- 作者：Armin Szegedi ; Jun Zhao ; Roger S. McIntyre
- 关键词：Bipolar mania ; Antipsychotics ; Early improvement ; YMRS ; CGI&ndash ; BP
- 刊名：Journal of Affective Disorders
- 出版年：2013
- 出版时间：25 September, 2013
- 年：2013
- 卷：150
- 期：3
- 页码：745-752
- 全文大小：1808 K
Objective
To assess whether early symptom improvement predicts later treatment outcome in acute manic/mixed episodes of bipolar I disorder using Young Mania Rating Scale (YMRS) or Clinical Global Impression scale, bipolar disorders (CGI-BP) assessments.Methods
Data were pooled from two 3-week randomized controlled studies with asenapine (ASE; n=372), olanzapine (OLA; n=391), or placebo (PL; n=197). Early improvement was defined as reduction of YMRS total scores (¡Ý15 % , ¡Ý20 % , ¡Ý25 % ) or CGI-BP severity scores (¡Ý1 point change) at days 2, 4, and 7. Treatment outcome at week 3 was defined as response (YMRS: ¡Ý50 % score reduction; CGI-BP severity: ¡°minimally ill¡± or better) or remission (YMRS total score ¡Ü12; CGI-BP severity: ¡°not at all ill¡±). Odds ratios (ORs) and predictive performance statistics were calculated.
Results
Early improvement occurred in a substantial percentage of patients and was associated with significantly increased ORs for response or remission. For ASE, results were significant as early as day 2 on all measures of YMRS and CGI-severity of mania assessment. For all treatments sensitivity and negative predictive values increased from days 2 to 7 for all YMRS and CGI-BP measures, while specificity values decreased.
Conclusion
In acute manic/mixed episodes, early improvement within 1 week of treatment was associated with significantly increased ORs of endpoint response or remission. While only a subset of early improvers reach the endpoint treatment goals, absence of improvement within week 1 of treatment initiation strongly predicts the unlikely success of subsequent treatment. Further, CGI-based predictors had predictive properties similar to those based on the YMRS scale.