Silverstone T, McPherson H, Hunt N, Romans S
Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, New Zealand.
Aust N Z J Psychiatry. 1998 Feb;32(1):61-6. doi: 10.3109/00048679809062707.
The effectiveness of lithium in preventing recurrences of bipolar disorder was examined prospectively for 2 years in two representative samples of bipolar I patients being treated in a comprehensive program following recommended guidelines.
One hundred and twenty patients were recruited from consecutive admissions to two catchment area psychiatric services (one in the United Kingdom, the other in New Zealand). They were seen at 3-monthly intervals by a member of the research team. Treatment was adjusted according to clinical needs.
Overall, two-thirds of the patients had a recurrence. Of the 57 on lithium as sole treatment, 39 (68%) had a further episode; 17 after stopping lithium. The 42 on other mood stabilisers and/or an antipsychotic, with or without lithium, did no better. By contrast, only eight (38%) of the 21 who were taking no prophylactic medication had a recurrence.
Lithium is much less effective in clinical practice than would be expected from clinical trial results. A major reason for this is poor compliance. Alternative treatment strategies are needed to improve the outcome for bipolar disorder patients.
在遵循推荐指南的综合项目中，对两组具有代表性的双相I型障碍患者样本进行了为期2年的前瞻性研究，以考察锂盐预防双相情感障碍复发的有效性。
从两个集水区精神科服务机构（一个在英国，另一个在新西兰）连续收治的患者中招募了120名患者。研究团队成员每3个月对他们进行一次访视。根据临床需要调整治疗方案。
总体而言，三分之二的患者复发。在仅接受锂盐治疗的57名患者中，39名（68%）出现了进一步发作；17名在停用锂盐后复发。在接受其他心境稳定剂和/或抗精神病药物治疗（无论是否联用锂盐）的42名患者中，情况并未改善。相比之下，在未接受预防性药物治疗的21名患者中，只有8名（38%）复发。
在临床实践中，锂盐的疗效远低于临床试验结果预期。造成这种情况的一个主要原因是依从性差。需要采用替代治疗策略来改善双相情感障碍患者的治疗结局。
