双相情感障碍研究进展

双相情感障碍在临床中并不少见,但漏诊情况时有发生,对双相抑郁发作的治疗仍有单一使用抗抑郁药的情况,这些会影响到对患者的有效治疗。本文对双相情感障碍的发病机制及治疗方案等作一回顾,目的是希望能提高诊断、治疗方案的一致性,更有效地治疗双相情感障碍。     

双相情感障碍复发风险因素的研究进展

双相情感障碍(bipolar disorder,BPD)是以情感或心境异常改变为主要特征的一组精神障碍,伴有与异常心境相适应的认知、行为、心理生理以及人际关系方面的改变或紊乱,一般分为双相Ⅰ型、双相Ⅱ型、混合型、快速循环型等。其终生患病率为2.6%~7.8%[1],约占精神科情感障碍的50%。双相障碍病程复杂,社会功能残疾和自残、自杀率相对较高,复发     

丙戊酸盐治疗双相情感障碍的研究进展

作为心境稳定剂,丙戊酸盐治疗各型双相情感障碍均有一定的疗效。近年来对各型双相情感障碍患者进行的临床研究证实：丙戊酸盐能改善躁狂症状;联合镇静药物治疗可有效改善抑郁症状;联合抗抑郁药物预防抑郁发作的疗效优于锂盐。丙戊酸盐与其他心境稳定剂联合治疗快速循环型双相情感障碍患者时可能更有益,也更适用于非快速循环型双相情感障碍患者的长程治疗。     

双相情感障碍实施心理护理的价值探究

目的了解双相情感障碍实施心理护理的价值。方法将沈阳市精神卫生中心心理三病房2016年8月至2018年12的76例双相情感障碍患者,随机分组,对照组的双相情感障碍的患者给予常规干预,心理护理组双相情感障碍在常规护理同时对患者开展心理护理。比较两组满意水平;双相情感障碍改善的时间、双相情感障碍从就诊到病情稳定出院时间;护理前后焦虑量表评分、抑郁量表评分、贝克-拉范森躁狂量表评分。结果心理护理组满意水平、焦虑量表评分、抑郁量表评分、贝克-拉范森躁狂量表评分、双相情感障碍改善的时间、双相情感障碍从就诊到病情稳定出院时间对比对照组有优势,P <0.05。结论双相情感障碍患者实施心理护理可减轻躁狂、焦虑和抑郁。     

双相情感障碍联合治疗研究进展与临床评价

目的 :研究双相情感障碍联合治疗的进展 ,评价其疗效与安全性 ,以期为临床合理应用提供参考。方法 :查阅近期相关国内、外文献 ,对涉及各临床时期的双相情感障碍联合治疗研究进展和临床评价进行介绍。结果与结论 :目前的研究结果提示 ,对于急性躁狂患者 ,非典型抗精神病药与心境稳定剂联用可明显提高疗效 ,且起效更迅速。对于双相抑郁患者 ,在心境稳定剂的基础上 ,加用帕罗西汀等新型抗抑郁药可改善疗效 ,且不增加转相的风险 ;关于维持治疗中的联合用药问题 ,锂盐和三环类抗抑郁药(TCA)长期联用并无优越性 ,且TCA会诱发躁狂。而心境稳定剂与新型抗抑郁药联用的长期随机对照研究仍很缺乏 ,还需要更多的研究来考察其疗效与安全性     

抗抑郁药物在双相情感障碍治疗中的应用

抗抑郁药物在双相情感障碍中的应用备受关注。抗抑郁药物治疗双相抑郁急性期疗效较为肯定,但有转躁等问题;长期治疗的预防效果尚有待进一步研究。本文从循证医学角度,综述抗抑郁药物在双相情感障碍(主要是双相抑郁)急性期和维持期治疗中的疗效以及转躁情况,阐述双相情感障碍治疗中抗抑郁药物合理使用的重要性和必要性。     

