Enhancing outcomes in patients with bipolar disorder: results from the Bipolar Disorder Center for Pennsylvanians Study
Enhancing outcomes in patients with bipolar disorder: results from the Bipolar Disorder Center for Pennsylvanians Study
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DOI：
10.1111/j.1399-5618.2009.00700.x
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发表时间：
2009-06-01
影响因子：
5.4
通讯作者：
Kupfer, David J.
中科院分区：
文献类型：
--
作者：
Fagiolini, Andrea;Frank, Ellen;Kupfer, David J.
我们开发了双相情感障碍（SCBD）的专业护理模型和与SCBD联合提供的心理社会治疗[增强型临床干预（ECI）]。我们调查了SCBD和ECI + SCBD是否能够改善年轻人和老年人、非裔美国人和农村双相情感障碍患者的结局并减少健康差异。随机分配到SCBD或ECI + SCBD，并在四个临床地点纵向随访1至3年。两个治疗组随时间推移均显著改善，基于年龄、种族、或居住地，除了老年受试者与成人受试者相比有显著更大的改善。ECI + SCBD组的生活质量改善更大。在进入研究时有症状的299名参与者中，213名在24个月内恢复，在此期间，213名受试者中的86名发生了新的发作。在经历过复发的参与者和没有经历复发的参与者之间，没有发现种族，居住地或年龄的显著差异。然而，青少年患者不太可能比成人和老年patients.This研究表明SCBD的有效性和ECI独立的年龄，种族，或居住地的额外好处。它还表明，新的情绪发作在双相情感障碍患者中很常见，尽管有专门的，基于指南的治疗，但仍有可能发生。
We developed models of Specialized Care for Bipolar Disorder (SCBD) and a psychosocial treatment [Enhanced Clinical Intervention (ECI)] that is delivered in combination with SCBD. We investigated whether SCBD and ECI + SCBD are able to improve outcomes and reduce health disparities for young and elderly individuals, African Americans, and rural residents with bipolar disorder.Subjects were 463 individuals with bipolar disorder, type I, II, or not otherwise specified, or schizoaffective disorder, bipolar type, randomly assigned to SCBD or ECI + SCBD and followed longitudinally for a period of one to three years at four clinical sites.Both treatment groups significantly improved over time, with no significant differences based on age, race, or place of residence, except for significantly greater improvement among elderly versus adult subjects. Improvement in quality of life was greater in the ECI + SCBD group. Of the 299 participants who were symptomatic at study entry, 213 achieved recovery within 24 months, during which 86 of the 213 subjects developed a new episode. No significant difference was found for race, place of residence, or age between the participants who experienced a recurrence and those who did not. However, the adolescent patients were less likely than the adult and elderly patients to experience a recurrence.This study demonstrated the effectiveness of SCBD and the additional benefit of ECI independent of age, race, or place of residence. It also demonstrated that new mood episodes are frequent in individuals with bipolar disorder who achieve recovery and are likely to occur in spite of specialized, guideline-based treatments.