Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
Serviço de Psiquiatria, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil.
Depress Anxiety. 2018 May;35(5):402-410. doi: 10.1002/da.22716. Epub 2018 Jan 12.
The impact of psychosis on the treatment of bipolar depression is remarkably understudied. The primary aim of this study was to compare treatment outcomes of bipolar depressed individuals with and without psychosis. The secondary aim was to compare the effect of lithium and quetiapine, each with adjunctive personalized treatments (APTs), in the psychotic subgroup.
We assessed participants with DSM-IV bipolar depression included in a comparative effectiveness study of lithium and quetiapine with APTs (the Bipolar CHOICE study). Severity was assessed by the Bipolar Inventory of Symptoms Scale (BISS) and by the Clinical Global Impression Scale-Severity-Bipolar Version (CGI-S-BP). Mixed models were used to assess the course of symptom change, and Cox regression survival analysis was used to assess the time to remission.
Psychotic features were present in 10.6% (n = 32) of the depressed participants (n = 303). Those with psychotic features had higher scores on the BISS before (75.2 ± 17.6 vs. 54.9 ± 16.3; P < .001) and after (37.2 ± 19.7 vs. 26.3 ± 18.0; P = .003) 6-month treatment. The CGI-S-BP yielded similar results. Participants with and without psychosis had similar course of symptom improvement and similar time to remission. There was no significant difference in the treatment outcomes of lithium (n = 11) and quetiapine (n = 21) among the psychotic subgroup.
Bipolar depressive episodes with psychotic features are more severe, and compared to nonpsychotic depressions, present a similar course of improvement. Given the small number of participants presenting psychosis, the lack of statistically significant difference between lithium- and quetiapine-based treatment of psychotic bipolar depressive episodes needs replication in a larger sample.
精神病对双相抑郁治疗的影响研究得还远远不够。本研究的主要目的是比较有和无精神病的双相抑郁个体的治疗结果。次要目的是比较锂盐和喹硫平在伴有精神病的亚组中的疗效，两者均联合附加个体化治疗（APTs）。
我们评估了参加锂盐和喹硫平联合附加个体化治疗（即双相选择研究）的 DSM-IV 双相抑郁患者。采用双相障碍症状量表（BISS）和临床总体印象严重程度-双相版本（CGI-S-BP）评估严重程度。采用混合模型评估症状变化的过程，采用 Cox 回归生存分析评估缓解时间。
精神病特征存在于 10.6%（n=32）的抑郁患者（n=303）中。伴有精神病特征的患者在治疗前（75.2±17.6 分 vs. 54.9±16.3 分；P<0.001）和治疗后（37.2±19.7 分 vs. 26.3±18.0 分；P=0.003）的 BISS 评分更高。CGI-S-BP 也得出了类似的结果。有精神病和无精神病的患者的症状改善过程相似，缓解时间也相似。在伴有精神病的亚组中，锂盐（n=11）和喹硫平（n=21）的治疗结果无显著差异。
伴有精神病特征的双相抑郁发作更严重，与非精神病性抑郁相比，改善过程相似。鉴于出现精神病的患者人数较少，锂盐和喹硫平治疗伴有精神病的双相抑郁发作的疗效差异在更大的样本中需要进一步验证。
