不典型抗精神病药物、心境稳定剂及抗抑郁剂对双相障碍患者的维持治疗对照研究

摘要

目的 观察不典型抗精神病药物、心境稳定剂及抗抑郁剂对双相障碍患者的维持治疗1年的结局. 方法选择符合ICD-10双相障碍诊断标准患者,急性期进行8周抗抑郁剂和心境稳定剂丙戊酸镁和喹硫平联合治疗,痊愈和有效者分别联用和不联用抗抑郁剂进入1年的维持治疗期. 用17项汉密尔顿抑郁量表( HAMD)、躁狂量表( BRMS)和临床疗效总评量表( CGI)评定疾病严重程度和疗效. 结果 120例患者急性期治疗后按就诊奇偶顺序随机分研究组(联用抗抑郁剂组,61例)和对照组(未取用抗抑郁药组,59例). 随访1年后,研究组61例共有40例维持痊愈,14例有效,5例症状复发,转躁2例,总发病率为11%;对照组59例随访1年后痊愈32例,有效10例,复发15例,转躁2例,总发病率为29%,两组差异有统计学意义(P<0. 05). 联用抗忧郁剂组复发率明显低于未联用抗抑郁剂组,转躁率无明显差异. 生成分析显示联用抗抑郁剂组平均复发时间显著长于未联用抗抑郁组. 结论 不典型抗精神病药物、心境稳定剂及抗抑郁剂治疗双相障碍患者1年后复发率低,转躁率无明显差异.%Objective To explore 1-year outcomes of patients with bipolar disrorder treated with atypical antipsychotics and mood stabilizer which combined with antidepressant. Methods Patients who met the bipolar disorder criterion of ICD-10(In-ternational Classification of Disease) were treated in 8-week acute period by atypical antipsychotics and mood stabilizer combined with antidepressant. Patients with remission and response after acute treatment participated in 1-year continuation of their medica-tion. 17 items Hamilton depression rating scale ( HAMD) ,Bech-Rafaelsen mania rating scale ( BRMS) and clinical global impres-sion(CGI) were employed to assess diseases severity and the outcome. Results After the acute treatment, 120 patients were ran-domly divided into the study group (61)( combined with antidepressant) and the control group (59). After the 1-year continuous treatment, At the study group, there were 40 patients maintaining remission and 14 patients response, 5 patients relapsed, 2 pa-tients mania relapsed. The relapse rate was 11 %. on the control group, there were 32 patients maintaining remission and 10 pa-tients response, 15 patients relapsed. 2 patients mania relapsed. The relapse rate was 29%. There were significantly difference in remission rate between the study group and the control group. The depression relapse rate in the study group was significant lower than that of control group. while the mania relapse rate was no significantly different between two groups. The mean time to relapse in the study group was longer than the control group. Conclusion 1-yaer outcome of patients with bipolar disrorder treated with a-typical antipsychotics and mood stabilizer combined with antidepressant was low relapses rate,but the mania relapse rate was no significantly different.