Department of Biomedical and Clinical Sciences 'Luigi Sacco', Department of Mental Health, ASST Fatebenefratelli-Sacco.
Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA.
Int Clin Psychopharmacol. 2020 Jan;35(1):49-58. doi: 10.1097/YIC.0000000000000283.
Evidence supports increasing antipsychotic use in bipolar disorder, especially second-generation antipsychotics. However, data regarding first-generation antipsychotic contemporary use are limited. We studied 380 Northern Italian bipolar disorder inter-episode patients, grouped according to current antipsychotic use, stratified by bipolar subtype (BDI vs. BDII). Furthermore, we compared first-generation antipsychotic users vs. non-users. In our sample (n = 357), 81.8% were taking antipsychotics (74% second-generation antipsychotics, 24.1% first-generation antipsychotics), with antipsychotic use in BDI significantly more prevalent than in BDII (85.2% vs. 72.0%). Overall, antipsychotic users vs. non-users had higher rates of hypo/manic last episode, lifetime psychiatric hospitalization, psychosis, and current psychotropic use, but lower rates of anxiety disorder main comorbidity and current antidepressant use. First-generation antipsychotic use rates (30.3% in BDI vs. 6.5% in BDII) were associated with more frequently being unpartnered, having elevated first/last episodes, higher lifetime hospitalization, involuntary commitment, psychosis, and psychosocial rehabilitation rates, and more current psychotropic use, but lower Global Assessment Functioning scores and less current antidepressant use. Bipolar disorder patients had robust antipsychotic (second-generation antipsychotic > first-generation antipsychotic) use, consistently with previous reports. FGAs were still prescribed for a substantial group of patients, likely suffering from severe bipolar disorder. Prescriptions need to be monitored to assess their appropriateness and adherence to evidence-based recommendations.
有证据支持在双相情感障碍中增加使用抗精神病药物，尤其是第二代抗精神病药物。然而，关于第一代抗精神病药物的当代使用的数据有限。我们研究了 380 名意大利北部的双相情感障碍间歇期患者，根据当前使用的抗精神病药物进行分组，分为双相Ⅰ型（BDI）和双相Ⅱ型（BDII）。此外，我们比较了第一代抗精神病药物使用者和非使用者。在我们的样本（n=357）中，81.8%的患者正在服用抗精神病药物（74%为第二代抗精神病药物，24.1%为第一代抗精神病药物），BDI 中抗精神病药物的使用明显比 BDII 更常见（85.2%比 72.0%）。总体而言，抗精神病药物使用者与非使用者相比，末次发作的轻躁狂/躁狂、终身精神科住院、精神病和当前精神药物使用的比例更高，而焦虑障碍主要合并症和当前抗抑郁药使用的比例更低。第一代抗精神病药物的使用比例（BDI 中为 30.3%，BDII 中为 6.5%）与以下因素相关：未婚比例更高、首发/末次发作更严重、更高的终生住院率、非自愿住院、精神病和心理社会康复率更高，以及当前精神药物使用更多，但总体功能评估评分更低，当前抗抑郁药使用更少。与之前的报告一致，双相情感障碍患者大量使用抗精神病药物（第二代抗精神病药物>第一代抗精神病药物）。第一代抗精神病药物仍被开给相当一部分患者，这些患者可能患有严重的双相情感障碍。需要对处方进行监测，以评估其适当性和对循证建议的遵守情况。
