Features associated with the delayed initiation of mood stabilizers at illness onset in bipolar disorder
Features associated with the delayed initiation of mood stabilizers at illness onset in bipolar disorder
复制标题
DOI：
10.4088/jcp.v63n1105
复制
发表时间：
2002-11-01
影响因子：
5.3
通讯作者：
Ernst, CL
中科院分区：
文献类型：
--
作者：
Goldberg, JF;Ernst, CL
背景资料：是否延迟启动适当的药物治疗双相情感障碍的负面影响的过程中，结果，或终身自杀风险仍然存在争议。方法：终身情感综合征和情感症状的初步出现进行了评估，在56个DSM-IV双相患者的lifecharting。通过临床访谈记录终生治疗干预，并通过记录审查进行确证。滞后时间开始的情绪稳定剂（最初的症状发作和/或第一次终身情感发作后）进行了评估相对于功能的结果和终身自杀attempts.Results：平均+/- SD滞后时间从最初的情感症状，直到第一次情绪稳定剂治疗是9.8 +/- 9.4年。从症状发作到首次使用情绪稳定剂的时间越长，过去一年的社会功能越差（r =-0.35，p = 0.008），每年住院人数更多（r = 0.38，p = 0.004），并且一生自杀企图的可能性更大（比值比= 7.26，95%置信区间= 1.62至32.59; Wald chi（2）= 6.69，df = 1，p = 0.010）。延迟使用情绪稳定剂与这些领域的不良结局相关，无论初始指数发作极性是躁狂还是抑郁。双相情感障碍诊断和情绪稳定剂使用的延迟时间较长，与情感症状发作的年龄较早（p <0.03）和初始症状的严重程度较轻（p = 0.003）相关。心理治疗的启动往往先于情绪稳定剂的介绍大于或等于8 years.Conclusion：延迟情绪稳定剂药物治疗的启动在疾病发作时，即使是相对轻微的症状在疾病发作时，无论指数发作极性，可能会增加自杀行为的风险，社会适应较差，更多的双相情感障碍住院治疗。对首次接受心理治疗的双相情感障碍患者进行更大范围的监测筛查可能有助于减少这些不良结局。
Background: Whether delays in the initiation of appropriate pharmacotherapy for bipolar illness negatively affect course, outcome, or lifetime suicide risk remains at issue.Method: Lifetime affective syndromes and the initial emergence of affective symptoms were assessed by lifecharting in 56 DSM-IV bipolar patients. Lifetime treatment interventions were recorded by clinical interview with corroboration via record reviews. Lag times to the initiation of a mood stabilizer (after initial symptom onset and/or first lifetime affective episode) were assessed relative to functional outcome and lifetime suicide attempts.Results: Mean +/- SD lag time from initial affective symptoms until first mood stabilizer treatment was 9.8 +/- 9.4 years. A greater number of years from symptom onset to first mood stabilizer was associated with poorer past year social functioning (r = -0.35, p = .008), more annual hospitalizations (r = 0.38, p = .004), and a greater likelihood for making a lifetime suicide attempt (odds ratio = 7.26, 95% confidence interval = 1.62 to 32.59; Wald chi(2) = 6.69, df = 1, p = .010). Delayed mood stabilizer initiation was linked with poorer outcomes in these domains regardless of initial index episode polarities of mania versus depression. Prolonged delays to bipolar diagnoses and mood stabilizer initiation were associated with earlier ages at affective symptom onset (p < .03) and milder severity of initial symptoms (p = .003). Psychotherapy initiation often preceded mood stabilizer introduction by greater than or equal to 8 years.Conclusion: Delays in the initiation of mood stabilizer pharmacotherapy at illness onset, even for relatively mild symptoms at illness onset and regardless of index episode polarity, may confer an elevated risk for suicidal behavior, poorer social adjustment, and more hospitalizations in bipolar disorder. Greater surveillance screening for bipolar illness in patients who first present for psychotherapy may help to diminish these adverse outcomes.