Bipolar Disorders最新文献_第7页

The Impact of Childhood Maltreatment on Central Pain Processing in Individuals With Psychosis 儿童虐待对精神病患者中枢性疼痛加工的影响。

IF 5 2区医学 Q1 CLINICAL NEUROLOGY

Bipolar Disorders

Pub Date : 2025-02-21 DOI: 10.1111/bdi.70013

Mariesa Cay, Raquel van Gool, Camryn Berry, Emma Golden, Amanda Cao, Hanne van der Heijden, Anthony Westbrook, Joseph Gonzalez-Heydrich, Ann K. Shinn, Jaymin Upadhyay

Introduction

Exposure to childhood maltreatment can contribute to multiple behavioral and clinical manifestations, including the development of psychotic illnesses and pain-related abnormalities. Aberrant pain perception in individuals with psychosis may be associated with the worsening psychiatric symptoms, including an increase in mood episodes and a higher risk for suicidality. Despite the multiple connections between psychosis, pain, and childhood maltreatment, the combined investigation of these three domains remains limited.

Methods

In this study, patients with schizophrenia (SZ, n = 20) or bipolar I disorder (BD, n = 24) and healthy controls (HC, n = 24) underwent a comprehensive clinical evaluation followed by quantitative sensory testing (QST), where behavioral sensitivity to thermal stimuli was quantified. Central pain circuitry was probed using a combination of functional and structural magnetic resonance imaging. Neuroimaging analyses focused on thermal stimulation fMRI responses, resting-state connectivity, and gray matter morphological properties.

Results

fMRI demonstrated diminished sensorimotor activation during an evoked pain state for both SZ and BD patients, where reduced activity in thalamic subdivisions (i.e., pulvinar nucleus) in BD patients negatively correlates with the severity of childhood maltreatment. Resting-state connectivity analyses revealed altered connectivity of various cortical regions with the postcentral gyri and thalamic nuclei, suggesting potential altered neural mechanisms underlying pain perception in patients with SZ and BD. Morphological analysis identified reduced gray matter thickness in the postcentral sulcus of BD patients, which correlated with the severity of childhood maltreatment.

Conclusion

These findings provide insight into the multidimensional nature of clinical presentations in SZ and BD and contribute to our understanding of the complex relationship between childhood maltreatment and central pain processing in patients with psychotic illnesses.

童年遭受虐待会导致多种行为和临床表现，包括精神疾病和疼痛相关异常的发展。精神病患者的异常痛觉可能与精神症状的恶化有关，包括情绪发作的增加和更高的自杀风险。尽管精神病、疼痛和儿童虐待之间存在多种联系，但对这三个领域的综合调查仍然有限。方法：在本研究中，精神分裂症（SZ, n = 20）或双相I型障碍（BD, n = 24）患者和健康对照（HC, n = 24）进行了全面的临床评估，然后进行了定量感觉测试（QST），其中量化了对热刺激的行为敏感性。使用功能和结构磁共振成像相结合的方法探测中枢疼痛电路。神经成像分析主要集中在热刺激fMRI反应、静息状态连通性和灰质形态特征。结果：fMRI显示SZ和BD患者在诱发疼痛状态时感觉运动激活减少，其中BD患者丘脑分支（即枕核）活动减少与儿童虐待的严重程度呈负相关。静息状态连通性分析显示，不同皮质区域与中枢后回核和丘脑核的连通性发生了改变，这表明SZ和BD患者疼痛感知的神经机制可能发生了改变。形态学分析发现，BD患者的中枢后沟灰质厚度减少，这与儿童虐待的严重程度有关。结论：这些发现揭示了SZ和BD临床表现的多维性，并有助于我们理解儿童虐待与精神病患者中枢性疼痛加工之间的复杂关系。

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引用次数: 0

Lateral Ventricular Enlargement and Asymmetry and Myelin Content Imbalance in Individuals With Bipolar and Depressive Disorders: Clinical and Research Implications 双相情感障碍和抑郁症患者侧脑室增大、不对称和髓磷脂含量失衡：临床和研究意义。

IF 5 2区医学 Q1 CLINICAL NEUROLOGY

Bipolar Disorders

Pub Date : 2025-02-21 DOI: 10.1111/bdi.70012

Anna Manelis, Hang Hu, Rachel Miceli, Skye Satz, Rachel Lau, Satish Iyengar, Holly A. Swartz

Background

The link between ventricular enlargement and asymmetry with other indices of brain structure remains underexplored in individuals with bipolar (BD) and depressive (DD) disorders. Our study compared the lateral ventricular size, ventricular asymmetry, and cortical myelin content in individuals with BD versus those with DD versus healthy controls (HC).

