Fujiwara Y, Honda T, Tanaka Y, Aoki S, Kuroda S
Department of Neuropsychiatry, Okayama University Medical School, Japan.
J Clin Psychopharmacol. 1998 Aug;18(4):282-8. doi: 10.1097/00004714-199808000-00005.
This study compared the clinical course and response to pharmacotherapy of patients with rapid cycling affective disorder (RCAD). A retrospective study was conducted on outpatients with affective disorder from 1991 to 1992 at Okayama University Medical School to select cases of RCAD. The subjects were 35 patients who fulfilled DSM-III-R criteria for mood disorder and had experienced at least four episodes of illness during the previous year. The subjects were divided into two groups according to their age at the first phase of affective illness: an early-onset group, consisting of patients aged 25 years or younger, and a late-onset group, consisting of patients aged 26 or older. There were 14 patients in the early-onset group and 21 in the late-onset group. Both the mean duration from onset to rapid cycling and the mean duration of each phase were shorter in the early-onset group than in the late-onset group. There were no significant differences between the groups in period of remission, character of the first episode, heredity, or thyroid function. Lithium carbonate therapy was more effective for reducing manic symptoms in the late-onset group than in the early-onset group, without maintaining a prophylactic effect in either group, whereas carbamazepine was more effective in the early-onset group. Antidepressants used in the depressive phase had a tendency to be more effective in the late-onset than in the early-onset group. However, rapid cycling induced by antidepressants was more evident in the late-onset than in the early-onset group. These findings supported the differentiation of RCAD into two groups based on age at onset, the early-onset group showing a rapid cycling course at an early stage and a good response to carbamazepine, the late-onset group having a relatively long disease duration until the appearance of a rapid cycling course and a good response to lithium carbonate in the manic phase and to antidepressants in the depressive phase.
本研究比较了快速循环型情感障碍（RCAD）患者的临床病程及药物治疗反应。1991年至1992年，对冈山大学医学院情感障碍门诊患者进行了一项回顾性研究，以筛选出RCAD病例。研究对象为35例符合DSM-III-R心境障碍标准且在前一年至少经历过四次发病的患者。根据情感疾病第一阶段时的年龄，将研究对象分为两组：早发组，由年龄在25岁及以下的患者组成；晚发组，由年龄在26岁及以上的患者组成。早发组有14例患者，晚发组有21例患者。早发组从发病到快速循环的平均病程及每个阶段的平均病程均短于晚发组。两组在缓解期、首发症状特点、遗传或甲状腺功能方面无显著差异。碳酸锂治疗对晚发组躁狂症状的减轻比早发组更有效，但两组均未维持预防效果，而卡马西平在早发组更有效。抑郁期使用的抗抑郁药在晚发组比早发组往往更有效。然而，抗抑郁药诱发的快速循环在晚发组比早发组更明显。这些发现支持根据发病年龄将RCAD分为两组，早发组在疾病早期呈现快速循环病程且对卡马西平反应良好，晚发组在出现快速循环病程前疾病持续时间相对较长，在躁狂期对碳酸锂反应良好，在抑郁期对抗抑郁药反应良好。
