Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia.
Orygen, Parkville, Victoria, Australia.
Int J Neuropsychopharmacol. 2023 Jan 19;26(1):61-69. doi: 10.1093/ijnp/pyac057.
The prevalence of posttraumatic stress disorder (PTSD) co-occurring in people with bipolar disorder (BD) is high. People with BD and PTSD may experience different outcomes and quality of life after pharmacologic treatment than those with BD alone. This review systematically explores the impact of PTSD on pharmacologic treatment outcomes for adults with BD.
We conducted a systematic search up to November 25, 2021, using MEDLINE Complete, Embase, American Psychological Association PsycInfo, and the Cochrane Central Register of Controlled Trials to identify randomized and nonrandomized studies of pharmacologic interventions for adults with BD that assessed for comorbid PTSD. We used the Newcastle-Ottawa Scale and Cochrane Risk of Bias tool to assess the risk of bias.
The search identified 5093 articles, and we reviewed 62 full-text articles. Two articles met inclusion criteria (N = 438). One article was an observational study, and the other was a randomized comparative effectiveness trial. The observational study examined lithium response rates and found higher response rates in BD alone compared with BD plus PTSD over 4 years. The randomized trial reported more severe symptoms in the BD plus PTSD group than in those with BD alone following 6 months of quetiapine treatment. There was no significant difference in the lithium treatment group at follow-up.
Comorbid PTSD may affect quetiapine and lithium treatment response in those with BD. Because of the high risk of bias and low quality of evidence, however, these results are preliminary. Specific studies exploring comorbid BD and PTSD are required to inform pharmacotherapy selection and guidelines appropriately. (International Prospective Register of Systematic Reviews ID: CRD42020182540).
创伤后应激障碍（PTSD）与双相障碍（BD）共病的患病率很高。与仅患有 BD 的患者相比，患有 BD 和 PTSD 的患者在药物治疗后的结局和生活质量可能不同。本综述系统探讨了 PTSD 对成人 BD 药物治疗结局的影响。
我们进行了系统检索，截至 2021 年 11 月 25 日，使用 MEDLINE Complete、Embase、美国心理协会 PsycInfo 和 Cochrane 对照试验中心注册库，以确定评估 BD 共病 PTSD 的成人药物干预的随机和非随机研究。我们使用纽卡斯尔-渥太华量表和 Cochrane 偏倚风险工具来评估偏倚风险。
检索共确定了 5093 篇文章，我们对 62 篇全文文章进行了审查。有 2 篇文章符合纳入标准（N=438）。其中 1 篇为观察性研究，另 1 篇为随机对照效果试验。观察性研究检查了锂的反应率，发现 4 年内 BD 单独治疗的反应率高于 BD 合并 PTSD。随机试验报告称，在接受喹硫平治疗 6 个月后，BD 合并 PTSD 组的症状比 BD 组更严重。锂治疗组在随访时无显著差异。
BD 共病 PTSD 可能会影响喹硫平和锂治疗的反应。然而，由于偏倚风险高和证据质量低，这些结果是初步的。需要专门研究共病 BD 和 PTSD，以适当为药物治疗选择和指南提供信息。（国际前瞻性系统评价注册中心 ID：CRD42020182540）。