Methods

We obtained T1w and T2w images from 149 individuals (age = 27.7 (SD = 6.1) years, 78% female, BD = 38, DD = 57, HC = 54) using Magnetic Resonance Imaging (MRI). The BD group consisted of individuals with BD Type I (n = 11) and BD Type II (n = 27), while the DD group consisted of individuals with major depressive disorder (MDD, n = 38) and persistent depressive disorder (PDD, n = 19) Cortical myelin content was calculated using the T1w/T2w ratio. Elastic net regularized regression identified brain regions whose myelin content was associated with ventricular size and asymmetry. A post hoc linear regression examined how participants' diagnosis, illness duration, and current level of depression moderated the relationship between the size and asymmetry of the lateral ventricles and levels of cortical myelin in the selected brain regions.

Results

Individuals with BD and DD had larger lateral ventricles than HC. Larger ventricles and lower asymmetry were observed in individuals with BD who had longer lifetime illness duration and more severe current depressive symptoms. A greater left asymmetry was observed in participants with DD than in those with BD (p < 0.01). Elastic net revealed that both ventricular enlargement and asymmetry were associated with altered myelin content in cingulate, frontal, and sensorimotor cortices. In BD, but not in other groups, ventricular enlargement was related to altered myelin content in the right insular regions.

Conclusions

Lateral ventricular enlargement and asymmetry are linked to myelin content imbalance, thus potentially leading to emotional and cognitive dysfunction in mood disorders.

背景：在双相情感障碍（BD）和抑郁症（DD）患者中，脑室增大和不对称性与其他脑结构指标之间的联系尚不清楚。我们的研究比较了BD患者、DD患者和健康对照（HC）的侧室大小、心室不对称性和皮质髓磷脂含量。方法：对149例患者（年龄27.7 （SD = 6.1）岁，78%为女性，BD = 38, DD = 57, HC = 54）进行磁共振成像（MRI），获取T1w和T2w图像。BD组由BD I型（n = 11）和BD II型（n = 27）组成，DD组由重度抑郁症（MDD, n = 38）和持续性抑郁症（PDD, n = 19）组成，采用T1w/T2w比值计算皮质髓磷脂含量。弹性网正则化回归识别髓磷脂含量与心室大小和不对称性相关的脑区。事后线性回归检验了参与者的诊断、疾病持续时间和当前抑郁水平如何调节侧脑室的大小和不对称性与选定脑区域皮质髓鞘水平之间的关系。结果：BD和DD患者侧脑室比HC大。在终生病程较长和当前抑郁症状较严重的双相障碍患者中，观察到更大的心室和更低的不对称性。与BD患者相比，DD患者的左脑不对称性更大(p)。结论：侧脑室增大和不对称性与髓磷脂含量失衡有关，因此可能导致情绪障碍患者的情绪和认知功能障碍。

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引用次数: 0

Will We Soon See a Low Cost, Small Portable Device for the Therapeutic Monitoring of Lithium? An Implementation Science Investigation 我们会很快看到一种低成本的小型便携式锂治疗监测设备吗？实施科学调查。

IF 5 2区医学 Q1 CLINICAL NEUROLOGY

Bipolar Disorders

Pub Date : 2025-02-21 DOI: 10.1111/bdi.70009

Santiago Pedraza-Sanabria, Seetal Dodd, Angela Marianne Paredes Castro, Lana J. Williams, Luis Fernando Giraldo-Cadavid, Rosa Helena Bustos

