心境稳定剂在治疗双相情感障碍抑郁发作中的临床疗效研究

目的探讨心境稳定剂在治疗双相情感障碍抑郁发作中的临床疗效。方法采用回顾性分析的方法对我院2015年1月至2016年9月于我院收治的100例双相情感障碍抑郁发作的患者的病历资料进行分析。随机分为两组:实验组和对照组,每组患者50例。实验组双相情感障碍抑郁发作的患者采用心境稳定剂联合抗抑郁药物治疗的方法进行治疗,而对照组双相情感障碍抑郁发作的患者则采用单用抗抑郁药物治疗的方法进行治疗。两组患者在治疗前后采用汉密尔顿抑郁量表及汉密尔顿焦虑量表进行评定给分。结果对照组双相情感障碍抑郁发作的患者在治疗后的总有效率为68%,实验组患者在治疗后的总有效率远高于对照组为92%,两组间比较(P<0.05),差异具有统计学意义。结论在临床中双相情感障碍抑郁发作的患者采用心境稳定剂联合抗抑郁药物进行治疗后,患者的临床症状有了很明显的改善,该方法值得临床推广和使用。     

心境稳定剂在治疗儿童精神障碍中的应用

心境稳定剂在儿童和青少年心理和行为障碍治疗中的应用广泛,适用于治疗双相情感障碍、破坏性行为障碍和注意力缺陷-多动障碍等行为障碍患者出现的冲动和攻击行为以及情绪不稳定和易激惹等表现,同时对发育迟缓儿童如精神发育迟滞和孤独症等患者出现的伤害他人或自伤行为治疗也有效果。在经典的心境稳定剂中,锂盐是唯一获准可一线用于儿童和青少年双相情感障碍患者躁狂发作和维持治疗的药物,而丙戊酸盐、卡马西平、奥卡西平和拉莫三嗪在治疗儿童攻击性或破坏性行为中也有一定的临床应用。选用心境稳定剂治疗儿童精神障碍时应考虑药物的疗效证据、安全性和不良反应以及患者的靶症状、疾病史、用药史和家族史等,以确保儿童用药安全、有效。     

齐拉西酮联合心境稳定剂治疗双相障碍躁狂发作和混合发作

目的：研究和探讨齐拉西酮合并碳酸锂或丙戊酸钠治疗躁狂发作和混合发作的疗效和安全性。方法：对符合CCMD-3躁狂发作和混合发作诊断标准的68例研究对象随机分成两组,试验组应用齐拉西酮合并碳酸锂或丙戊酸钠,对照组单一使用碳酸锂或丙戊酸钠,治疗观察6周。采用杨氏躁狂量表（YMRS）评定疗效,以副反应量表（TESS）及实验室有关辅助检查评价安全性。 结果：两组在治疗前后症状均有显著降低（F＝9.05,P＜0.01;F＝6.10,P＜0.01）。齐拉西酮组在治疗第1周末的减分率比对照组显著,这种差异在1~6周持续存在,而且第6周结束后的临床痊愈率也显著高于对照组。研究组1周末、治疗2周末、治疗4周末、治疗6周末YMRS分别是21.4±8.4,14.6±5.5,8.9±3.3,6.5±3.4,对照组分别是23.9±7.2,20.9±8.1,17.8±7.8,12.8±8.9,组间差异有统计学意义（P＜120.01）,试验组的相对变化分别是6.1±3.5,12.9±4.8,20.1±5.3,21.4±5.5,对照组分别是2.1±3.0,6.8±4.5,11.5±5.6,14.4±5.3,组间比较差异有统计学意义（P＜0.01）。两组间有效率差异有统计学差异（68.5%,48.5%, X2=4.47,P＜0.05）。两组间痊愈率也有统计学意义（54.3%, 18.2%, X2=9.52,P＜0.01）。但是两组间均没有严重的药物副作用,因无疗效和副作用导致的脱落率两组差异无显著性。结论：齐拉西酮合并碳酸锂或丙戊酸钠治疗躁狂发作和混合发作双相障碍的疗效比较理想,比单一使用心境稳定剂更好。     