双相情感障碍患者临床治疗中的护理要点分析

目的了解双相情感障碍患者临床治疗中的护理要点。方法将我院2017年10月至2019年2月收治的96例双相情感障碍患者随机进行分组,每组48例。常规护理组予以基础护理,人性化服务组在常规护理的基础上充分关注患者的人性化服务,给予患者心理层面的护理。比较两组恢复效果、症状好转时间、患者对整体护理工作的满意度、护理前后抑郁程度[汉密尔顿抑郁量表(HAMD)]、自杀风险[自杀风险评估量表(NGASR)、躁狂症状[Bech-Rafaelsen躁狂量表(BRMS)]以及自我伤害事件发生率。结果人性化服务组的恢复效果优于常规护理组,P <0.05。人性化服务组HAMD评分低于常规护理组,P <0.05。人性化服务组NGASR评分低于常规护理组,P <0.05。人性化服务组症状好转时间短于常规护理组,P <0.05。人性化服务组患者对整体护理工作的满意度高于常规护理组,P <0.05。人性化服务组自我伤害事件发生率低于常规护理组,P <0.05。两组护理前BRMS评分无差异,P> 0.05;人性化服务组护理后显著低于护理前及常规护理组,P <0.05。人...     

梵高与“双相情感障碍”

3月30日是世界著名画家梵高的生曰。这位被双相情感障碍所困的画家经历了波折困顿的一生。自2015年起,由世界双相障碍协会和国际双相障碍基金会发起,将每年3月30日定为“世界双相情感障碍日”。2021年我们迎来了第7个世界双相情感障碍日。何为双相情感障碍双相情感障碍是一类既有躁狂或轻躁狂发作,又有抑郁发作的常见精神障碍。躁狂发作常见情感高涨、言语活动增多、精力充沛等情况;抑郁发作则出现情绪低落,并有愉快感丧失、言语活动减少、疲劳迟钝等症状。双相情感障碍临床表现复杂,在情绪低落或高涨反复、交替、不规则呈现的同时,常见焦虑强迫,病程多形演变,发作性、循环往复性、混合迁延性、潮起潮落式的病程不一而足。     

心理护理干预对双相情感障碍的护理效果分析

目的分析心理护理干预在双相情感障碍中的护理效果。方法选取我院收治的60例双相情感障碍的患者作为研究对象,将其按照数字表法分为对照组和观察组,每组各30例患者,对照组行常规护理,观察组在常规护理基础上联合心理护理干预,对比两组患者的护理效果。结果护理前,两组患者的焦虑评分、抑郁评分比较(P>0.05),护理后,对照组患者的焦虑评分、抑郁评分均高于观察组,组间比较(P<0.05)。结论心理护理干预在双相情感障碍中应用,可以有效的改善患者的焦虑、抑郁情绪,提高了患者的生活质量,具有重要的应用价值。     

Sleep deprivation in rapid-cycling bipolar affective disorder: case report

We described a 4-month long hypomanic response to sleep deprivation in a patient with consistent (20-day cycles) rapid cycling. He subsequently reverted to very rapid cycling; however, sleep deprivation remained effective for each attack of depression. Sleep deprivation treatment, its immediate but short-lived beneficial effect, may have a role in the treatment of the ultra-short depressions encountered in very rapid cycling.     

齐拉西酮与奎硫平合并碳酸锂治疗双相情感障碍躁狂发作对照研究

目的探讨齐拉西酮合并碳酸锂治疗双相情感障碍躁狂发作的疗效和安全性。方法将80例双相情感障碍躁狂发作患者随机分为齐拉西酮联合碳酸锂治疗组（研究组）和奎硫平联合碳酸锂治疗组（对照组）各40例。观察4周。分别采用杨氏躁狂量表（YMRS）、治疗中出现的症状量表（TESS）评定疗效和不良反应。结果治疗4周,研究组痊愈率为20.00%,总有效率为85.00%;对照组分别为25.00%和87.50%,两组比较,差异无统计学意义（P〉0.05）。两组YMRS评分治疗前差异无统计学意义（P〉0.05）,治疗后各周均有显著下降（P均〈0.01）,两组比较,差异无统计学意义（P〉0.05）。研究组和对照组不良反应发生率分别为42.50%和47.50%,差异无统计学意义（P〉0.05）,研究组静坐不能、肌张力增高的发生率高于对照组（P均〈0.05）,体质量增加发生率低于对照组（P〈0.05）。结论齐拉西酮联合碳酸锂治疗双相情感障碍躁狂发作有良好疗效,不良反应轻微。     

Functional magnetic resonance spectroscopy in patients with schizophrenia and bipolar affective disorder: Glutamate dynamics in the anterior cingulate cortex during a working memory task

