Differential efficacy of olanzapine and lithium in preventing manic or mixed recurrence in patients with bipolar I disorder based on number of previous manic or mixed episodes
Differential efficacy of olanzapine and lithium in preventing manic or mixed recurrence in patients with bipolar I disorder based on number of previous manic or mixed episodes
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DOI：
10.4088/jcp.v67n0113
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发表时间：
2006-01-01
影响因子：
5.3
通讯作者：
Tohen, M
中科院分区：
文献类型：
--
作者：
Ketter, TA;Houston, JP;Tohen, M
简介：双相情感障碍的结果随着躁狂发作次数的增加而减少，这表明在疾病早期预防复发可以改善患者的预后。我们调查了治疗效果在预防情绪发作的患者亚组的数量先前躁狂发作。方法：本研究是对来自多中心、双盲、在431例最初心境正常、既往至少有2次躁狂/混合型发作且DSM- IV诊断为双相1型障碍的患者中进行的12个月复发/再发临床试验，随机分配至奥氮平组（5-20 mg/天）或锂（血清浓度0.6 - 1.2 mEq/L）。数据收集于1999年8月至2002年6月之间。根据既往躁狂/混合发作次数，按疾病阶段对患者进行亚分类-早期：既往发作2次（N = 53，锂; N = 48，奥氮平），中期：3 - 5次既往发作（N = 80，锂; N = 98，奥氮平）和晚期：既往发作超过5次（N = 81，锂; N = 71，奥氮平）-并评估复发/复发率。治疗（p <0.001）和疾病分期（p = 0.006）对躁狂/混合复发/复发率有显著影响，但无显著相互作用（p = 0.107）。在早期、中期和晚期组中，奥氮平与锂盐治疗的躁狂/混合复发/复发率分别为2.1%与26.4%（p = 0.008）、13.3%与23.8%（p = 0.073）和23.9%与33.3%（p = 0.204）。治疗（p = 0.096）或疾病阶段（p = 0.731）对抑郁症复发/复发无显著影响。结论：与锂剂相比，奥氮平治疗早期（而非中期或晚期）患者躁狂/混合发作的复发/复发率显著降低。因此，奥氮平维持治疗在双相情感障碍病程早期可能特别有效。
Introduction: Bipolar disorder outcome worsens as number of manic episodes increases, suggesting that prevention of recurrent episodes early during the disorder could improve patient prognosis. We investigated treatment efficacy in prevention of mood episodes in patients subgrouped by number of prior manic episodes.Method: This study was a post hoc analysis of data from a multicenter, double-blind, 12-month clinical trial of relapse/recurrence in 431 initially euthymic patients with at least 2 prior manic/mixed episodes and a DSM- IV diagnosis of bipolar 1 disorder randomly assigned to olanzapine (5-20 mg/day) or lithium (serum concentration 0.6 to 1.2 mEq/L). Data were collected between August 1999 and June 2002. Patients were subcategorized by illness stage according to number of prior manic/mixed episodes-early stage: 2 prior episodes (N = 53, lithium; N = 48, olanzapine), intermediate stage: 3 to 5 prior episodes (N = 80, lithium; N = 98, olanzapine), and later stage: more than 5 prior episodes (N = 81, lithium; N = 71, olanzapine)-and were evaluated for rates of relapse/recurrence.Results: There were significant effects for treatment (p < .001) and illness stage (p = .006) but no significant interaction (p = .107) on rate of manic/mixed relapse/recurrence. Rates of manic/mixed relapse/recurrence for olanzapine versus lithium were 2.1 % versus 26.4% (p = .008), 13.3% versus 23.8% (p = .073), and 23.9% versus 33.3% (p = .204) for early-, intermediate-, and later-stage groups, respectively. There was no significant effect for treatment (p = .096) or illness stage (p = .731) for depressive relapse/recurrence.Conclusions: Early-stage (but not intermediate-or later-stage) patients had a significantly lower rate of relapse/recurrence of manic/mixed episodes with olanzapine compared to lithium. Thus, olanzapine maintenance therapy may be particularly effective early in the course of bipolar illness .