来自全球双相障碍老龄化与老年化实验数据库（GAGE-BD）的抗精神病药物治疗老年双相障碍患者的人口统计学和临床特征。
Demographic and Clinical Characteristics of Antipsychotic Drug-Treated Older Adults with Bipolar Disorder from the Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD).
机构信息
Chen MD, MPH, PhD, Department of Psychiatry, Geriatric Psychiatry Division, Geriatric Research, Education and Clinical Center (GRECC), Case Western Reserve University School of Medicine, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA. Eyler, PhD, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Gildengers, MD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Beunders, MD, MSc, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Blumberg, MD, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Briggs, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Dols, MD, PhD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands and Amsterdam Neuroscience, Amsterdam, the Netherlands. Rej, MD, MSc, Jewish General Hospital/Lady Davis Institute, McGill University, Montreal, Canada. Forlenza, MD, PhD, Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Jimenez, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Mulsant, MD, PhD, Department of Psychiatry, University of Toronto, Center for Addiction & Mental Health, Toronto, Canada. Schouws, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands. Orhan, MD, GGZ inGeest, Amsterdam, the Netherlands and Amsterdam UMC, location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, the Netherlands and Amsterdam Public Health research institute, Amsterdam, the Netherlands. Sarna, MS, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Sutherland, MA, Department of Psychiatry, University of California San Diego, San Diego, CA, USA and Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA. Vieta, MD, PhD, Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Tsai, MD, Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Yala, MPH, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Villa, PhD, Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Sajatovic, MD, Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
出版信息
Psychopharmacol Bull. 2022 May 31;52(2):8-33.
OBJECTIVES
Antipsychotic drugs (APS) are widely used to treat patients with bipolar disorder (BD), but there is limited information in older-age bipolar disorder (OABD). This analysis of the Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) investigated characteristics of OABD patients prescribed APS vs. those not prescribed APS.
EXPERIMENTAL DESIGN
The observational analysis used baseline, cross-sectional data from 16 international studies for adults aged ≥ 50 years with BD comprising 1,007 individuals with mean age 63.2 years (SD = 9.0), 57.4% women, and mean age of onset 31.6 years (SD = 15.0). The dependent variable was current APS treatment status. The independent variables included demographic and clinical variables, and a random effect for study, that were included in generalized mixed models.
PRINCIPAL OBSERVATIONS
46.6% of individuals (n = 469) were using APS. The multivariate model results suggest that those treated with APS were younger (p = 0.01), less likely to be employed (p < 0.001), had more psychiatric hospitalizations (p = 0.009) and were less likely to be on lithium (p < 0.001). Of individuals on APS, only 6.6% of those (n = 27) were on first-generation antipsychotics (FGAs) and experienced a greater burden of psychiatric hospitalizations (p = 0.012).
CONCLUSIONS
APS are widely prescribed in OABD, observed in nearly half of this sample with great variation across sites. Individuals with OABD on APS have more severe illness, more frequent hospitalizations and are more often unemployed vs. those not on APS. Future studies need to examine longitudinal outcomes in OABD prescribed APS to characterize underlying causal relationships.
目的
抗精神病药物（APS）广泛用于治疗双相情感障碍（BD）患者，但在老年双相情感障碍（OABD）中信息有限。本研究对全球老龄化和双相情感障碍实验数据库（GAGE-BD）进行了分析，研究了处方 APS 的 OABD 患者与未处方 APS 的 OABD 患者的特征。
实验设计
该观察性分析使用了来自 16 项国际研究的横断面数据，共纳入 1007 名年龄≥50 岁的 BD 成年患者，平均年龄 63.2 岁（标准差=9.0），女性占 57.4%，发病年龄平均为 31.6 岁（标准差=15.0）。因变量为当前 APS 治疗状况。自变量包括人口统计学和临床变量，以及研究的随机效应，这些因素都被纳入广义混合模型中。
主要观察结果
46.6%的个体（n=469）正在使用 APS。多变量模型结果表明，使用 APS 的患者年龄较小（p=0.01），就业可能性较低（p<0.001），住院次数较多（p=0.009），使用锂的可能性较低（p<0.001）。在使用 APS 的个体中，只有 6.6%（n=27）的个体使用第一代抗精神病药物（FGAs），且他们的精神病住院负担更重（p=0.012）。
结论
APS 在 OABD 中广泛应用，本研究中近一半的患者都处方了 APS，且各研究中心的差异较大。使用 APS 的 OABD 患者病情更严重，住院更频繁，失业的可能性更高，与未使用 APS 的患者相比。未来的研究需要检查 OABD 中使用 APS 的纵向结局，以确定潜在的因果关系。
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