Early specialised treatment for bipolar disorder: Long-term follow-up from the early intervention in affective disorders (EIA) randomised controlled trial

IF 5.3 2区医学 Q1 PSYCHIATRY Acta Psychiatrica Scandinavica Pub Date : 2024-06-02 DOI:10.1111/acps.13716

Klaus Munkholm, Lars Vedel Kessing

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Abstract

Background

It is unclear whether treatment early after onset in bipolar disorder may improve the long-term illness course. The early intervention in affective disorders (EIA) randomised controlled trial found that 2-years treatment in a specialised mood disorder clinic combining evidence-based pharmacological treatment with group psychoeducation improved clinical outcomes compared with standard treatment in patients with bipolar disorder discharged after their 1st, 2nd, or 3rd hospital admission. We aimed to assess the 16 years long-term outcomes after randomisation of the participants in the EIA trial.

Methods

Data were obtained by linking nation-wide Danish population-based registers. All 158 participants of the EIA trial (Trial Registration Number NCT00253071) were followed from time of randomisation (2005–2009) to end of study (31 December 2021). The primary outcome was risk of psychiatric readmission. Secondary outcomes were total admissions and costs, medication use, intentional self-harm or suicide attempt or suicide, and socio-economic measures.

Results

The absolute mean risk of psychiatric readmission was 49.3% in the intervention group and 59.8% in the control group, with no statistically significant difference between the groups (b = −0.10, 95% CI: −0.26 to 0.047, p = 0.18). Compared with the control group, patients in the intervention group had numerically fewer total admission days (mean (SD) 44 (77) versus 62 (109)), lower total cost of psychiatric hospital admissions and hospital-based outpatient visits (mean (SD) 22,001 (36793) euros versus 29,822 (52671) euros) and higher use of lithium and antipsychotics, but the differences were not statistically significant. Fewer patients in the intervention group had an event of intentional self-harm or suicide attempt or suicide during follow-up (OR 0.25, 95% CI: 0.15–0.40, p < 0.001) compared with the control group and more patients in the intervention group used antiepileptics (OR 2.21, 95% CI: 1.08–4.60, p = 0.031).

Conclusion

Analyses of very long-term outcomes of the EIA trial may potentially indicate a beneficial effect of the intervention at the long term but were likely underpowered to detect a more subtle effect and for most outcomes the differences between groups were not statistically significant.

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双相情感障碍的早期专业治疗：情感障碍早期干预（EIA）随机对照试验的长期随访。

背景：目前尚不清楚躁郁症患者发病后尽早接受治疗是否能改善长期病程。情感障碍早期干预（EIA）随机对照试验发现，与标准治疗相比，在第一次、第二次或第三次入院后出院的双相情感障碍患者在情绪障碍专科门诊接受为期两年的治疗，结合循证药物治疗和集体心理教育，可改善临床疗效。我们的目的是评估EIA试验参与者随机分组后16年的长期疗效：方法：我们通过丹麦全国范围内的人口登记册获取数据。我们对 EIA 试验（试验注册号 NCT00253071）的所有 158 名参与者进行了从随机分配（2005-2009 年）到研究结束（2021 年 12 月 31 日）的跟踪调查。主要结果是精神疾病再入院风险。次要结果为入院总人数和费用、药物使用情况、故意自残或自杀未遂或自杀以及社会经济指标：干预组的精神病再入院绝对平均风险为 49.3%，对照组为 59.8%，组间差异无统计学意义（b = -0.10，95% CI：-0.26 至 0.047，p = 0.18）。与对照组相比，干预组患者入院总天数较少（平均（标清）44（77）天对62（109）天），精神科住院和医院门诊总费用较低（平均（标清）22001（36793）欧元对29822（52671）欧元），锂和抗精神病药物的使用率较高，但差异无统计学意义。对 EIA 试验的长期结果进行分析，有可能表明干预措施具有长期的有益效果，但可能不足以检测出更微妙的效果，而且对于大多数结果而言，组间差异在统计学上并不显著。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Psychiatrica Scandinavica 医学-精神病学

CiteScore

11.20

自引率

3.00%

发文量

135

审稿时长

6-12 weeks

期刊介绍： Acta Psychiatrica Scandinavica acts as an international forum for the dissemination of information advancing the science and practice of psychiatry. In particular we focus on communicating frontline research to clinical psychiatrists and psychiatric researchers. Acta Psychiatrica Scandinavica has traditionally been and remains a journal focusing predominantly on clinical psychiatry, but translational psychiatry is a topic of growing importance to our readers. Therefore, the journal welcomes submission of manuscripts based on both clinical- and more translational (e.g. preclinical and epidemiological) research. When preparing manuscripts based on translational studies for submission to Acta Psychiatrica Scandinavica, the authors should place emphasis on the clinical significance of the research question and the findings. Manuscripts based solely on preclinical research (e.g. animal models) are normally not considered for publication in the Journal.