Hopkins H S, Gelenberg A J
Department of Psychiatry, University of Arizona Health Sciences Center, Tucson 85724.
Psychopharmacol Bull. 1994;30(1):27-38.
Research on bipolar disorder continues to indicate that recurrent episodes of mania and depression have a deteriorative effect on patient functioning, response to treatment, and prognosis. Lithium is the treatment of choice for both acute affective episodes and long-term maintenance, but not all patients respond adequately to lithium therapy. Alternatives or adjuncts to lithium in acute mania include carbamazepine, valproate, electroconvulsive therapy (ECT), and clozapine. For acute depression, antidepressants often are added to lithium treatment or used alone; nonpharmacologic options include ECT and light therapy. Studies suggest that carbamazepine and valproate may be as effective as lithium in maintenance therapy and that thyroid supplementation may increase response in rapid-cycling patients. Using psychosocial intervention in addition to maintenance pharmacologic treatment may increase medication compliance, decrease hospitalizations, and increase overall functioning.
双相情感障碍的研究持续表明，躁狂和抑郁的反复发作会对患者的功能、治疗反应及预后产生恶化影响。锂盐是急性情感发作和长期维持治疗的首选药物，但并非所有患者对锂盐治疗都有充分反应。急性躁狂发作时，锂盐的替代药物或辅助药物包括卡马西平、丙戊酸盐、电休克治疗（ECT）和氯氮平。对于急性抑郁，常将抗抑郁药添加到锂盐治疗中或单独使用；非药物治疗选择包括ECT和光疗。研究表明，卡马西平和丙戊酸盐在维持治疗中可能与锂盐一样有效，补充甲状腺素可能会提高快速循环型患者的反应。除维持性药物治疗外，采用心理社会干预可能会提高药物依从性、减少住院次数并改善整体功能。
