Early improvement of psychotic symptoms with lithium monotherapy as a predictor of later response in mania
Early improvement of psychotic symptoms with lithium monotherapy as a predictor of later response in mania
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DOI：
10.1016/j.jpsychires.2012.08.011
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发表时间：
2012-12-01
影响因子：
4.8
通讯作者：
Machado-Vieira, Rodrigo
中科院分区：
文献类型：
--
作者：
de Sousa, Rafael T.;Busnello, Joao V.;Machado-Vieira, Rodrigo
尽管锂一直是治疗双相情感障碍 (BD) 的一线药物，但很少有研究评估锂对伴有精神病的躁狂症的疗效及其与后期反应的关系。此外，考虑到人们对抗精神病药物副作用的广泛关注，回答“单独使用锂盐是否可以治疗精神病性和非精神病性躁狂症”这一问题似乎是一个非常相关的问题。本研究探讨了锂单药疗法在急性躁狂中的抗精神病功效以及精神病症状的早期改善作为躁狂症状后期反应的预测因子。 46 名出现躁狂发作的患者（32 名有精神病特征，14 名无精神病特征）接受了为期 4 周的锂单药治疗，并每周使用青年躁狂评定量表 (YMRS) 进行评估。快速循环、药物滥用/依赖或混合发作的受试者被排除在外。评估了锂在精神病组与非精神病组中的总体抗躁狂功效。此外，还评估了精神病症状的早期改善及其对随后反应（YMRS 总分下降 >50%）或缓解的预测。锂对精神病和非精神病性躁狂症都显示出相似的功效。精神病症状的早期改善与临床反应和终点缓解相关。 (C) 2012 Elsevier Ltd. 保留所有权利。
Although lithium has been the first line agent in the treatment of bipolar disorder (BD), few studies have evaluated lithium's efficacy in mania with psychosis and its association with later response. Furthermore, given the widespread concern about antipsychotic side effects, answering a question about whether lithium alone can manage to treat both psychotic and non-psychotic mania seems a very relevant one. The present study addresses the antipsychotic efficacy of lithium monotherapy in acute mania and early improvement of psychotic symptoms as a predictor of later response of manic symptoms. Forty-six patients presenting a manic episode (32 with psychotic features and 14 subjects without psychotic features) were treated for 4 weeks with lithium monotherapy and evaluated weekly using the Young Mania Rating Scale (YMRS). Subjects with rapid cycling, substance abuse/dependence, or mixed episodes were excluded. The overall antimanic efficacy of lithium in psychosis vs. non-psychosis groups was evaluated. In addition, early improvement of psychotic symptoms and its prediction of subsequent response (>50% decrease in total YMRS scores) or remission were evaluated. Lithium showed a similar efficacy in both psychosis and non-psychosis mania. Early improvement of psychotic symptoms was associated with clinical response and remission at endpoint. (C) 2012 Elsevier Ltd. All rights reserved.