Depressive illness burden associated with complex polypharmacy in patients with bipolar disorder: findings from the STEP-BD.
Depressive illness burden associated with complex polypharmacy in patients with bipolar disorder: findings from the STEP-BD.
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DOI：
10.4088/jcp.08m04301
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发表时间：
2009-02
期刊：
影响因子：
--
通讯作者：
Thase ME
中科院分区：
文献类型：
--
作者：
Goldberg JF;Brooks JO 3rd;Kurita K;Hoblyn JC;Ghaemi SN;Perlis RH;Miklowitz DJ;Ketter TA;Sachs GS;Thase ME
许多双相情感障碍患者接受多种药物治疗方案，但接受复杂药物治疗的患者的区别概况尚未建立。在进入双相情感障碍系统治疗强化计划（STEP-BD）之前，对4035名双相情感障碍（DSM-IV）患者的锂、抗惊厥药、抗抑郁药和抗精神病药的处方模式进行了检查。1999年11月至2005年7月期间，研究对象被招募到美国22个研究中心。采用质量受试者工作特征（ROC）法对接受复杂方案的患者进行综合分析（所有迭代p < 0.01）。40%的受试者使用3种或更多药物，18%的受试者使用4种或更多药物。高质量的ROC分析显示，如果受试者(1)曾经服用过非典型抗精神病药物，(2)一生中抑郁发作≥6次，(3)企图自杀，(4)年收入≥75,000美元，则接受复杂方案（≥4种药物）的风险为64%。复合多药最少与锂、双丙戊酸或卡马西平相关，最常与非典型抗精神病药或抗抑郁药相关。与预期相反，精神病史、发病年龄、双相I与II亚型、快速循环史、既往住院史、当前疾病状态、酒精或物质使用障碍史并没有显著改变接受复杂方案的风险概况。大约五分之一的双相情感障碍患者存在至少四种药物的复杂多重用药。使用传统的情绪稳定剂与较少的联合治疗有关。复杂的治疗方案在有严重抑郁症负担和自杀倾向的患者中尤其常见，对他们来说，简单的药物治疗方案可能无法产生可接受的反应水平。clinicaltrials.gov标识符：NCT00012558
Many patients with bipolar disorder receive multi-drug treatment regimens, but the distinguishing profiles of patients who receive complex pharmacologies have not been established. Prescribing patterns of lithium, anticonvulsants, antidepressants, and antipsychotics were examined for 4035 subjects with bipolar disorder (DSM-IV) immediately prior to entering the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Subjects were recruited for participation across 22 centers in the United States between November 1999 and July 2005. The quality receiver operating characteristic (ROC) method was used to develop composite profiles of patients receiving complex regimens (p < .01 for all iterations). Use of 3 or more medications occurred in 40% of subjects, while 18% received 4 or more agents. Quality ROC analyses revealed that subjects had a 64% risk for receiving a complex regimen (≥ 4 medications) if they had (1) ever taken an atypical antipsychotic, (2) ≥ 6 lifetime depressive episodes, (3) attempted suicide, and (4) an annual income ≥ $75,000. Complex polypharmacy was least often associated with lithium, divalproex, or carbamazepine and most often associated with atypical antipsychotics or antidepressants. Contrary to expectations, a history of psychosis, age at onset, bipolar I versus II subtype, history of rapid cycling, prior hospitalizations, current illness state, and history of alcohol or substance use disorders did not significantly alter the risk profiles for receiving complex regimens. Complex polypharmacy involving at least 4 medications occurs in approximately 1 in 5 individuals with bipolar disorder. Use of traditional mood stabilizers is associated with fewer cotherapies. Complex regimens are especially common in patients with substantial depressive illness burden and suicidality, for whom simpler drug regimens may fail to produce acceptable levels of response. clinicaltrials.gov Identifier: NCT00012558
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影响因子：
3.8
作者：
Baldessarini, Ross J.;Leahy, Leslie;Hennen, John
通讯作者：
Hennen, John
影响因子：
2.9
作者：
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Walden, J
影响因子：
5.3
作者：
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Dunbar, GC
影响因子：
3.8
作者：
Hoblyn, Jennifer C.;Balt, Steve L.;Brooks, John O., III
通讯作者：
Brooks, John O., III
影响因子：
5.4
作者：
Sachs, G;Chengappa, KNR;Sweitzer, DE
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Sweitzer, DE