<p>Lithium is a first-line medication for the treatment of bipolar disorder [<span>1</span>], and is included on the World Health Organization list of essential medicines [<span>2</span>]. Despite this, lithium use is declining in North America and Europe [<span>3</span>]. The need to achieve a narrow therapeutic range means that some clinicians and patients opt for other alternatives. Currently, lithium therapeutic drug monitoring (TDM) is a barrier for new patients, increases patient burden, is stigmatizing, and may contribute to treatment noncompliance. In some rural and remote locations, and outside of major urban centres in developing economies, lithium TDM may not be available and this essential medicine cannot be prescribed. Recent technological advances indicate the potential to develop a small portable device for the TDM of lithium [<span>4</span>]. Our research group is currently developing a portable device for the TDM of lithium and has conducted focus groups to understand where this device is needed and what design of device will best serve that need (Figure 1). This project bridges the gap between technological innovations and the consumer by using an implementation science framework to explore barriers and facilitators to adopting this new technology.</p><p>The Group 1 video (clinicians) was a 37-min recording, and the Group 2 video was 33 min, Group 3 was 54 min, and Group 4 was 50 min. The codes commonly mentioned were concerned with the design of the novel device, including cost, features, and what information the device would display. Codes referencing toxicity, adverse events, and being outside of the therapeutic window were also commonly mentioned.</p><p>A dissenting option was expressed by one of the participants with lived experience, who felt that the current system worked well for her and change was not required. Several participants also mentioned that they would like the device to also measure liver and thyroid function.</p><p>A small portable device for the TDM of lithium is expected to be developed in the near future and several separate research groups may be currently working on this tool. Our study has suggested some key design features that may maximize the usefulness of the device, aid in making lithium available to more patients, and make the lived experience of lithium treatment less of a burden. Firstly, everything possible should be done to minimize the cost of the device. Some participants may suggest an increased range of functions for the device, but any impact on cost for these functions may negate their benefit. For example, it is not necessary that the device should also measure liver and thyroid function, as changes in liver and thyroid health occur slowly and an annual test is sufficient, whereas blood lithium levels can change suddenly. Adding these extra functions may be an unnecessary increase in device costs, and receiving results from other variables may be confusing to patients and create more s

锂是治疗双相情感障碍[1]的一线药物，并被列入世界卫生组织基本药物清单[1]。尽管如此，北美和欧洲的锂使用量正在下降。需要达到一个狭窄的治疗范围意味着一些临床医生和患者选择其他替代方案。目前，锂治疗药物监测（TDM）对新患者来说是一个障碍，增加了患者负担，使患者感到耻辱，并可能导致治疗不依从性。在一些农村和偏远地区，以及发展中经济体主要城市中心以外的地区，可能无法获得锂TDM，也无法开出这种基本药物。最近的技术进步表明，开发一种小型便携式锂[4]TDM设备的潜力。我们的研究小组目前正在开发一种用于锂TDM的便携式设备，并进行了焦点小组讨论，以了解需要这种设备的地方，以及哪种设计的设备最能满足需求（图1）。该项目通过使用实施科学框架探索采用这项新技术的障碍和促进因素，弥合了技术创新与消费者之间的差距。第1组（临床医生）录像37 min，第2组录像33 min，第3组录像54 min，第4组录像50 min。通常提到的代码与新设备的设计有关，包括成本、功能和设备将显示的信息。涉及毒性、不良事件和治疗窗口外的代码也经常被提及。一位有实际经验的与会者表示反对，她认为目前的制度对她来说很好，不需要改变。几位参与者还提到，他们希望该设备也能测量肝脏和甲状腺功能。一种用于锂TDM的小型便携式设备有望在不久的将来被开发出来，几个独立的研究小组目前可能正在研究这种工具。我们的研究提出了一些关键的设计特征，可以最大限度地提高设备的实用性，帮助更多的患者获得锂，并使锂治疗的生活体验减轻负担。首先，应该尽一切可能将设备的成本降至最低。一些参与者可能会建议增加设备的功能范围，但对这些功能的成本的任何影响可能会抵消它们的好处。例如，该设备没有必要同时测量肝脏和甲状腺功能，因为肝脏和甲状腺健康的变化是缓慢的，每年检查一次就足够了，而血液中的锂含量可能会突然变化。增加这些额外的功能可能会不必要地增加设备成本，并且从其他变量接收结果可能会使患者感到困惑，并且由于不知道如何处理这些数据而产生更多的压力。另一个设计挑战是，小型设备需要满足或超过锂TDM程序在认可实验室中建立的准确性、特异性和灵敏度的规格，这是一个具有挑战性的基准。从临床医生的角度来看，护理点设备的其他优点是，当发现亚治疗水平时，有机会与患者讨论低依从性的原因，以及当水平达到超治疗水平时，可以立即做出决定。进一步重要的设计特点包括设备的坚固性和易用性。首选非侵入性设备或使用针刺获得血滴的设备。许多人都熟悉用于监测糖尿病患者血糖水平的小型设备，这些设备让人们期望类似的设备也能用于监测锂离子。目前正在开发一种用于锂TDM的小型设备，它将成为接受锂治疗的人的重要工具。这种设备的技术已经存在。该设备是患者和临床医生所需要的，可以改善临床护理和获得锂治疗。开发这种设备的科学家需要意识到哪些设计特征最适合我们的患者，注意避免开发具有许多功能的昂贵设备，而是专注于将最大数量的患者受益的低成本设备。该研究是根据《赫尔辛基宣言》进行的，并得到了Barwon Health人类研究伦理委员会的批准（批准号92487,2023年6月26日）。撰写本文的个人同意参与研究，并已审查并批准该手稿发表。作者声明无利益冲突。

