Yasui-Furukori Norio, Adachi Naoto, Kubota Yukihisa, Azekawa Takaharu, Goto Eiichiro, Edagawa Koji, Katsumoto Eiichi, Hongo Seiji, Ueda Hitoshi, Miki Kazuhira, Kato Masaki, Yoshimura Reiji, Nakagawa Atsuo, Kikuchi Toshiaki, Tsuboi Takashi, Watanabe Koichiro, Shimoda Kazutaka
Department of Psychiatry, Dokkyo Medical University, School of Medicine, Tochigi, Japan.
The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan.
Clin Psychopharmacol Neurosci. 2020 Nov 30;18(4):599-606. doi: 10.9758/cpn.2020.18.4.599.
: Several evidence-based practice guidelines have been developed to better treat bipolar disorder. However, the articles cited in these guidelines were based on clinical or basic studies with specific conditional settings and were not sufficiently based on real-world clinical practice. In particular, there was little information on the doses of mood stabilizers.
The MUlticenter treatment SUrvey on BIpolar disorder in Japanese psychiatric clinics (MUSUBI) is a study conducted to accumulate evidence on the real-world practical treatment of bipolar disorder. The questionnaire included patient characteristics such as comorbidities, mental status, treatment period, Global Assessment of Functioning (GAF) score, and details of pharmacological treatment.
Most patients received mood stabilizers such as lithium (n = 1,317), valproic acid (n = 808), carbamazepine (n = 136), and lamotrigine (n = 665). The dose of lithium was correlated with age, body weight, number of episodes, depression and GAF. The dose of valproic acid was correlated with body weight, number of episodes, presence of a rapid cycle and GAF. The dose of carbamazepine was correlated with age, mania, and the presence of a rapid cycle. The dose of lamotrigine was correlated with the number of episodes, depression, mania, psychotic features, and the presence of a rapid cycle. Doses of coadministered mood stabilizers were significantly correlated, except for the combination of valproic acid and lamotrigine.
The dose of mood stabilizers was selectively administered based on several factors, such as age, body composition, current mood status and functioning. Further prospective studies are required to confirm these findings.
已经制定了若干循证实践指南以更好地治疗双相情感障碍。然而，这些指南中引用的文章基于具有特定条件设置的临床或基础研究，并非充分基于现实世界的临床实践。特别是，关于心境稳定剂剂量的信息很少。
日本精神科诊所双相情感障碍多中心治疗调查（MUSUBI）是一项为积累双相情感障碍现实世界实际治疗证据而开展的研究。调查问卷包括患者特征，如共病情况、精神状态、治疗时间、功能总体评定量表（GAF）评分以及药物治疗细节。
大多数患者接受了心境稳定剂治疗，如锂盐（n = 1317）、丙戊酸（n = 808）、卡马西平（n = 136）和拉莫三嗪（n = 665）。锂盐剂量与年龄、体重、发作次数、抑郁及GAF相关。丙戊酸剂量与体重、发作次数、快速循环的存在及GAF相关。卡马西平剂量与年龄、躁狂及快速循环的存在相关。拉莫三嗪剂量与发作次数、抑郁、躁狂、精神病性特征及快速循环的存在相关。除丙戊酸与拉莫三嗪联合使用外，联合使用的心境稳定剂剂量显著相关。
心境稳定剂的剂量是根据年龄、身体组成、当前情绪状态及功能等多种因素选择性给予的。需要进一步的前瞻性研究来证实这些发现。
