Small J G, Klapper M H, Milstein V, Marhenke J D, Small I F
Department of Psychiatry, Indiana University School of Medicine, Indianapolis, USA.
Psychopharmacol Bull. 1996;32(4):623-7.
The results of sequential therapeutic trials in hospitalized manic patients conducted over a 16-year period are summarized, followed by an analysis of pooled data to assess relative efficacy. No clinically important baseline differences were found in the patients admitted to these studies despite the long time span. They were not overly "difficult to treat" or treatment resistant, and most were discharged to the community. Nearly all outcome measures showed statistically significant differences between groups after 8 weeks of treatment. The best responses occurred in the patients who received a mean series of nine electroconvulsive therapy (ECT) treatments with sparing use of neuroleptics followed by lithium maintenance. The next best outcome was observed with lithium combined with low doses of standard neuroleptics or risperidone. The combination of carbamazepine and lithium had significantly fewer neurological side effects than moderate doses of haloperidol with lithium, with equivalent therapeutic results. Monotherapy with either lithium or carbamazepine was less effective than the combination treatments. Minor differences in study design may contribute to the variance in outcome.
总结了在16年期间对住院躁狂患者进行的序贯治疗试验结果，随后对汇总数据进行分析以评估相对疗效。尽管时间跨度很长，但纳入这些研究的患者在临床上未发现重要的基线差异。他们并非过度“难治”或治疗抵抗，大多数患者出院后回归社区。治疗8周后，几乎所有结局指标在组间均显示出统计学上的显著差异。最佳反应出现在平均接受9次电休克治疗（ECT）且少量使用抗精神病药物、随后进行锂盐维持治疗的患者中。次优结果是锂盐联合低剂量标准抗精神病药物或利培酮。与锂盐联合中等剂量氟哌啶醇相比，卡马西平和锂盐联合使用的神经副作用显著更少，治疗效果相当。单独使用锂盐或卡马西平的疗效不如联合治疗。研究设计上的微小差异可能导致了结果的差异。