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引用次数: 0

The Type, Impacts, and Experiences of Peer Support for People Living With Bipolar Disorder: A Scoping Review 双相情感障碍患者同伴支持的类型、影响和经验：范围综述。

IF 5 2区医学 Q1 CLINICAL NEUROLOGY

Bipolar Disorders

Pub Date : 2025-02-19 DOI: 10.1111/bdi.70006

Emma Morton, Elsy Willis, Jeff Brozena, Andrew Kcomt, Erin E. Michalak

Background

Internationally, mental health policy has highlighted the exchange of peer support between people with lived experience as a key component of recovery-oriented care. There is some evidence to support the benefits of peer support in mixed-diagnosis groups, major depressive disorder, and schizophrenia. However, no reviews have specifically described the types and impacts of peer support interventions for bipolar disorder (BD).

Methods and Analysis

A scoping review was conducted to explore the type, outcomes, and experience of peer support interventions in BD. Databases searched were MEDLINE, EMBASE, and PsycINFO, using terms related to peer support and BD. Extracted data included study design, participant demographics, intervention characteristics, and qualitative or quantitative data on outcomes and experiences.

Results

Thirty studies met eligibility criteria and were included in the review. A diverse array of interventions incorporating peer support were evaluated, including unstructured face-to-face group programs, peer-facilitated psychoeducation, and web-based psychoeducation with accompanying peer support. Quantitative studies largely assessed clinical outcomes, with some attention to functioning and quality of life. Qualitative data included observations of interaction patterns and subjective experiences of programs.

Discussion

Given this heterogeneous literature, the effects of peer support in BD cannot be firmly concluded. However, qualitative research and rates of engagement with peer support programs are suggestive of subjective appeal. Priorities for future research include comparative studies to parse out the effects of different types of peer support, routine reporting of the characteristics of peer support programs, assessment of recovery-oriented outcomes, and partnership with community organizations to optimize trial designs.

背景：在国际上，精神卫生政策强调有生活经验的人之间的同伴支持交流是面向康复的护理的关键组成部分。有一些证据支持同伴支持在混合诊断组、重度抑郁症和精神分裂症中的益处。然而，没有评论专门描述双相情感障碍（BD）同伴支持干预的类型和影响。方法和分析：对双相障碍同伴支持干预的类型、结果和经验进行了范围审查。检索数据库为MEDLINE、EMBASE和PsycINFO，使用与同伴支持和双相障碍相关的术语。提取的数据包括研究设计、参与者人口统计、干预特征以及结果和经验的定性或定量数据。结果：30项研究符合入选标准，纳入本综述。包括同伴支持的多种干预措施进行了评估，包括非结构化的面对面小组计划，同伴促进心理教育，以及伴随同伴支持的基于网络的心理教育。定量研究主要评估临床结果，并关注功能和生活质量。定性数据包括对互动模式的观察和对节目的主观体验。讨论：鉴于这些异质性的文献，同伴支持对双相障碍的影响还不能得到确切的结论。然而，定性研究和参与同伴支持计划的比率暗示了主观吸引力。未来研究的重点包括比较研究以分析不同类型同伴支持的效果，定期报告同伴支持项目的特征，评估以恢复为导向的结果，以及与社区组织合作以优化试验设计。

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引用次数: 0

Targeting the Training and Educational Priorities of Bipolar Disorder-Focused Early and Mid-Career Researchers and Clinicians 针对双相情感障碍的早期和中期职业研究人员和临床医生的培训和教育重点。

