Comparative prophylactic efficacy of lithium, carbamazepine, and the combination in bipolar disorder
Comparative prophylactic efficacy of lithium, carbamazepine, and the combination in bipolar disorder
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DOI：
10.4088/jcp.v58n1102
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发表时间：
1997-11-01
影响因子：
5.3
通讯作者：
Post, RM
中科院分区：
文献类型：
--
作者：
Denicoff, KD;SmithJackson, EE;Post, RM
背景：我们比较了锂盐、卡马西平及其联合用药的预防效果，并确定了可能的临床反应标志物。方法：采用双盲设计，将 52 名符合 DSM-III-R 双相情感障碍标准的门诊患者随机分配到锂盐或卡马西平治疗的第 1 年，在第二档中交叉使用相反药物，然后进行联合治疗的第 3 年。患者接受每月的详细评估以及功能程度的日常生活图表评级结果：对于可评估的患者：42 名患者中，有 13 名（31.0%）因缺乏疗效而未能完成一整年的锂盐治疗，2 名因副作用而放弃治疗，35 名患者中，13 名（37.1%）因缺乏疗效而在第一年内退出卡马西平，10 名因副作用而退出（10 名中的 9 名出现皮疹；7 名） 29 名因缺乏疗效而退出联合治疗的患者中，有 24.1% 的患者在临床总体印象量表上有显着或中度改善，锂剂组为 33.3%，卡马西平组为 11.4%，联合治疗组为 55.2%，两者没有显着差异。通过多种措施，锂剂在预防躁狂方面比卡马西平更有效。单一疗法效果较差（28.0% 对锂盐有反应；19.0% 对卡马西平有反应），但联合治疗效果明显更好（56.3%，p < .05）。结论：这些前瞻性随机数据表明，尽管根据需要使用辅助药物，但对情绪稳定剂或其组合的反应不足的发生率很高。需要额外的新治疗方案来更好地降低大量双相情感障碍门诊患者的情感发病率。
Background: We compared the prophylactic efficacy of lithium, carbamazepine, and the combination and identified possible clinical markers of response.Method: Fifty-two outpatients who met DSM-III-R criteria for bipolar illness were randomly assigned in a double-blind design fur an intended I year of treatment with lithium or carbamazepine, a crossover to the opposite drug in the second gear, and then a third year on the combination, Patients received monthly detailed evaluations, and daily life chart ratings of the degree of functional incapacity associated with mania or depression were completed.Results: For evaluable patients: 13 (31.0%) of 42 failed to complete a full year of lithium therapy owing to lack of efficacy, and 2 dropped our because of side effects, 13 (37.1%) of 35 withdrew from carbamazepine within the first year owing to lack of efficacy, and 10 dropped out because of side effects (9 of the 10 had a rash; 7 (24.1%) of 29 withdrew from the combination therapy owing to lack of efficacy. The percentage of the evaluable patients who had marked or moderate improvement on the Clinical Global Impressions scale was 33.3% on lithium, 11.4% on carbamazepine, and 55.2% on the combination treatment, which was not significantly different, By a variety of measures, lithium was more effective than carbamazepine in the prophylaxis of mania, Patients with a past history of rapid cycling did poorly on monotherapy (28.0% responded to lithium; 19.0% responded to carbamazepine), but significantly better on the combination (56.3%, p < .05).Conclusion: These prospective, randomized data suggest a high incidence of inadequate response to either mood stabilizer or their combination despite use of adjunctive agents as needed, Additional novel treatment regimens are needed to better decrease affective morbidity in large numbers of bipolar outpatients.