Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
South London & Maudsley NHS Foundation Trust, London, UK.
Acta Psychiatr Scand. 2022 Oct;146(4):290-311. doi: 10.1111/acps.13471. Epub 2022 Jul 20.
Rapid cycling is a common and disabling phenomenon in individuals with bipolar disorders. In the absence of a recent literature examination, this systematic review and meta-analysis aimed to synthesise the evidence of efficacy, acceptability and tolerability of treatments for individuals with rapid cycling bipolar disorder (RCBD).
A systematic search was conducted to identify randomised controlled trials assigning participants with RCBD to pharmacological and/or non-pharmacological interventions. Study inclusion and data extraction were undertaken by two reviewers independently. The primary outcome was continuous within-subject RCBD illness severity before and after treatment. Pre-post random effects meta-analyses were conducted for each outcome/intervention arm studied, generating a standardised effect size (hedge's g) and 95% confidence interval (CI).
A total of 34 articles describing 30 studies were included. A total of 16 separate pharmacological treatments were examined in contrast to 1 psychological therapy study. Only quetiapine and lamotrigine were assessed in >5 studies. By assessing 95% CI overlap of within-subject efficacy effects compared to placebo, the only interventions suggesting significant depression benefits (placebo g = 0.60) were olanzapine (with/without fluoxetine; g = 1.01), citalopram (g = 1.10) and venlafaxine (g = 2.48). For mania, benefits were indicated for quetiapine (g = 1.01), olanzapine (g = 1.19) and aripiprazole (g = 1.09), versus placebo (g = 0.33). Most of these effect sizes were from only one trial per treatment. Heterogeneity between studies was variable, and 20% were rated to have a high risk of bias.
While many interventions appeared efficacious, there was a lack of robust evidence for most treatments. Given the limited and heterogeneous evidence base, the optimal treatment strategies for people with RCBD are yet to be established.
快速循环是双相情感障碍患者常见且致残的现象。由于缺乏最近的文献检查，本系统评价和荟萃分析旨在综合评估治疗快速循环双相情感障碍（RCBD）患者的疗效、可接受性和耐受性的证据。
系统搜索旨在确定将 RCBD 患者分配给药物和/或非药物干预的随机对照试验。两名审查员独立进行了研究纳入和数据提取。主要结局是治疗前后 RCBD 疾病严重程度的连续个体内变化。对每个研究的结局/干预组进行了预-后随机效应荟萃分析，生成标准化效应量（ Hedge's g）和 95%置信区间（CI）。
共纳入 34 篇描述 30 项研究的文章。共检查了 16 种单独的药物治疗方法，而只有 1 项心理治疗研究。只有喹硫平和拉莫三嗪被评估超过 5 项研究。通过评估与安慰剂相比，个体内疗效效应的 95%CI 重叠，唯一提示显著抑郁益处的干预措施是奥氮平（联合/不联合氟西汀；g=1.01）、西酞普兰（g=1.10）和文拉法辛（g=2.48）。对于躁狂症，奎硫平（g=1.01）、奥氮平（g=1.19）和阿立哌唑（g=1.09）与安慰剂（g=0.33）相比，均显示出益处。这些效应大小大多数来自每种治疗方法的一项试验。研究之间的异质性是可变的，20%的研究被评为存在高偏倚风险。
虽然许多干预措施似乎有效，但大多数治疗方法缺乏稳健的证据。鉴于有限且异质的证据基础，RCBD 患者的最佳治疗策略尚未确定。
