Clinical correlates associated with the long-term response of bipolar disorder patients to lithium, valproate or lamotrigine: A retrospective study


Autoři: Young Sup Woo aff001;  Bo-Hyun Yoon aff002;  Jye-Heon Song aff002;  Jeong Seok Seo aff003;  Beomwoo Nam aff003;  Kwanghun Lee aff004;  Jonghun Lee aff005;  Young-Eun Jung aff006;  Moon-Doo Kim aff006;  Jung Goo Lee aff007;  Sheng-Min Wang aff001;  Young-Joon Kwon aff009;  Won-Myong Bahk aff001
Působiště autorů: Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea aff001;  Department of Psychiatry, Naju National Hospital, Naju, Republic of Korea aff002;  Department of Psychiatry, School of Medicine, Konkuk University, Chungju, Republic of Korea aff003;  Department of Psychiatry, College of Medicine, Dongguk University, Gyeongju, Republic of Korea aff004;  Department of Psychiatry, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea aff005;  Department of Psychiatry, School of Medicine, Jeju National University, Jeju, Republic of Korea aff006;  Department of Psychiatry, Haeundae Paik Hospital, Paik Institute for Clinical Research, College of Medicine, Inje University, Busan, Republic of Korea aff007;  Department of Health Science and Technology, Graduate School of Inje University, Busan, Republic of Korea aff008;  Department of Psychiatry, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea aff009
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
prolekare.web.journal.doi_sk: 10.1371/journal.pone.0227217

Souhrn

Background

Although mood stabilizers such as lithium (LIT), valproate (VAL), and lamotrigine (LMT) appear to be efficacious treatments for bipolar disorder (BD) in research settings, the long-term response to these mood stabilizers in clinical practice is highly variable among individuals. Thus, the present study examined the characteristics associated with good or insufficient responses to long-term treatment with LIT, VAL, or LMT for BD.

Methods

This study retrospectively analyzed the medical records of patients who visited an outpatient clinic with a diagnosis of BD I or II. Data from patients who were treated with one of three mood stabilizing medications (LIT, VAL, or LMT) for more than 6 months were selected, and the long-term treatment responses were evaluated using the Alda scale. For the purposes of this study, two response categories were formed: insufficient response (ISR), including non-response or poor response (Alda total score ≤ 6), and good response (GR; Alda total score ≥ 7).

Results

Of the 645 patients included in the present study, 172 were prescribed LIT, 320 were prescribed VAL, and 153 were prescribed LMT for at least 6 months. A binary logistic regression analysis revealed that a diagnosis of BD II (odds ratio [OR], 8.868; 95% confidence interval [CI], 1.123–70.046; p = 0.038), comorbid alcohol/substance use disorder (OR, 4.238; 95% CI, 1.154–15.566; p = 0.030), and a history of mixed episodes (OR, 4.363; 95% CI, 1.191–15.985; p = 0.026) were significant predictors of LIT-ISR. Additionally, a depressive-predominant polarity significantly predicted LMT-GR (OR, 8.586; 95% CI, 2.767–26.644; p < 0.001).

Conclusion

The present findings demonstrated that patients with a diagnosis of BD II, a comorbid alcohol/substance problem, or a history of mixed episodes were not likely to respond to LIT treatment. Additionally, LMT might be a better treatment choice for patients with a depressive-predominant polarity.

Klíčová slova:

Antidepressants – Antipsychotics – Bipolar disorder – Cognitive impairment – Depression – Drug metabolism – Drug therapy – Lithium


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