心境稳定剂临床应用中常见不良反应

心境稳定剂 (ｍｏｏｄｓｔａｂｉｌｉｚｅｒｓ) ,有时也被译为心境 (情感、情绪 )调整剂 ,或称情感稳定性药物 (ｍｏｏｄ/ａｆｆｅｃｔｉｖｅｓｔａｂｉｌｉｚｉｎｇｄｒｕｇｓ/ａｇｅｎｔｓ)。心境稳定剂原称“抗躁狂药”(ａｎｔｉｍａｎｉｃｄｒｕｇｓ) ,近年来的“改名”突出了此类药物对双相情感障碍躁狂及抑郁症状均有效 ,而不仅仅是抗躁狂作用。本文就心境稳定剂临床应用中常见的不良反应作简要综述。1　种类一般认为 ,某种药物只需具备对躁狂及抑郁双相均有治疗 /预防作用即可归入此类。此类药物中 ,锂盐和卡马西平不良反应较多 ;新…     

丙戊酸盐治疗双相情感障碍的研究进展

作为心境稳定剂,丙戊酸盐治疗各型双相情感障碍均有一定的疗效。近年来对各型双相情感障碍患者进行的临床研究证实：丙戊酸盐能改善躁狂症状;联合镇静药物治疗可有效改善抑郁症状;联合抗抑郁药物预防抑郁发作的疗效优于锂盐。丙戊酸盐与其他心境稳定剂联合治疗快速循环型双相情感障碍患者时可能更有益,也更适用于非快速循环型双相情感障碍患者的长程治疗。     

内质网应激在三种常见精神疾病中的研究进展

精神疾病常常表现为慢性病程,具有反复发作、慢性迁延及致残的特点,是严重影响人类健康的疾病之一.近年来精神疾病的患病率逐年升高,给社会带来了严重的疾病负担.但是,目前大部分精神疾病的发病机制尚未完全阐明.不断增加的研究证据表明,内质网应激(ERS)与精神疾病的发生发展有着密切联系,这些疾病以精神分裂症、双相障碍及抑郁障碍这三种常见精神疾病为代表.同时,研究也发现一些相关药物可能通过靶向ERS而发挥作用,提示ERS可能是精神疾病的潜在作用靶点.因此,未来深入探讨ERS在精神疾病中的具体作用机制,可为精神疾病的治疗提供新的思路.     

诱导多能干细胞技术在精神疾病中的应用

精神疾病是一类遗传变异多样、临床症状多变的复杂脑疾病,给患者家庭和社会造成了沉重的负担。目前,人脑的复杂性和现有研究模型系统的局限性使得精神疾病病因的探索和有效治疗方法的研发面临着巨大挑战。近年来,诱导多能干细胞(induced pluripotent stem cells, iPSCs)技术取得了突破性进展,该技术主要通过对患者的体细胞进行重编程,诱导为iPSCs,随后将其分化为与疾病相关的细胞类型,为探究疾病的致病机制与开发有效治疗措施提供了新模型。本文主要综述了iPSCs技术在精神分裂症、双相情感障碍、孤独症、重性抑郁障碍以及物质成瘾等常见精神疾病中的应用和研究进展。     

双相情感障碍及其治疗药物--心境稳定剂

生活中常有抑郁与兴奋,七情六欲乃正常反应,但是,如若某些情绪持续存在,则为心境障碍。双相情感障碍是心境障碍的一种临床类型,旧称躁狂抑郁症．呈现躁狂和抑郁,或交替发作的临床症状。双相情感障碍的药物治疗,除要求安全有效外,还需要不致促发情感转相,并能预防反复发作。本文介绍治疗双相情感障碍的药物——心境稳定剂,并兼述其他临床治疗措施。     

心境稳定剂研究进展及合理应用

心境稳定剂（Mood Stabilizers）是几类不同药物具有相同治疗作用的统称，它包括了抗躁狂药物碳酸锂，抗抽搐药物卡马西平、丙戊酸盐和不典型抗精神病药物奥氮平、利培酮、奎硫平等。     

