1 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
2 Serviço de Psiquiatria, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Aust N Z J Psychiatry. 2018 Oct;52(10):994-1002. doi: 10.1177/0004867417741982. Epub 2017 Nov 16.
Activation encompasses energy and activity and is a central feature of bipolar disorder. However, the impact of activation on treatment response of bipolar depression requires further exploration. The aims of this study were to assess the association of decreased activation and sustained remission in bipolar depression and test for factors that could affect this association.
We assessed participants with Diagnostic and Statistical Manual of Mental Disorders (4th ed) bipolar depression ( n = 303) included in a comparative effectiveness study of lithium- and quetiapine-based treatments (the Bipolar CHOICE study). Activation was evaluated using items from the Bipolar Inventory of Symptoms Scale. The selection of these items was based on a dimension of energy and interest symptoms associated with poorer treatment response in major depression.
Decreased activation was associated with lower remission rates in the raw analyses and in a logistic regression model adjusted for baseline severity and subsyndromal manic symptoms (odds ratio = 0.899; p = 0.015). The manic features also predicted lower remission (odds ratio = 0.934; p < 0.001). Remission rates were similar in the two treatment groups.
Decreased activation and subsyndromal manic symptoms predict lower remission rates in bipolar depression. Patients with these features may require specific treatment approaches, but new studies are necessary to identify treatments that could improve outcomes in this population.
激活是指能量和活动，是双相情感障碍的一个核心特征。然而，激活对双相情感障碍抑郁治疗反应的影响仍需进一步探讨。本研究旨在评估双相情感障碍抑郁患者的激活程度降低与持续缓解之间的关联，并检验可能影响这种关联的因素。
我们评估了 303 名符合《精神障碍诊断与统计手册》（第 4 版）双相情感障碍抑郁诊断标准的患者，这些患者被纳入锂盐和喹硫平治疗的比较有效性研究（Bipolar CHOICE 研究）。采用双相障碍症状清单量表的项目评估激活情况。这些项目的选择基于与重度抑郁症治疗反应较差相关的能量和兴趣症状维度。
在原始分析和调整基线严重程度和亚综合征性躁狂症状的逻辑回归模型中，激活程度降低与较低的缓解率相关（优势比=0.899；p=0.015）。躁狂特征也预测缓解率较低（优势比=0.934；p<0.001）。两种治疗组的缓解率相似。
激活程度降低和亚综合征性躁狂症状可预测双相情感障碍抑郁的缓解率较低。具有这些特征的患者可能需要特定的治疗方法，但需要新的研究来确定可以改善该人群结局的治疗方法。
