Does stage of illness impact treatment response in bipolar disorder? Empirical treatment data and their implication for the staging model and early intervention
Does stage of illness impact treatment response in bipolar disorder? Empirical treatment data and their implication for the staging model and early intervention
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DOI：
10.1111/j.1399-5618.2011.00889.x
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发表时间：
2011-02-01
影响因子：
5.4
通讯作者：
McGorry, Patrick D.
中科院分区：
文献类型：
--
作者：
Berk, Michael;Brnabic, Alan;McGorry, Patrick D.
目的：分期模型表明，双相情感障碍的早期阶段对治疗有更好的反应和更有利的预后。本研究旨在为该模型和早期干预的相关结构提供实证支持。方法：对奥氮平的躁狂症、抑郁症和维持性研究的汇集数据进行分析。结果：躁狂症和维持性研究的应答率在有1-5次病史的个体中分别为52-69%和10-50%，在有5-5次病史的个体中为29-59%和11-40%。在大多数反应指标上，1-5组的这些比率明显更高，那些先前发作较少的人的反应机会最多增加了两倍。在抑郁症研究中，仅在两项指标中，1-5组的应答率显著更高。在维持性研究中，与10次发作组相比，经历过1-5次发作或6-10次发作的人复发到躁狂或抑郁的几率分别降低了40%-60%。这一趋势仅在1-5发作组的躁狂症复发时有统计学意义(p=0.005)。结论：那些处于疾病最早阶段的个体始终对治疗有更有利的反应。这与分阶段模式是一致的，并强调了支持早期干预政策的必要性。
Objective:The staging model suggests that early stages of bipolar disorder respond better to treatments and have a more favourable prognosis. This study aims to provide empirical support for the model, and the allied construct of early intervention.Methods:Pooled data from mania, depression, and maintenance studies of olanzapine were analyzed. Individuals were categorized as having had 0, 1-5, 6-10, or > 10 prior episodes of illness, and data were analyzed across these groups.Results:Response rates for the mania and maintenance studies ranged from 52-69% and 10-50%, respectively, for individuals with 1-5 previous episodes, and from 29-59% and 11-40% for individuals with > 5 previous episodes. These rates were significantly higher for the 1-5 group on most measures of response with up to a twofold increase in the chance of responding for those with fewer previous episodes. For the depression studies, response rates were significantly higher for the 1-5 group for two measures only. In the maintenance studies, the chance of relapse to either mania or depression was reduced by 40-60% for those who had experienced 1-5 episodes or 6-10 episodes compared to the > 10 episode group, respectively. This trend was statistically significant only for relapse into mania for the 1-5 episode group (p = 0.005).Conclusion:Those individuals at the earliest stages of illness consistently had a more favourable response to treatment. This is consistent with the staging model and underscores the need to support a policy of early intervention.