Olié J P, Launay C, Poirier M F
Service Hospitalo-Universitaire de Santé mentale et Thérapeutique, Centre hospitalier Sante-Anne, Paris.
Encephale. 1995 Mar;21 Spec No 2:71-8.
It is currently agreed that starting a lithium therapy is justified, as soon as the evolution of recurrent affective disorder is evident, by: the occurrence of an acute depressive episode during the four years preceding the current acute episode, that is to say 2 obvious acute episodes within 5 years which is enough to make highly probable a new acute short or medium dated episode; an acute manic episode caused by the high level of recurrence in bipolar patients and the frequent severe congruencies of an acute manic episode. The prophylactic efficacy of the lithium salts has been proved by several placebo-controlled studies: the result of these trials states that with placebo the recurrence level varies between 38% and 93%, whereas with lithium it is between 0% and 44%. The controlled trials in the sixties and seventies have made evident that about 1/3 of bipolar patients do not respond to lithium, the results varying according to the selection tests, the duration of the observation, the definition of the failure. We'll address three up to date questions. 1) Whereas the level of the lithium therapy is rather well established (0.6 to 1 mEq/l) and is of a great preventive efficacy with patients that are maintained in the high zone of the therapy scale, the present question is to know if it is necessary to split up the dose of lithium or to administer the daily dose in a single dose in the evening.(ABSTRACT TRUNCATED AT 250 WORDS)
目前人们一致认为，一旦复发性情感障碍的病情发展明显，开始锂盐治疗是合理的，依据如下：在当前急性发作前四年内出现急性抑郁发作，也就是说5年内有2次明显的急性发作，这足以使新的急性短期或中期发作极有可能发生；双相情感障碍患者复发率高导致急性躁狂发作，且急性躁狂发作频繁严重。锂盐的预防效果已在多项安慰剂对照研究中得到证实：这些试验结果表明，使用安慰剂时复发率在38%至93%之间，而使用锂盐时则在0%至44%之间。六七十年代的对照试验表明，约1/3的双相情感障碍患者对锂盐无反应，结果因选择测试、观察持续时间、失败定义的不同而有所差异。我们将探讨三个最新问题。1）鉴于锂盐治疗的水平已相当明确（0.6至1毫当量/升），且对维持在治疗量表高值范围的患者具有很强的预防效果，目前的问题是，是否有必要将锂盐剂量分开，还是在晚上一次性给予每日剂量。（摘要截断于250字）
