Stability of lithium treatment in bipolar disorder - long-term follow-up of 346 patients
Stability of lithium treatment in bipolar disorder - long-term follow-up of 346 patients
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DOI：
10.1186/2194-7511-1-11
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发表时间：
2013-12-01
影响因子：
4
通讯作者：
Pfennig, Andrea
中科院分区：
文献类型：
--
作者：
Berghoefer, Anne;Alda, Martin;Pfennig, Andrea
背景：本研究的目的是在一个自然环境下的前瞻性、国际、多中心双相患者队列中调查长期锂治疗的有效性和稳定性。方法：根据DSM IV双相情感障碍诊断标准，选择需要长期治疗的患者。他们在属于锂治疗患者研究国际小组的五个中心进行了前瞻性随访和记录。这是一项没有对照组的前瞻性队列研究。锂治疗是在一个自然的和专门的门诊设置。所有患者都接受了全面的精神病学检查，其中包括使用标准评定量表，以及基于发病率指数（MI）的临床病程评估。在分析抑郁、躁狂和总发病率指数与病程若干特征之间的关系时，采用Wald检验来评估固定效应和协变量的显著性。结果和讨论：共有346例双相情感障碍I或II患者被随访，平均时间为10.0年（标准差（SD） 6.2，范围1至20）。随着时间的推移，发病率指数保持稳定：第一年的平均MI为0.125 (SD 0.299)，第20年的平均MI为0.110 （SD 0.267）。心肌梗死与锂离子治疗的持续时间、治疗前发作的次数或频率、双相情感障碍发病到锂离子治疗开始的潜伏期无关。在研究期间，辍学率很高。我们的研究结果表明，锂维持治疗的长期疗效随着时间的推移保持稳定。
Background: The purpose of this study was to investigate the effectiveness and stability of long-term lithium treatment in a prospective, international, multicenter cohort of bipolar patients in a naturalistic setting.Methods: Patients were selected according to DSM IV criteria for bipolar disorder and required long-term treatment. They were prospectively followed and documented in five centers belonging to the International Group for the Study of Lithium-Treated Patients. This was a prospective cohort study without a comparison group. Lithium treatment was administered in a naturalistic and specialized outpatient setting. All patients underwent a comprehensive psychiatric examination, which included the use of standard rating scales, as well as an evaluation of clinical course based on the morbidity index (MI). Wald tests were used to assess the significance of fixed effects and covariates when analyzing the relationship between depressive, manic, and total morbidity index and several characteristics of illness course.Results and discussion: A total of 346 patients with bipolar disorder I or II were followed for a mean period of 10.0 years (standard deviation (SD) 6.2, range 1 to 20). The morbidity index remained stable over time: the mean MI was 0.125 (SD 0.299) in year 1 and 0.110 ( SD 0.267) in year 20. The MI was not associated with the duration of lithium treatment, the number or frequency of episodes prior to treatment, or latency from the onset of bipolar disorder to the start of lithium treatment. The drop-out rate was high over the study period. Our findings suggest that long-term response to lithium maintenance treatment remains stable over time.