Long-Term Effectiveness of Lithium in Bipolar Disorder: A Multicenter Investigation of Patients With Typical and Atypical Features
Long-Term Effectiveness of Lithium in Bipolar Disorder: A Multicenter Investigation of Patients With Typical and Atypical Features
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DOI：
10.4088/jcp.v69n1203
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发表时间：
2008-12-01
影响因子：
5.3
通讯作者：
Pfennig, Andrea
中科院分区：
文献类型：
--
作者：
Berghoefer, Anne;Alda, Martin;Pfennig, Andrea
目的：据报道，长期锂治疗反应不佳与双相情感障碍的非典型特征有关。本研究的目的是在自然环境下前瞻性、多中心双相情感障碍患者队列中调查非典型症状对长期锂盐治疗的有效性和稳定性的影响。 方法：最初根据国际疾病分类第八版修订版、双相情感障碍标准和需要长期治疗来选择患者。他们的诊断在 DSM-IV 发布后得到了重新确认。截至 2004 年，他们在参与国际锂治疗患者研究组的 5 个中心进行了为期约 20 年的前瞻性随访。检查包括全面的精神病学评估、8项量表的典型和非典型特征评估以及使用发病指数的临床病程评估。使用具有结构化协方差矩阵的不平衡重复测量回归模型来评估发病指数受非典型症状、治疗持续时间和治疗前特征影响的程度。 结果：总共对 242 名患者进行了平均 10 年的随访。在142名患者中，典型特征的数量大于非典型特征的数量，而在100名患者中，非典型特征的数量大于或等于典型特征的数量。两组患者的平均发病指数在 20 年内保持稳定，并且与非典型特征的存在、锂盐治疗的持续时间、发作次数或频率或从双相情感障碍发病到开始锂盐治疗的潜伏期没有显着相关。结论：我们的研究表明，无论是典型特征患者还是非典型特征患者，对锂盐维持治疗的长期反应都是稳定的。在该双相情感障碍患者样本中，典型或非典型特征的占主导地位并没有导致对长期锂治疗的不同反应。
Objective: Poor response to long-term lithium treatment has been reported to be associated with atypical features of bipolar disorder. The purpose of this study was to investigate the influence of atypical symptoms on the effectiveness and stability of long-term lithium treatment in a prospective, multicenter cohort of bipolar patients in a naturalistic setting.Method: Patients were initially selected according to International Classification of Diseases, 8th Revision, criteria for bipolar disorder and required long-term treatment. Their diagnoses were reconfirmed according to DSM-IV upon its publication. They were prospectively followed for an approximately 20-year period ending in 2004 in 5 centers participating in the International Group for the Study of Lithium-Treated Patients. Examinations included a comprehensive psychiatric evaluation, an assessment of typical and atypical features on an 8-item scale, and an evaluation of clinical course using the morbidity index. Unbalanced repeated-measures regression models with structured covariance matrices were used to assess the extent to which the morbidity index was influenced by atypical symptoms, duration of treatment, and pretreatment features.Results: A total of 242 patients were followed for a mean period of 10 years. In 142 patients, the number of typical features was greater than the number of atypical features, whereas in 100 patients the number of atypical features was greater than or equal to the number of typical features. The mean morbidity index remained stable over a period of 20 years in both groups of patients and was not significantly associated with the presence of atypical features, the duration of lithium treatment, the number or frequency of episodes, or latency from the onset of bipolar disorder to the start of lithium treatment.Conclusion: Our study suggests that long-term response to lithium maintenance treatment is stable both in patients with typical and in patients with atypical features. The predominance of either typical or atypical features did not result in different responses to long-term lithium treatment in this sample of bipolar patients.