Calabrese J R, Rapport D J, Kimmel S E, Reece B, Woyshville M J
Mood Disorders Program, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106.
Can J Psychiatry. 1993 Apr;38(3 Suppl 2):S57-61.
A large subgroup of lithium-resistant manic patients are rapid cyclers and as many as 82% of them exhibit poor responses to lithium. Thus, a substantial percentage of poor responses to lithium is accounted for on the basis of rapid cycling. Although controlled trials have demonstrated the efficacy of carbamazepine for the treatment of rapid cycling bipolar disorder, the response to carbamazepine frequently deteriorates. Furthermore, its ability to auto-induce and hetero-induce drug metabolism complicates its routine use. These findings suggest that substantial numbers of rapid cyclers do not respond to either carbamazepine or lithium and that additional mood stabilizers are needed. Our recent findings on 101 rapid cycling bipolar patients continue to support the impression that valproate has marked antimanic efficacy and poor to moderate antidepressant properties. Most patients with mixed states exhibited good antimixed state responses but then became depressed. Predictors of a good antimanic response included decreasing or stable episode frequencies and non psychotic mania. Predictors of a good antidepressant response were non psychotic mania worsening over the years of the illness and absence of borderline personality disorder comorbidity. These open prospective trials, as well as other positive reports of valproate's efficacy in bipolar rapid cycling, await replication with ongoing, controlled maintenance trials.
很大一部分对锂盐耐药的躁狂患者是快速循环型患者，其中多达82%的人对锂盐反应不佳。因此，很大一部分对锂盐反应不佳是由快速循环导致的。尽管对照试验已证明卡马西平对治疗快速循环型双相情感障碍有效，但对卡马西平的反应常常会恶化。此外，它自身诱导和异源诱导药物代谢的能力使其常规使用变得复杂。这些发现表明，大量快速循环型患者对卡马西平或锂盐均无反应，因此需要其他心境稳定剂。我们最近对101例快速循环型双相情感障碍患者的研究结果继续支持以下观点：丙戊酸盐具有显著的抗躁狂疗效，且具有较弱至中等程度的抗抑郁特性。大多数混合状态的患者表现出良好的抗混合状态反应，但随后会转为抑郁。良好抗躁狂反应的预测因素包括发作频率降低或稳定以及非精神病性躁狂。良好抗抑郁反应的预测因素是在疾病过程中多年来非精神病性躁狂症状恶化以及不存在边缘性人格障碍共病。这些开放性前瞻性试验以及其他关于丙戊酸盐治疗双相快速循环有效率的阳性报告，有待正在进行的对照维持试验进行重复验证。