Mood stabilization in the treatment of bipolar disorder: focus on quetiapine

The use of at least one mood-stabilizing agent is common clinical practice in the treatment of bipolar disorder, regardless of the treatment setting or disease phase. However, a consensus definition of 'mood stabilizer' remains to be established. A mood stabilizer has been operationally described as an agent that is useful in at least one phase of bipolar disorder while not worsening any other phase of the illness. More stringent definitions have been proposed, and it can be argued that a clinically effective mood stabilizer would have efficacy in a broad range of affective, psychotic, behavioral and cognitive domains in all phases of bipolar disorder and would be well tolerated across a range of doses for sustained periods. Clinically effective mood stabilizers should treat mania and depression, while preventing recurrence and improving quality of life. Effective treatment should not precipitate mania, depression, or rapid cycling, and should minimize the burden of treatment-emergent side effects. Data from clinical studies of quetiapine are reviewed in context with the literature discussing traditional and emerging mood stabilizers. Using a liberal definition, the evidence for quetiapine qualifies it as a bimodal mood stabilizer based on its demonstrated effectiveness in the treatment of bipolar mania and depression. Further data suggest that quetiapine has promise across all phases of bipolar disorder with the potential to meet even the most stringent definitions of a mood stabilizer.     

心境稳定剂的药物相互作用

心境稳定剂在临床应用中普遍存在联合用药现象,不仅有多种心境稳定剂的合用,也有与抗精神病药、抗抑郁药的合用,还有心境稳定剂本身作为辅助用药等问题。目前广泛使用的心境稳定剂包括锂盐与抗癫痫药物,而多药联用就有可能在药物体内过程的各环节发生相互作用。本文将从药物在体内的分布、代谢与排泄等药动学过程及药效学方面来综述心境稳定剂与其他可能合用药物的相互作用,以期为临床合理选药提供参考。     

双情感稳定剂快速缓解躁狂症状的对照研究

目的探讨双情感稳定剂快速治疗躁狂症的临床效果和不良反应。方法对88例患者分别应用双情感稳定剂(丙戊酸钠和碳酸锂联合应用的联合组)与单用碳酸锂组进行对照治疗;采用Bech-Rafaelsen躁狂量表(BRMS)及治疗时副反应量表(TESS)等评定。结果联合组与治疗前相比较,在第1周BRMS评分总分及动作、言语、意念飘忽、敌意/破坏、情绪、自我评价和睡眠等因子分明显下降(P<0.01～0.05),与碳酸锂组比较有显著性差异(P<0.01～0.05);在第2周BRMS评分语言/喧闹、接触、性兴趣和工作等因子分也明显下降(P<0.01),动作、言语、意念飘忽、语言/喧闹、敌意/破坏、情绪和睡眠等因子分与碳酸锂组比较有显著性差异(P<0.01～0.05)。与治疗前比较,碳酸锂组在第2周BRMS评分总分及言语、意念飘忽等因子分明显下降(P<0.05),在第4周BRMS评分动作、语言/喧闹、敌意/破坏、情绪、自我评价、接触、睡眠、性兴趣和工作等因子分明显下降(P<0.01～0.05)。在第4周两组BRMS评分情绪和接触因子之间仍有显著性差异(P<0.01～0.05)。两组药物不良反应发生率之间比较无显著性差异(P>0.05)。结论双情感稳定剂能够快速缓解躁狂症状,且有较好的安全性。     

An update on the treatment of bipolar depression

Background: Although depression accounts for a large part of the burden associated with bipolar disorder, its drug treatment has been under-studied. Objective: To provide the best available evidence supporting the pharmacotherapy of bipolar depression. Methods: A systematic review was conducted, focusing on randomized, controlled trials (RCTs) and meta-analyses. Results/conclusions: Despite FDA approval of both the olanzapine–fluoxetine combination and quetiapine for the treatment of acute bipolar depression, independent RCTs (i.e., not trials conducted ‘under the umbrella’ of a drug company) have not found any drug to have antidepressant effects similar to those seen in unipolar depression. A practice-based suggestion, valuable for both short- and long-term treatment, might be to have a background of mood stabilizers and to add drugs, following one of several treatment options, trusting to find a drug with a degree of effectiveness by trial and error. The list of drugs that could be used would include all the current antidepressants, the olanzapine–fluoxetine combination and probably quetiapine too. Special features and situations might also influence treatment options.     

Combination of aripiprazole with mood stabilizers for the treatment of bipolar disorder: from acute mania to long-term maintenance

Introduction: Bipolar disorder is characterized by a complex set of symptoms, including recurrent manic, depressive or mixed episodes. Acute and long-term treatment of patients with bipolar disorder is mandatory to prevent symptom relapse and episode recurrences. Outcomes with monotherapy are often unsatisfactory in clinical practice, hence combinations of mood stabilizers and antipsychotics are widely utilized in patients showing no or partial response to, as well as intolerance to, monotherapies. This may offer a therapeutic advantage, however, the possibility of an increased incidence of side effects should be considered.