IF 5 2区医学 Q1 CLINICAL NEUROLOGY

Bipolar Disorders

Pub Date : 2025-02-19 DOI: 10.1111/bdi.70008

Norma Verdolini, Rebekah S. Huber, Emma Morton, Tamsyn Van Rheenen, Gabriel Fries, Olivia Dean, Fabiano Gomes, Rachel Mitchell, Georgina M. Hosang, Katie M. Douglas

引用次数: 0

Olanzapine-Induced Black Hairy Tongue: A Case Report 奥氮平致黑毛舌1例报告。

IF 5 2区医学 Q1 CLINICAL NEUROLOGY

Bipolar Disorders

Pub Date : 2025-02-19 DOI: 10.1111/bdi.70015

Muhammed Fatih Tabara, Beyza Vatan, Mehmet Gurkan Gurok, Murad Atmaca

引用次数: 0

Research on Youth With and at Risk for Bipolar Disorder: A 5-Year Update 青少年双相情感障碍风险研究：5年最新进展

IF 5 2区医学 Q1 CLINICAL NEUROLOGY

Bipolar Disorders

Pub Date : 2025-02-14 DOI: 10.1111/bdi.70003

Mikaela K. Dimick, Xinyue Jiang, Katrin Kutlucinar, Kathryn Burrows, Benjamin I. Goldstein

引用次数: 0

Long-Acting Injectables: A Strategy to Mitigate Nonadherence in Bipolar Disorder 长效注射剂：减轻双相情感障碍患者依从性的策略。

IF 5 2区医学 Q1 CLINICAL NEUROLOGY

Bipolar Disorders

Pub Date : 2025-02-14 DOI: 10.1111/bdi.70005

Justin Faden, Elina Maymind

Despite our best efforts, partial or nonadherence to treatment is common in bipolar disorder. Varying definitions of nonadherence make a clear prevalence difficult to determine, but a recent nationwide bipolar disorder cohort study identified rates of nonadherence to treatment to be as high as 60%, with a mean prevalence of 40% [1]. The study included > 33,000 individuals with bipolar disorder, and approximately 60% were nonadherent at least once during the monitoring period. This begs the question, why? Nonadherence to pharmacologic treatment is not unique to bipolar disorder, but rates are notoriously high in mental health conditions. Reasons are multifactorial but include the number of comorbidities, young age, co-occurring substance use disorders, limited primary support system, psychotic symptoms, intensity of manic symptoms, and limited insight, amongst others [1, 2].

The consequence of nonadherence to treatment, especially in early disease bipolar disorder, can be dire. Manic exacerbations have been shown to result in brain damage, functional and cognitive impairment, and worse outcomes [3, 4]. Additionally, potentially due to increased impulsivity, bipolar disorder is strongly associated with increased loss of life due to suicide. The best way to prevent these exacerbations and deleterious outcomes is by maintaining adherence to efficacious treatment, thereby preserving brain function and quality of life.

In a recent article published in bipolar disorders, Vieta and colleagues expound on the landscape of long-acting injectable (LAI) antipsychotics for the treatment of bipolar disorder and provide expert consensus recommendations [4]. Key findings include moving past the preconceived notion that LAIs can be used only for bipolar disorder patients with severe disease, and utilizing LAIs as early as possible in the bipolar disease course, ideally during the first manic episode [4]. Historically, LAIs have been reserved for patients with chronic nonadherence to treatment and schizophrenia. However, robust evidence supports that LAIs can enhance fidelity to treatment, reduce psychotic and manic exacerbations, and reduce the risk of rehospitalization when compared to oral antipsychotics [4].

Bipolar 1 disorder can be difficult to treat, and individuals will often require multiple medications. However, polypharmacy has also been shown to reduce adherence [1]. LAIs can lower this burden by limiting the number of daily medications, providing consistent medication serum levels, and eliminating the guesswork about treatment adherence status. Using an LAI as the core treatment allows for rational polypharmacy and the utilization of other medications, such as lithium, in a synergistic manner. However, individuals are often not given the option of an LAI due to lack of healthcare provider awareness.

