Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA.
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
Psychiatry Res. 2023 May;323:115174. doi: 10.1016/j.psychres.2023.115174. Epub 2023 Mar 21.
Individuals with bipolar disorder (BD) require chronic pharmacotherapy, typically including medication switches or polypharmacy due to persisting symptoms or intolerable side effects. Here, we quantified pharmacotherapy exposure (PE) of Mayo Clinic BD Biobank participants using the number of cross-sectional (at enrollment) and lifetime BD-specific medications and medication classes, to understand the relationship between PE and markers of disease severity or treatment failure, psychiatric comorbidities, and polygenic risk scores (PRS) for six major psychiatric disorders. Being female (p < 0.05), older (p < 0.01), having history of suicide attempts (p < 0.0001), and comorbid attention-deficit/hyperactivity disorder (p < 0.05) or generalized anxiety disorder (p < 0.05) were uniformly associated with higher PE. Lifetime exposure to unique medication classes among participants with BD-I was significantly lower than for those with schizoaffective disorder (estimate = -2.1, p < 0.0001) while significantly higher than for those with BD-II (estimate = 0.5, p < 0.01). Further, higher PRS for schizophrenia (SCZ) and anxiety resulted in greater lifetime medication counts (p < 0.01), both driven by antipsychotic (p < 0.001) and anxiolytic use (p < 0.05). Our results provide initial evidence of the utility of PE as a measure of disease complexity or treatment resistance, and that PE may be predicted by higher genetic risk for SCZ and anxiety.
个体患有双相情感障碍（BD）需要长期药物治疗，通常由于持续存在的症状或无法忍受的副作用，需要药物转换或联合用药。在这里，我们使用在招募时的横截面（横断面）和终生 BD 特异性药物和药物类别数量来量化 Mayo 诊所 BD 生物库参与者的药物治疗暴露（PE），以了解 PE 与疾病严重程度或治疗失败、精神共病和六种主要精神障碍的多基因风险评分（PRS）之间的关系。女性（p<0.05）、年龄较大（p<0.01）、有自杀企图史（p<0.0001）、共患注意缺陷/多动障碍（p<0.05）或广泛性焦虑症（p<0.05）与更高的 PE 一致。BD-I 患者一生中接触独特的药物类别明显低于精神分裂症谱系障碍患者（估计值=-2.1，p<0.0001），明显高于 BD-II 患者（估计值=0.5，p<0.01）。此外，精神分裂症（SCZ）和焦虑症的 PRS 越高，一生中的药物使用量就越高（p<0.01），这都是由抗精神病药（p<0.001）和抗焦虑药（p<0.05）引起的。我们的结果提供了 PE 作为疾病复杂性或治疗抵抗的衡量标准的初步证据，并且 PE 可能可以通过更高的 SCZ 和焦虑症的遗传风险来预测。
