Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain.
Barcelona Clínic Schizophrenia Unit, Hospital Clínic of Barcelona, Department of Medicine, Neuroscience Institute, Universitat de Barcelona, CIBERSAM, IDIBAPS, Barcelona, Catalonia, Spain.
J Affect Disord. 2021 Nov 1;294:513-520. doi: 10.1016/j.jad.2021.07.062. Epub 2021 Jul 22.
We primarily aimed to explore the associations between duration of untreated illness (DUI), treatment response, and functioning in a cohort of patients with bipolar disorder (BD).
261 participants with BD were recruited. DUI was defined as months from the first affective episode to the start of a mood-stabilizer. The functioning assessment short test (FAST) scores and treatment response scores for lithium, valproate, or lamotrigine according to the Alda Scale Total Score (TS) were compared between patients with short (<24 months) or long DUI. Differences in FAST scores among good (GR; TS≥7), poor (PR; TS=2-6), or non-responders (NR; TS<2) to each mood-stabilizer were analyzed. Linear regression was computed using the FAST global score as the dependent variable.
DUI and FAST scores showed no statistically significant correlation. Patients with a longer DUI showed poorer response to lithium (Z=-3.196; p<0.001), but not to valproate or lamotrigine. Response to lithium (β=-1.814; p<0.001), number of hospitalizations (β=0.237; p<0.001), and illness duration (β=0.160; p=0.028) were associated with FAST total scores. GR to lithium was associated with better global functioning compared to PR or NR [H=27.631; p<0.001].
The retrospective design could expose our data to a recall bias. Also, only few patients were on valproate or lamotrigine treatment.
Poor functioning in BD could be the result of multiple affective relapses, rather than a direct effect of DUI. A timely diagnosis with subsequent effective prophylactic treatment, such as lithium, may prevent poor functional outcomes in real-world patients with BD.
本研究旨在探讨未治疗期（DUI）、治疗反应与双相障碍（BD）患者功能之间的相关性。
共纳入 261 例 BD 患者。DUI 定义为从首次情感发作至开始使用心境稳定剂的月数。比较 DUI 时间较短（<24 个月）和较长（≥24 个月）的患者在锂盐、丙戊酸盐或拉莫三嗪治疗时的功能评估简表（FAST）评分和 Alda 总评分（TS）治疗反应评分。分析锂盐治疗反应良好（GR；TS≥7）、差（PR；TS=2-6）或无反应（NR；TS<2）的患者间 FAST 评分的差异。采用 FAST 总分作为因变量进行线性回归分析。
DUI 与 FAST 评分无显著相关性。DUI 时间较长的患者对锂盐的反应较差（Z=-3.196；p<0.001），但对丙戊酸盐或拉莫三嗪无影响。锂盐治疗反应（β=-1.814；p<0.001）、住院次数（β=0.237；p<0.001）和病程（β=0.160；p=0.028）与 FAST 总分相关。与 PR 或 NR 相比，锂盐治疗的 GR 与更好的总体功能相关[H=27.631；p<0.001]。
回顾性设计可能使我们的数据存在回忆偏倚。此外，只有少数患者接受丙戊酸盐或拉莫三嗪治疗。
BD 患者的功能不良可能是多次情感发作的结果，而不是 DUI 的直接影响。及时诊断并随后进行有效的预防性治疗，如锂盐治疗，可能会预防 BD 真实世界患者的不良功能结局。