Areas covered: This paper reviews the current treatment guidelines for the treatment of bipolar disorder and examines the rationale behind the use of aripiprazole in combination with mood stabilizers for acute and long-term treatment of bipolar disorder.

Expert opinion: The combination of aripiprazole and mood stabilizers seems to offer an effective and relatively well-tolerated option for the treatment of acute mania and for the maintenance treatment of patients with bipolar I disorder. The combination presents a lower risk of metabolic side effects compared with other combination therapies, but increases the risk of extrapyramidal side effects with long-term treatment. The aripiprazole–valproate combination seems to be particularly promising in the treatment of patients with comorbidities such as anxiety and drug abuse, obsessive-compulsive disorder and bipolar disorder, as well as in mixed depressive disorder. Controlled trials are necessary in order to confirm these observations and to provide a useful insight for improving the use of drug combinations in bipolar patients.     

Pharmacotherapy of mood disorders and psychosis in pre- and post-natal women

Introduction: Untreated mood and psychotic disorders can have substantial adverse impacts on the patient, the fetus and the family, while treatment can ameliorate such problems. To address concerns by clinicians about the risks of psychotropic medications, this review addresses the risk/benefit analysis of somatic therapies for psychiatric disorders during pregnancy and lactation.

Areas covered: All available research was reviewed on the impact on pregnancy and breastfeeding of mood and psychotic disorders, and of antidepressants, mood stabilizers, antipsychotic drugs, and electroconvulsive therapy. References cited in other reviews, case series, formal studies, pharmacologic discussions, and theoretical pieces were added. Available case control and other studies were critically reviewed and diverse explanations for their findings were considered.

Expert opinion: The potential benefits of treatment of mood and psychotic disorders often outweigh the risks after alternative therapies have been considered. Some medications, particularly paroxetine and valproate, pose greater risks during pregnancy, while the teratogenic risks of lithium have probably been overstated. There is more experience with first than with second generation antipsychotic drugs during pregnancy and lactation. Nursing an infant is possible while taking a number of antidepressants, mood stabilizers or antipsychotic drugs.     

Combination of mood stabilizers with quetiapine for treatment of acute bipolar disorder: an open label study

OBJECTIVES: The atypical antipsychotics are being increasingly used to control acute manic episodes, and data are emerging to support their mood-stabilizing and antidepressant properties. This study investigated the short-term efficacy of quetiapine as an add-on therapy in the treatment of acute mania. METHOD: This study was a 4-week, open-label, add-on, prospective investigation using quetiapine in addition to mood stabilizers. Data on 18 patients fulfilling DSM-IV diagnostic criteria for bipolar I disorder were analysed. The Young mania rating scale (YMRS), the Hamilton scale for depression (HDRS), the brief psychiatric rating scale (BPRS) and extrapyramidal symptom rating scale (ESRS) were applied at baseline and at weeks 1, 2 and 4. The clinical global impression scale (CGI) was evaluated at baseline and week 4. RESULTS: The addition of quetiapine produced a statistically significant improvement on the YMRS, HDRS, BPRS and CGI score at week 4 from baseline (p<0.005). Quetiapine was well tolerated, with no subjects discontinuing because of side effects. CONCLUSIONS: The combination of quetiapine was associated with a substantial symptomatic improvement in patients with acute mania. Randomized placebo-controlled prospective studies are needed.     

Epigenetic biomarkers in psychiatric disorders

The discovery of biomarkers in psychiatric disorders may help in the diagnosis, prevention and treatment of patients with these disorders. Here, I discuss the potential role of epigenetic biomarkers, that is, epigenetically altered genes and/or expression patterns of proteins or metabolites, in psychiatric disorders. Before epigenetic biomarkers can be clinically applied in these disorders, several issues need to be addressed. These include establishing a connection between biomarkers and the disease process; determining the predictive quality of the biomarkers; determining the effects of disease heterogeneity on the biomarkers; and identifying sample sources for the biomarkers that are easily accessible for testing.