: 10.1016/j.jad.2017.06.005. Epub 2017 Jun 13.
It is common for patients with bipolar disorder (BP) to receive multiple psychotropics, but few studies have assessed demographic and clinical features associated with risk for receiving complex psychotropic polypharmacy.
This longitudinal cohort study examined 2712 inpatients with a DSM-IV clinical diagnosis of BP to assess associations between complex polypharmacy (defined as ≥4 psychotropics) and demographic and clinical features; associations with risk of rehospitalization were also examined. Logistic regressions were performed with the sample as a whole and with each of four DSM-IV BP subtypes individually.
Complex polypharmacy was present in 21.0%. BP-I depressed patients were more likely to receive complex regimens than BP-I manic, BP-I mixed or BP-II patients. In the sample as a whole, variables significantly associated with complex polypharmacy included female, white, psychotic features and a co-diagnosis of borderline personality, post-traumatic stress or another anxiety disorder. The only examined medication not significantly associated with complex polypharmacy was lithium, although only in BP-I depressed and BP-I mixed. Complex polypharmacy was associated with rehospitalization in BP-I mania within 15 and 30days post index hospitalization.
All data were from one clinical facility; results may not generalize to other settings and patient populations.
BP-I depression may pose a greater treatment challenge than the other BP subtypes. Lithium may confer an overall advantage compared to other medications in BP-I depressed and BP-I mixed. Further research is needed to guide pharmacotherapy decisions in BP patients.
双相情感障碍（BP）患者通常会接受多种精神药物治疗，但很少有研究评估与接受复杂精神药物联合治疗风险相关的人口统计学和临床特征。
这项纵向队列研究对2712名符合《精神疾病诊断与统计手册》第四版（DSM-IV）临床诊断标准的双相情感障碍住院患者进行了检查，以评估复杂联合用药（定义为使用≥4种精神药物）与人口统计学和临床特征之间的关联；还研究了其与再次住院风险的关联。对整个样本以及DSM-IV双相情感障碍的四种亚型分别进行了逻辑回归分析。
21.0%的患者存在复杂联合用药情况。与双相情感障碍I型躁狂、双相情感障碍I型混合或双相情感障碍II型患者相比，双相情感障碍I型抑郁患者更有可能接受复杂的治疗方案。在整个样本中，与复杂联合用药显著相关的变量包括女性、白人、精神病性特征以及同时诊断为边缘性人格障碍、创伤后应激障碍或其他焦虑症。唯一未与复杂联合用药显著相关的研究药物是锂盐，不过仅在双相情感障碍I型抑郁和双相情感障碍I型混合患者中如此。复杂联合用药与双相情感障碍I型躁狂患者在首次住院后15天和30天内再次住院有关。
所有数据均来自一个临床机构；结果可能不适用于其他环境和患者群体。
与其他双相情感障碍亚型相比，双相情感障碍I型抑郁可能带来更大的治疗挑战。在双相情感障碍I型抑郁和双相情感障碍I型混合患者中，锂盐可能比其他药物具有总体优势。需要进一步研究以指导双相情感障碍患者的药物治疗决策。
