Taylor-Desir Monica J, Sanchez-Ruiz Jorge A, Vallender Eric J, Singh Balwinder, Meagher Karen M, Frye Mark A
Taylor-Desir, MD, MPH, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
Sanchez-Ruiz, MD, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
Psychopharmacol Bull. 2025 Jan 1;55(1):47-63.
Bipolar disorder is a chronic disease that imposes a lifelong burden on those that suffer from it. Lithium is still considered both gold standard treatment and first-line maintenance treatment, and access to treatment with lithium is paramount to improving patient outcomes. However, access to adequate treatment is not only contingent on symptom recognition, accurate diagnosis, and individualization of treatment, but also affected by racial and ethnic disparities at each stage of patient experience. Individuals of African Ancestry with bipolar disorder are more frequently misdiagnosed with non-affective psychoses, less likely to receive minimally adequate treatment or be prescribed lithium, and more likely to be prescribed antipsychotics. To compare prescription patterns in the treatment of bipolar disorder between individuals of African and European Ancestry, we conducted a pooled meta-analysis of four cohorts spanning different clinical settings, recruitment periods, and ascertainment methods, followed by sex-stratified analyses. We found that, overall, individuals of African Ancestry with bipolar disorder were significantly less likely to be prescribed lithium, and more likely to be prescribed first and second-generation antipsychotics during their lifetime, than those of European Ancestry. Furthermore, both men and women of African Ancestry were independently less likely to be prescribed lithium and more likely to be prescribed second generation antipsychotics than men and women of European Ancestry. However, women appeared to be more burdened by the significantly increased likelihood of first-generation antipsychotic prescription than men, for whom the association was marginally non-significant. This continued underutilization of lithium likely stems from the complex interaction of multiple biases.
双相情感障碍是一种慢性疾病，给患者带来终身负担。锂盐仍然被视为金标准治疗方法和一线维持治疗药物，获得锂盐治疗对于改善患者预后至关重要。然而，获得充分治疗不仅取决于症状识别、准确诊断和治疗个体化，还受到患者就医各阶段种族和民族差异的影响。患有双相情感障碍的非洲裔个体更容易被误诊为非情感性精神病，接受最低限度充分治疗或被开具锂盐处方的可能性较小，而更有可能被开具抗精神病药物。为了比较非洲裔和欧洲裔个体在双相情感障碍治疗中的处方模式，我们对四个不同临床环境、招募时期和确定方法的队列进行了汇总荟萃分析，随后进行了性别分层分析。我们发现，总体而言，患有双相情感障碍的非洲裔个体在其一生中被开具锂盐处方的可能性显著低于欧洲裔个体，而被开具第一代和第二代抗精神病药物的可能性更高。此外，非洲裔男性和女性与欧洲裔男性和女性相比，独立地被开具锂盐处方的可能性较小，被开具第二代抗精神病药物的可能性较大。然而，女性似乎比男性更受第一代抗精神病药物处方可能性显著增加的负担影响，而男性的这种关联略微不显著。锂盐的持续未充分使用可能源于多种偏差的复杂相互作用。
