关于在常规临床实践中使用锂治疗双相情感障碍的事实和误解:一份专家共识文件。

IF 3.6 3区 医学 Q1 PSYCHIATRY Annals of General Psychiatry Pub Date : 2023-12-06 DOI:10.1186/s12991-023-00481-y
Andrea Fiorillo, Gaia Sampogna, Umberto Albert, Giuseppe Maina, Giulio Perugi, Maurizio Pompili, Gianluca Rosso, Gabriele Sani, Alfonso Tortorella
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引用次数: 0

摘要

背景:双相情感障碍是最沉重的严重精神障碍之一,其特点是高水平的个人和社会残疾。患者通常需要综合药理学和非药理学方法。锂离子不仅在精神病学,而且在整个医学领域都是最有效的治疗方法之一,其临床疗效优于其他情绪稳定剂。然而,在过去的20年里,世界范围内的锂处方呈下降趋势,这支持了锂是一种“被遗忘的药物”的观点,并强调了大多数双相情感障碍患者错过了最好的药物选择。基于这些前提,对与锂治疗相关的最常见的“误解”和“刻板印象”进行了叙述性回顾;我们还提供了在普通临床实践中使用锂的“好理由”清单,以克服这些错误的神话。正文:对现有文献进行了叙述性搜索,输入以下关键词:“双相情感障碍”,“锂”,“神话”,“神话”,“药物治疗”和“误解”。对最常见的错误观念进行了批判性的修正,并提出了以下观点:(1)锂应该是治疗双相情感障碍患者的首选;(2)锂离子治疗对双相情感障碍不同患者群体均有效;(3)锂治疗过程中药物相互作用风险易于管理;(4)锂处理的优化管理包括定期实验室检测;(5)缓释锂制剂相对于速释锂制剂具有优势;(6)锂治疗具有抗自杀特性;(7)怀孕期间要小心使用锂。结论:近年来,在双相情感障碍患者中使用锂治疗的循证建议与临床实践之间的差异已被强调。现在是时候传播关于锂治疗双相情感障碍患者的临床疗效、有效性、耐受性和易用性的明确和公正的信息了。有必要重振临床和学术对锂疗效的讨论,以抵消整个医学中最有效的药物之一的处方减少趋势。
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Facts and myths about the use of lithium for bipolar disorder in routine clinical practice: an expert consensus paper.

Background: Bipolar disorder is one of the most burdensome severe mental disorders, characterized by high levels of personal and social disability. Patients often need an integrated pharmacological and non-pharmacological approach. Lithium is one of the most effective treatments available not only in psychiatry, but in the whole medicine, and its clinical efficacy is superior to that of other mood stabilizers. However, a declining trend on lithium prescriptions has been observed worldwide in the last 20 years, supporting the notion that lithium is a 'forgotten drug' and highlighting that the majority of patients with bipolar disorder are missing out the best available pharmacological option. Based on such premises, a narrative review has been carried out on the most common "misconceptions" and "stereotypes" associated with lithium treatment; we also provide a list of "good reasons" for using lithium in ordinary clinical practice to overcome those false myths.

Main text: A narrative search of the available literature has been performed entering the following keywords: "bipolar disorder", "lithium", "myth", "mythology", "pharmacological treatment", and "misunderstanding". The most common false myths have been critically revised and the following statements have been proposed: (1) Lithium should represent the first choice for the treatment of patients with bipolar disorder; (2) lithium treatment is effective in different patients' groups suffering from bipolar disorder; (3) Drug-drug interaction risk can be easily managed during lithium treatment; (4) The optimal management of lithium treatment includes periodical laboratory tests; (5) Slow-release lithium formulation has advantages compared to immediate release formulation; (6) Lithium treatment has antisuicidal properties; (7) Lithium can be carefully managed during pregnancy.

Conclusions: In recent years, a discrepancy between evidence-based recommendations and clinical practice in using lithium treatment for patients with bipolar disorder has been highlighted. It is time to disseminate clear and unbiased information on the clinical efficacy, effectiveness, tolerability and easiness to use of lithium treatment in patients with bipolar disorder. It is necessary to reinvigorate the clinical and academic discussion about the efficacy of lithium, to counteract the decreasing prescription trend of one of the most effective drugs available in the whole medicine.

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来源期刊
CiteScore
6.60
自引率
2.70%
发文量
43
审稿时长
>12 weeks
期刊介绍: Annals of General Psychiatry considers manuscripts on all aspects of psychiatry, including neuroscience and psychological medicine. Both basic and clinical neuroscience contributions are encouraged. Annals of General Psychiatry emphasizes a biopsychosocial approach to illness and health and strongly supports and follows the principles of evidence-based medicine. As an open access journal, Annals of General Psychiatry facilitates the worldwide distribution of high quality psychiatry and mental health research. The journal considers submissions on a wide range of topics including, but not limited to, psychopharmacology, forensic psychiatry, psychotic disorders, psychiatric genetics, and mood and anxiety disorders.
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