Evans D L, Byerly M J, Greer R A
Department of Psychiatry, University of Florida College of Medicine, Gainesville 32610-0256.
J Clin Psychiatry. 1995;56 Suppl 3:31-7.
Increasing evidence indicates that subtypes of bipolar disorder differ not only in symptomatology and associated clinical features, but by differences in age at onset, illness course, and response to treatment. Secondary manic states differ from typical bipolar states and are often especially difficult to treat. Although the correction of the underlying organic factors (toxic, metabolic, or infectious) may effectively reverse the manic presentation, many organic factors are not reversible (trauma, stroke, and aging), and the presence of these etiologic factors can complicate traditional antimanic treatments. Lithium may be effective for treating patients with secondary mania, but data from published studies show that in this population the associated adverse effects often limit its usefulness. Anticonvulsants appear to offer an effective alternative. Divalproex sodium, in particular, has been shown to be an effective and well-tolerated treatment in open trials in the elderly and other patient groups with secondary mania. Controlled clinical trials are necessary to confirm the efficacy and tolerability of mood-stabilizing anticonvulsants in the treatment of secondary mania.
越来越多的证据表明，双相情感障碍的亚型不仅在症状学和相关临床特征上存在差异，在发病年龄、病程以及对治疗的反应方面也有所不同。继发性躁狂状态与典型的双相情感障碍状态不同，且往往特别难以治疗。尽管纠正潜在的器质性因素（中毒、代谢或感染性）可能有效逆转躁狂表现，但许多器质性因素是不可逆的（创伤、中风和衰老），并且这些病因的存在会使传统的抗躁狂治疗复杂化。锂盐可能对治疗继发性躁狂患者有效，但已发表研究的数据表明，在这类人群中，相关的不良反应常常限制了其效用。抗惊厥药物似乎提供了一种有效的替代方案。特别是丙戊酸钠，在针对老年人和其他患有继发性躁狂的患者群体的开放试验中，已被证明是一种有效且耐受性良好的治疗方法。需要进行对照临床试验，以确认心境稳定剂类抗惊厥药物在治疗继发性躁狂方面的疗效和耐受性。