The glutamate system is implicated in the pathophysiology of schizophrenia and mood disorders. Using functional magnetic resonance spectroscopy (¹H-fMRS), it is possible to monitor glutamate dynamically in activated brain areas and may give a closer estimate of glutamatergic neurotransmission than standard magnetic resonance spectroscopy. 14 patients with schizophrenia, 15 patients with bipolar disorder II (BPII) and 14 healthy volunteers underwent a 15?min N-back task in a 48s block design during ¹H-fMRS acquisition. Data from the first, second and third 16s group of 8 spectra for each block were analysed to measure levels of glutamate and Glx (glutamate?+?glutamine), scaled to total creatine (TCr), across averaged 0-back and 2-back conditions. A 6?×?3 repeated-measures analysis of variance (rmANOVA) demonstrated a significant main effect of time for Glx/TCr (P?=?0.022). There was a significant increase in Glu/TCr (P?=?0.004) and Glx/TCr (P?<?0.001) between the final spectra of the 0-back and first spectra of the 2-back condition in the healthy control group only. 2?×?2 rmANOVA revealed a significant time by group interaction for Glx/TCr (P?=?0.019) across the 0-back condition, with levels reducing in healthy controls and increasing in the schizophrenia group. While healthy volunteers showed significant increases in glutamatergic measures between task conditions, the lack of such a response in patients with schizophrenia and BPII may reflect deficits in glutamatergic neurotransmission. Abnormal increases during periods of relatively low executive load, without the same dynamic modulation as healthy volunteers with increasing task difficulty, further suggests underlying abnormalities of glutamatergic neurotransmission in schizophrenia.     

Improving the design of maintenance studies for bipolar disorder

Abstract

Background:

In contrast to the trial design of acute mania studies, there is no standard design for bipolar maintenance studies. Over the past 15 years, the design of monotherapy maintenance studies in bipolar disorder has evolved significantly, but recent study designs continue to differ in important ways.     

Characterizing decision-making and reward processing in bipolar disorder: A cluster analysis

The presence of abnormalities in emotional decision-making and reward processing among bipolar patients (BP) has been well rehearsed. These disturbances are not limited to acute phases and are common even during remission. In recent years, the existence of discrete cognitive profiles in this psychiatric population has been replicated. However, emotional decision making and reward processing domains have barely been studied. Therefore, our aim was to explore the existence of different profiles on the aforementioned cognitive dimensions in BP. The sample consisted of 126 euthymic BP. Main sociodemographic, clinical, functioning, and neurocognitive variables were gathered. A hierarchical-clustering technique was used to identify discrete neurocognitive profiles based on the performance in the Iowa Gambling Task. Afterward, the resulting clusters were compared using ANOVA or Chi-squared Test, as appropriate. Evidence for the existence of three different profiles was provided. Cluster 1 was mainly characterized by poor decision ability. Cluster 2 presented the lowest sensitivity to punishment. Finally, cluster 3 presented the best decision-making ability and the highest levels of punishment sensitivity. Comparison between the three clusters indicated that cluster 2 was the most functionally impaired group. The poorest outcomes in attention, executive function domains, and social cognition were also observed within the same group. In conclusion, similarly to that observed in “cold cognitive” domains, our results suggest the existence of three discrete cognitive profiles concerning emotional decision making and reward processing. Amongst all the indexes explored, low punishment sensitivity emerge as a potential correlate of poorer cognitive and functional outcomes in bipolar disorder.     

An overview of pharmacotherapy for bipolar I disorder

Introduction: Bipolar I disorder (BD I) is complex with a chronic course that significantly impacts a sufferer’s quality of life. As of right now, there are many available treatments that aim to rapidly treat manic or depressive episodes and stabilize mood. The purpose of this report is to provide an up-to-date comprehensive review of the available evidence-based trials of pharmacotherapy for the treatment of BD I.

Areas covered: This paper reviews randomized active comparator-controlled or placebo-controlled trials evaluating the use of current pharmacotherapy in adults with BD I from phase III to clinical practice. Monotherapy and combination therapy for acute and long-term treatment were reviewed for this purpose.

Expert opinion: There are many treatments available for BD mania; however, the depressive and stabilization phases of the illness remain a clinical challenge. Unfortunately, randomized controlled trials do not represent ‘real world’ patients, as their strict inclusion and exclusion criteria do not allow for different features sometimes present in patients to be considered. Research efforts must also focus on treating cognitive deficits, which adds to lower functional outcome. The authors believe that there is dire need for new, more targeted treatments in BD I, with a critical view of the side effects.     

