Treatment strategies according to clinical features in a naturalistic cohort study of bipolar patients: A principal component analysis of lifetime pharmacological and biophysic treatment options

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• 作者：Alessandra M.A. Nivoli^a ; ^b ; ^c ; Francesc Colom^a ; Isabella Pacchiarotti^a ; ^d ; ^e ; Andrea Murru^a ; Jan Scott^f ; ⁱ ; ^j ; Marc Valentí ; ^a ; Lorenzo Mazzarini^a ; ^d ; ^e ; ^g ; Caterina del Mar Bonnin^a ; José ; Sá ; nchez-Moreno^a ; ^{jose.sanchez.moreno@cibersam.es} ; Alessandro Serretti^h ; Eduard Vieta^a ; ^{EVIETA@clinic.ub.es}
• 关键词：Bipolar disorder ; Mania ; Depression ; Antipsychotic ; Mood stabiliser ; Antidepressants
• 刊名：European Neuropsychopharmacology
• 出版年：2013
• 出版时间：April, 2013
• 年：2013
• 卷：23
• 期：4
• 页码：263-275
• 全文大小：286 K

文摘

Background: The treatment of patients with bipolar disorder (BD) is complex and psychiatrists often have to change treatment strategies. However, available data do not provide information about the most frequent patterns of treatment strategies prescribed in clinical practice and clinical/socio-demographic factors of drugs prescription. Objective: The aims of this study were: (1) to identify specific patterns of life-time treatment strategies in a representative sample of bipolar patients; (2) to assess consistency with guidelines recommendations; and (3) to investigate clinical/socio-demographic of patients. Methods: Six-hundred and four BD I and II out-patients were enrolled in a naturalistic cohort study at the Barcelona Bipolar Disorders Program, in a cross-sectional analysis. A principal component analysis was applied to group psychotropic drugs into fewer underlying clusters which represent patterns of treatment strategies more frequently adopted in the life-time naturalistic treatment of BD. Results: Three main factors corresponding to three main prescription patterns were identified, which explained about 60 % of cases, namely, Factor 1 (21.1 % of common variance), defined the ¡°antimanic stabilisation package¡± including treatments with antimanic mechanism of action in predominantly manic-psychotic BD I patients; Factor 2 (20.4 % ), ¡°antidepressive stabilisation package¡± that grouped predominantly depressed patients, and Factor 3 (16.4 % ) defined the ¡°anti-bipolar II package¡±, including antidepressant monotherapy in BD II patients with depressive predominant polarity, melancholic features and higher rates of suicide behaviours. Conclusions: This study identified three patterns of lifetime treatment strategies in three specific and different groups of naturalistically treated bipolar patients.