Childhood trauma and mixed episodes are associated with poor response to lithium in bipolar disorders
Childhood trauma and mixed episodes are associated with poor response to lithium in bipolar disorders
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DOI：
10.1111/acps.12684
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发表时间：
2017-04-01
影响因子：
6.7
通讯作者：
Bellivier, F.
中科院分区：
文献类型：
--
作者：
Etain, B.;Lajnef, M.;Bellivier, F.
目的：双相情感障碍（BD）对锂治疗反应的可靠预测因子仍然缺乏。然而，儿童期创伤已被假设为与锂反应不良有关。方法：我们纳入了148例BD患者，当回顾性和临床评估锂反应和儿童期创伤时，使用可靠的量表进行胸腺功能正常。结果：根据“Alda量表”，样本中有20.3%的锂盐反应良好，49.3%的部分反应者和30.4%的无反应者。较高水平的身体虐待与锂的反应水平较低显著相关（P = 0.009）。与未暴露于任何虐待的患者相比，至少有两次创伤虐待（情感，身体或性）的患者更容易属于无应答组（OR = 4.91 95%CI（1.01-27.02））。在研究的临床变量中，混合发作和酒精滥用的终生存在与锂无反应相关。多因素分析显示，身体虐待和混合发作与锂盐治疗反应不良独立相关（分别为P = 0.005和P = 0.013.Conclusions：儿童期身体虐待可能与锂盐预防反应不良有关，这种影响与BD临床表现和锂盐治疗反应不良之间的关系无关。
Objectives: Reliable predictors of response to lithium are still lacking in bipolar disorders (BDs). However, childhood trauma has been hypothesized to be associated with poor response to lithium.Methods: We included 148 patients with BD, euthymic when retrospectively and clinically assessed for response to lithium and childhood trauma using reliable scales.Results: According to the 'Alda scale', the sample consisted in 20.3% of excellent responders, 49.3% of partial responders and 30.4% of nonresponders to lithium. A higher level of physical abuse significantly correlated with a lower level of response to lithium (P = 0.009). As compared to patients not exposed to any abuse, patients with at least two trauma abuses (emotional, physical or sexual) were more at risk of belonging to the non-responders group (OR = 4.91 95% CI (1.01-27.02)). Among investigated clinical variables, lifetime presence of mixed episodes and alcohol misuse were associated with non-response to lithium. Multivariate analyses demonstrated that physical abuse and mixed episodes were independently associated with poor response to lithium (P = 0.005 and P = 0.013 respectively).Conclusions: Childhood physical abuse might be involved in a poor future response to lithium prophylaxis, this effect being independent of the association between clinical expression of BD and poor response to lithium.