In recent years, there has been a

尽管我们尽了最大的努力，但部分或不坚持治疗在双相情感障碍中很常见。对不依从的不同定义使得难以确定明确的患病率，但最近一项全国性双相情感障碍队列研究确定治疗不依从率高达60%，平均患病率为40%。该研究包括33,000名双相情感障碍患者，大约60%的患者在监测期间至少有一次不坚持服药。这就引出了一个问题，为什么？不坚持药物治疗并不是双相情感障碍所独有的，但在精神健康状况中，不坚持药物治疗的比率是出了名的高。原因是多因素的，但包括合并症的数量、年龄小、同时发生的物质使用障碍、有限的初级支持系统、精神病症状、躁狂症状的强度和有限的洞察力等[1,2]。不坚持治疗的后果，特别是在早期双相情感障碍中，可能是可怕的。躁狂加重已被证明会导致脑损伤、功能和认知障碍，以及更糟糕的结果[3,4]。此外，可能由于冲动增加，双相情感障碍与自杀造成的生命损失增加密切相关。预防这些恶化和有害结果的最佳方法是坚持有效治疗，从而保持脑功能和生活质量。在最近发表在《双相情感障碍》杂志上的一篇文章中，Vieta和他的同事详细阐述了治疗双相情感障碍的长效注射（LAI）抗精神病药物的前景，并提供了专家一致的建议。主要发现包括：改变了先前的观念，即LAIs只能用于双相情感障碍的严重疾病患者，并在双相情感障碍病程中尽早使用LAIs，最好是在第一次躁狂发作时使用。历史上，LAIs一直保留给慢性不坚持治疗和精神分裂症的患者。然而，强有力的证据支持，与口服抗精神病药物相比，LAIs可以提高治疗的保真度，减少精神病和躁狂加重，并降低再住院的风险。双相情感障碍很难治疗，患者通常需要多种药物治疗。然而，多种药物也被证明会降低依从性。LAIs可以通过限制每日用药数量、提供一致的血清药物水平和消除对治疗依从性状况的猜测来减轻这一负担。将LAI作为核心治疗方法，可以实现合理的多药治疗，并以协同方式利用其他药物，如锂。然而，由于缺乏医疗保健提供者的意识，个人通常不会选择LAI。近年来，LAI抗精神病药物的可获得性发生了范式转变，一些新配方已推向市场，另一些已进入临床开发阶段。这些新配方有不同的“护理设施”，允许患者和提供者进行个性化治疗。可考虑的选择包括：给药方法（肌肉注射还是皮下注射）、注射间隔（从2周到6个月不等）、注射部位、起始剂量、口服抗精神病药物补充持续时间、针头大小、注射量、预充注射器、剂量强度和批准的适应症等[5,6]。患者是否会接受LAI取决于选择的沟通方式，LAI不应被视为惩罚性治疗bb0。如果考虑双相情感障碍的抗精神病药物，应在最初的治疗讨论中提供LAIs，使其在双相情感障碍早期管理中的使用正常化。此外，在双相情感障碍病程的早期讨论LAIs可以减少耻辱感和它只能作为“最后手段”使用的观念。作为共同决策的一部分，最初的谈话应该讨论LAIs的潜在好处和缺点以及患者的治疗目标是什么。此外，提供者应该花时间审查可用LAI配方的不断扩大的列表。从耐受性到给药频率，确定个体对药物最看重的是什么，可以增强治疗的协作性，加强治疗联盟，并优化护理。如果选择LAI抗精神病药，应充分讨论各种护理便利。然而，远程医疗服务也存在实际限制和障碍，例如报销障碍和COVID-19带来的远程医疗影响。由于一些lai是新的，保险公司可能不愿意授权覆盖，如果一个人没有保险，确定适用的病人援助计划将是必要的。此外，随着远程医疗的兴起，医疗保健提供者往往是虚拟地看他们的病人，这使得管理LAI在后勤上具有挑战性。了解社区资源，例如能够提供注射药物的药店和诊所，将是必要的。双相情感障碍患者对治疗的不依从性很高。LAIs是一种未充分利用的药理学选择，有证据支持其疗效和在维持治疗忠实度方面的作用。随着它们的使用和研究的增加，它们可能会被纳入治疗指南。Justin Faden：资助支持- BioXcel Therapeutics。顾问- Bristol Myers Squibb， nov。艾琳娜·梅梅德声明没有利益冲突。

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引用次数: 0

Pharmacotherapy in Comorbid Bipolar Disorder and Post-Traumatic Stress Disorder From the STEP-BD Cohort STEP-BD队列中共病双相情感障碍和创伤后应激障碍的药物治疗。

