Finnish Institute for Health and Welfare, Mental Health Unit, Helsinki, Finland; Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden.
Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; Karolinska Institutet, Center for Psychiatry Research, Stockholm, Sweden.
Eur Neuropsychopharmacol. 2022 Aug;61:36-42. doi: 10.1016/j.euroneuro.2022.05.012. Epub 2022 Jun 25.
The aim of the study was to compare the real-world effectiveness of mood stabilizers and antipsychotics in the prevention of psychiatric hospitalizations and treatment failure after lithium discontinuation in a nationwide bipolar cohort. Using health-care registers, we identified everyone in Finland diagnosed with bipolar disorder during 1987-2018 who discontinued lithium after using it for at least one year (n = 4 052, median period of lithium use before discontinuation 2.7 years). The risk of psychiatric hospitalization and treatment failure (psychiatric hospitalization, death or change in medication) were investigated with within-individual Cox regression. Of mood stabilizer monotherapies, the periods of valproate use (HR = 0.83, 95% CI = 0.71 - 0.97) had lower risk of hospitalization than nonuse of mood stabilizers. Of antipsychotic monotherapies, the use of long-acting injectable (LAI) antipsychotics (HR = 0.48, 95% CI = 0.26 - 0.88) and chlorprothixene (HR = 0.62, 95% CI = 0.44 - 0.88) were associated with lower risk and the use of quetiapine (HR = 1.26, 95% CI = 1.07 - 1.48) and oral olanzapine (HR = 1.23, 95% CI = 1.01 - 1.49) with higher risk of psychiatric hospitalizations than nonuse of antipsychotics. Of mood stabilizer monotherapies, lithium use was associated with lower risk of treatment failure (HR = 0.82, 95% CI = 0.76 - 0.88) than valproate use. The results suggest that antipsychotic LAIs are especially effective in the prevention of psychiatric hospitalizations after lithium discontinuation. The need to alter used medications may be the lowest when lithium is restarted.
这项研究的目的是比较心境稳定剂和抗精神病药在锂停药后预防精神病住院和治疗失败方面的真实世界疗效，研究对象是一个全国性双相队列中的锂停药患者。我们使用医疗保健登记数据，确定了芬兰在 1987 年至 2018 年期间被诊断患有双相障碍且至少使用一年锂（n=4052，锂停药前的中位使用时间为 2.7 年）的患者。通过个体内 Cox 回归调查了精神病住院和治疗失败（精神病住院、死亡或药物改变）的风险。在心境稳定剂单药治疗中，与不使用心境稳定剂相比，使用丙戊酸钠（HR=0.83，95%CI=0.71-0.97）的患者住院风险较低。在抗精神病药单药治疗中，使用长效注射（LAI）抗精神病药（HR=0.48，95%CI=0.26-0.88）和氯普噻吨（HR=0.62，95%CI=0.44-0.88）与较低的住院风险相关，而使用喹硫平（HR=1.26，95%CI=1.07-1.48）和奥氮平（HR=1.23，95%CI=1.01-1.49）与较高的住院风险相关。在心境稳定剂单药治疗中，与使用丙戊酸钠相比，锂的使用与较低的治疗失败风险相关（HR=0.82，95%CI=0.76-0.88）。这些结果表明，抗精神病药 LAI 特别有助于预防锂停药后的精神病住院。当重新开始使用锂时，可能需要改变使用的药物的可能性最低。
