Long-term outcome of lithium prophylaxis in bipolar disorder: A 5-year prospective study of 402 patients at a lithium clinic
Long-term outcome of lithium prophylaxis in bipolar disorder: A 5-year prospective study of 402 patients at a lithium clinic
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DOI：
10.1176/ajp.155.1.30
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发表时间：
1998-01-01
影响因子：
17.7
通讯作者：
Bartoli, L
中科院分区：
文献类型：
--
作者：
Maj, M;Pirozzi, R;Bartoli, L
目的：在这项前瞻性研究中，收集了在锂诊所开始锂预防治疗超过15年的所有双相I型患者的信息。方法：患者每两个月进行一次评估，只要他们服用锂。治疗监测符合国际公认的准则。在开始预防5年后，每位患者都接受了随访。结果如下：在402名入组患者中，27.9%在随访时不再服用锂; 38.1%服用锂并至少有一次疾病复发; 23.4%服用锂并没有复发。在仍在服用锂的患者中，其血浆锂水平低于0.5 mmol/L的检查不超过10%，88.0%的患者平均每年住院时间比参考治疗前至少减少50%，43.0%的患者没有复发。随访时未服用锂盐的患者比服用锂盐的患者预后差，但不再服用任何精神药物的患者与服用锂盐的患者没有差异。倾向于长期服用锂盐的患者在指数发作中出现精神病特征的频率高于仍在服用锂盐的患者。结论：锂盐预防治疗对双相情感障碍病程的影响受到高脱落率的严重限制。在双相情感障碍患者中，定期服用锂盐几年，住院时间的大幅减少几乎是规则;这些患者代表了一个自我选择的人群，其中至少有一个结局不良的高风险人群代表性不足。
Objective: In this prospective study, information was collected on all bipolar I patients who started lithium prophylaxis at a lithium clinic during more than 15 years. Method: Patients were evaluated bimonthly with standardized instruments for as long as they took lithium. Treatment surveillance conformed to internationally accepted guidelines. Five years after starting prophylaxis, each patient was contacted for a follow-up interview. Results: Of the 402 enrolled patients, 27.9% were no longer taking lithium at follow-up; 38.1% were taking lithium and had had at least one recurrence of the disorder; and 23.4% were taking lithium and had had no recurrence. Among patients still taking lithium whose plasma lithium levels had been below 0.5 mmol/liter on no more than 10% of checks, 88.0% had at least it 50% reduction in mean annual time spent in the hospital compared to a reference pretreatment period, and 43.0% had had no recurrence. Patients not taking lithium at follow-up had a poorer outcome than those taking lithium, but patients no longer taking any psychotropic drug did not differ from those taking lithium. Patients pro longer taking lithium had had a higher frequency of psychotic features in the index episode than those still taking lithium. Conclusions: The impact of lithium prophylaxis on the course of bipolar disorder is severely limited by the high dropout rate. In bipolar patients taking lithium regularly for several years, a drastic reduction of time spent in the hospital is almost the rule; these patients represent a self-selected population in which at least one group at high risk of poor outcome is under-represented.