IF 5 2区医学 Q1 CLINICAL NEUROLOGY

Bipolar Disorders

Pub Date : 2025-02-14 DOI: 10.1111/bdi.70002

Samantha E. Russell, Anna L. Wrobel, David R. Skvarc, Mojtaba Lotfaliany, Olivia M. Dean, Melanie M. Ashton, Pedro V. S. Magalhães, Andrew Nierenberg, Michael Berk, Alyna Turner

Introduction

Post-traumatic stress disorder (PTSD) is more prevalent in those with bipolar disorder (BD) than in the general population, with rates of PTSD as high as 55% in some BD cohorts. Despite this, little research explores the effects of pharmacotherapy treatments in those with comorbid BD and PTSD. This study aims to explore patterns of pharmacotherapy use at baseline and their impact on symptoms in individuals with BD alone and comorbid BD and PTSD.

Methods

The Systematic Treatment Enhancement Program for BD (STEP-BD) cohort was utilised to examine and compare BD symptoms and pharmacotherapy treatments between those with BD alone (n = 3393) and those with comorbid BD and PTSD (n = 304). We conducted regression models to compare those with and without comorbid PTSD. Models included measures of depression, mania, functioning and quality of life over 24 months of the STEP-BD study. We included baseline pharmacotherapies (lithium, valproate, antidepressants, antipsychotics and benzodiazepines) as predictor outcome variables in all models.

Results

At baseline, reported use of lithium was lower in the comorbid BD and PTSD group, while the use of antidepressants, antipsychotics and benzodiazepines was significantly higher in the comorbid BD and PTSD than in the BD alone group. Benzodiazepine use was associated with a small improvement in depression symptom scores and poorer quality of life in those with comorbid BD and PTSD. Lastly, those with comorbid PTSD experienced higher levels of mania and depression symptoms and lower functioning and quality of life compared to BD alone, irrespective of pharmacotherapy treatment.

Conclusion

Clinical trial participants with BD and PTSD reported worse symptoms and outcomes across 24 months of the STEP-BD study compared to those without comorbid PTSD, regardless of baseline medication use. These results highlight the importance of considering comorbidity in the treatment of mental health conditions, specifically BD, and the need for further exploration of effective treatment options.

简介：创伤后应激障碍（PTSD）在双相情感障碍（BD）患者中比在一般人群中更为普遍，在一些双相情感障碍队列中PTSD的发病率高达55%。尽管如此，很少有研究探讨药物治疗对双相障碍和创伤后应激障碍患者的影响。本研究旨在探讨基线时药物治疗的使用模式及其对双相障碍和双相障碍合并PTSD患者症状的影响。方法：采用双相障碍系统治疗增强计划（STEP-BD）队列研究，比较单独双相障碍患者（n = 3393）和双相障碍合并PTSD患者（n = 304）的双相障碍症状和药物治疗效果。我们采用回归模型来比较合并和不合并PTSD的患者。模型包括在STEP-BD研究中超过24个月的抑郁、躁狂、功能和生活质量的测量。我们将基线药物治疗（锂、丙戊酸盐、抗抑郁药、抗精神病药和苯二氮卓类药物）作为所有模型的预测结果变量。结果：基线时，报告的双相障碍和PTSD合并症组锂的使用较低，而双相障碍和PTSD合并症组抗抑郁药、抗精神病药和苯二氮卓类药物的使用明显高于单独双相障碍组。苯二氮卓类药物的使用与双相障碍和创伤后应激障碍共病患者抑郁症状评分的小幅改善和较差的生活质量有关。最后，与单独的双相障碍相比，合并PTSD的患者经历了更高水平的躁狂和抑郁症状，以及更低的功能和生活质量，无论药物治疗如何。结论：在24个月的STEP-BD研究中，与没有合并PTSD的患者相比，双相障碍和PTSD的临床试验参与者报告的症状和结果更差，无论基线药物使用情况如何。这些结果强调了在治疗精神健康状况，特别是双相障碍时考虑合并症的重要性，以及进一步探索有效治疗方案的必要性。

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引用次数: 0

Workshopping Depression to Effect Better Recognition 工作时的沮丧会产生更好的认知。

IF 5 2区医学 Q1 CLINICAL NEUROLOGY

Bipolar Disorders

Pub Date : 2025-02-13 DOI: 10.1111/bdi.70004

Gracie Meng-Cin Tsai, Ching-Wen Hung, Erica Bell, Gin Malhi, Chia-Yi Wu

引用次数: 0