Asenapine for the treatment of bipolar disorder

Introduction: Bipolar I disorder (BDI) is amongst the most debilitating psychiatric conditions with a great impact on both patients and their families. A class of drugs commonly used in this condition is second-generation antipsychotics (SGAs) including asenapine, one of the latest to be introduced into the clinical practice worldwide to treat manic episodes in BDI.

Areas covered: The aim of this paper is to critically review the literature on the pharmacological characteristics, tolerability, and safety data of asenapine, as well as on its short- and long-term clinical trials in manic episodes as both a monotherapy and as an add-on treatment.

Expert opinion: The available data indicate that asenapine is an effective antimanic agent in both adult and pediatric patients and that it might also improve depressive symptoms and recurrences in BDI patients. Its tolerability profile is good, and its most common side effects are somnolence, light extrapyramidal symptoms, dizziness, weight gain, and oral (but reversible) hypoesthesia. Taken together, the published studies indicate that asenapine might be an effective therapeutic agent in BDI with a broad spectrum of clinical activities. Further double-blind, short- and long-term studies are, however, necessary to clarify its precise role in the treatment of BD.     

Quetiapine monotherapy for mania associated with bipolar disorder: combined analysis of two international,double-blind,randomised, placebo-controlled studies

ABSTRACT

Objective: To evaluate the efficacy and safety of quetiapine monotherapy for mania in bipolar disorder by an a priori defined combined analysis of data from two placebo-controlled studies.

Method: The intent-to-treat (ITT) populations from two studies of patients with DSM-IV bipolar I disorder, manic episode, randomised to 12 weeks of double-blind treatment with quetiapine (up to 800?mg/day) or placebo were combined. The primary efficacy endpoint was change in Young Mania Rating Scale (YMRS) score from baseline to Day 21. Secondary endpoints included change from baseline in YMRS to Day 84, YMRS response and remission rates and change from baseline to Days 21 and 84 in the Montgomery–Asberg Depression Rating Scale (MADRS), Clinical Global Impressions (CGI), Clinical Global Impressions – Bipolar (CGI-BP) and the Positive and Negative Syndrome Scale (PANSS). These endpoints were analysed as continuous variables, using an analysis of covariance (ANCOVA), with the baseline as covariate. In order to account for any difference in response between studies, the analyses were stratified by study as a fixed effect, and centre as a random effect. The Cochran–Mantel–Haenszel test was used to analyse binary variables. A chi square test was used to compare the frequency of adverse events between the treatment groups.

Results: The combined analysis included a total of 403 patients from two quetiapine monotherapy studies in patients with bipolar I disorder. A significant improvement in YMRS score was observed from Day 4 (?p = 0.021) onward in the quetiapine group compared with placebo. The treatment advantage of quetiapine over placebo continued to increase to Day 21 (?p < 0.001) and Day 84 (?p < 0.001). Significantly more quetiapine-treated than placebo-treated patients achieved a response (?p < 0.001). The average quetiapine dose in responders was approximately 600?mg daily. Of adverse events occurring in ≥ 5% of patients, quetiapine-treated patients had a significantly greater incidence versus placebo of somnolence (16.3% vs. 4.0%), dry mouth (15.8% vs. 3%), weight gain (9.1% vs. 1.5%) and dizziness (6.7% vs. 2.5%).

Conclusions: The data from this combined analysis support the results from the individual studies and indicate that quetiapine monotherapy is effective across a broad range of mood symptoms, fast-acting and well tolerated in the treatment of mania.     

Pharmacotherapy for the peripartum management of bipolar disorder

ABSTRACT

Introduction: The peripartum period in bipolar disorder (BD) patients is associated with high risk of relapse. Relapse during this period may affect fetal and child development. The consequences of psychotropic medication during pregnancy are also a major concern. The extent to which mood stabilizers may potentially affect the embryogenesis or the child development varies from high (e.g. valproate) to less clear and more debated (e.g. lithium).

Areas covered: This review describes the current state of evidence with respect to the impact of recommended pharmacological interventions for BD during the peripartum period. It compares recent international treatment guidelines for the management of BD during the peripartum period. Last, this review presents a summary of key recommendations for BD women of childbearing age, for BD women during pregnancy and postpartum period from the international guidelines.

Expert opinion: Management of the pharmacological treatment for BD patients during the perinatal period is challenging. Although treatment guidelines may be of significant help, high heterogeneity exists across them. Shared decision-making represents a useful patient-centered approach during the perinatal period. Large cohort studies are needed to better identify risk associated to treatment discontinuation or treatment exposure.