内科共病影响双相障碍患者病程

菲尼克斯(EGMN)——根据在美国国立精神卫生研究所(NIMH)主办的临床新药评价单元(NCDEU)会议上报告的LiTMUS (中等剂量锂盐治疗研究)研究结果，双相Ⅰ型和Ⅱ型障碍患者的共病负担较高，且与精神药物处方量增加相关。

在该项研究中，凯斯西储大学的David E. Kemp博士及其同事评估了双相障碍患者的内科疾病发病率和负担，并试图确定共病与双相障碍临床特征的相关性。受试者为≥18岁成人双相Ⅰ型或Ⅱ型障碍患者，心境症状严重程度至少为轻度(定义为临床总体印象量表-双相障碍版评分≥3分)，以保证治疗后症状有所变化。

结果显示，在264例累积疾病评估量表(CIRS)评分有效的受试者中，139例表现为有临床意义的疾病负担(定义为CIRS评分≥4分，提示患者至少存在2种需要一线治疗的中度失能性内科疾病)。139例共病负担较高的患者比共病负担较低者更多表现为目前重度抑郁发作(71.3% vs. 57.8%)、强迫性精神障碍(14.4% vs. 5.6%)、既往心境发作(66.5% vs. 37.7%)和既往躁狂或轻度躁狂发作(34.9% vs. 18.3%)。虽然没有达到统计学显著水平，但共病程度较高的患者更多为女性(61.9% vs. 50.4%)且多有抑郁发作经历(29.5% vs. 19.7%)。研究者称，“与共病负担较低者相比，共病负担较高患者一生平均经历10次额外抑郁发作和15次额外躁狂或轻度躁狂发作。”

就精神药物使用情况而言，高共病患者平均用药2.9种，而低共病者为2.3种，具有统计学显著差异。

最常见共病为偏头痛、高血压、高脂血症和哮喘，分别占24%、17%、15%和15%。最常受累的是肌肉骨骼、呼吸和内分泌系统(分别占33%、27%和 25%)。值得注意的是，高血压和血脂异常通常被低估且治疗不足。44%的受试者被医生诊断为高血压，但患者报告率仅为17%；血脂异常患者医生确诊比例为31%，但患者报告率仅为15%。此外，70%的受试者超重或肥胖。男性双相Ⅰ型障碍患者超重比例高于女性，而女性双相Ⅰ型障碍患者肥胖比例高于男性。非裔美国患者2级肥胖比例最高(体重指数≥35 kg/m2)。

研究者指出，已知双相障碍患者罹患多种常见病的风险增加，与普通人群相比，共病可导致该类患者预期寿命缩短多达30%。既往研究证实心血管代谢疾病与精神疾病严重程度有关，提示遗传和病理生理因素使易感个体出现情绪症状和疾病。上述结果进一步表明双相障碍与高共病负担相关，而后者似乎可影响病程和精神药物处方模式，凸显了双相障碍可能涉及多个系统以及进一步了解精神病理与共病关系的必要性。

该研究由NIMH资助，作者报告无相关利益冲突。

爱思唯尔  版权所有

BY SHARON WORCESTER
Elsevier Global Medical News
Breaking News

PHOENIX (EGMN) – The burden of comorbid medical illness is high, and is linked to increased prescribing of psychotropic drugs, in patients with bipolar I and II disorder, based on findings from the Lithium Treatment – Moderate Dose Use Study, or LiTMUS.

Clinically significant medical burden, defined by a score of 4 or more on the Cumulative Illness Rating Scale (CIRS), was present in 139 of 264 LiTMUS participants with available CIRS data. A score of 4 or higher on the 14-point scale indicates that a patient has at least two moderately disabling medical problems requiring first-line treatment, Dr. David E. Kemp of Case Western Reserve University, Cleveland, and his colleagues reported in a poster. They presented their findings at a meeting of the New Clinical Drug Evaluation Unit sponsored by the U.S. National Institute of Mental Health.

The 139 patients with high medical comorbidity were significantly more likely than were those with low medical comorbidity to present in a current major depressive episode (71.3% vs. 57.8%), to have obsessive-compulsive disorder (14.4% vs. 5.6%), and to have previous mood episodes (66.5% vs. 37.7%), and previous manic or hypomanic episodes (34.9% vs. 18.3%), the investigators said.

Those with high medical comorbidity were also more likely to be female (61.9% vs. 50.4%) and to have previous depressive episodes (29.5% vs. 19.7%), although these measures did not reach statistical significance.

“Patients with high vs. low medical comorbidity burden experienced an average of 10 additional depressive episodes and 15 additional manic or hypomanic episodes over their lifetime,” the investigators noted.

As for psychotropic medication use, those with high medical comorbidity were prescribed an average of 2.9 medications, compared with 2.3 for those with low medical comorbidity, a statistically significant difference, the investigators said.

The most common comorbid medical conditions in LiTMUS participants were migraines, hypertension, hyperlipidemia, and asthma, occurring in 24%, 17%, 15%, and 15% of study participants, respectively. The most common organ systems affected by medical comorbidity were the musculoskeletal, respiratory, and endocrine systems (in 33%, 27%, and 25% of participants, respectively).

Of note, hypertension and dyslipidemia were frequently underrecognized and undertreated in this population. Hypertension was diagnosed by a clinician in 44% of participants, but reported by only 17% of the patients; dyslipidemia was diagnosed by a clinician in 31% of participants, but reported by only 15%.

Additionally, 70% of the sample was overweight or obese. More males than females with bipolar I disorder were overweight, whereas more females than males with bipolar I disorder were obese. African Americans were the ethnic group with the highest rate (31%) of grade 2 obesity, defined as a body mass index of 35 kg/m2 or greater, they noted.

LiTMUS was undertaken to estimate the prevalence and burden of general medical illnesses among patients with bipolar disorder and to identify the potential associations between those illnesses and the clinical features of bipolar disorder, the investigators said. Dr. Kemp and his colleagues explained that patients with bipolar disorder are known to have an increased risk for several general medical conditions, which contribute to an up to 30% shorter life expectancy in this population, compared with the general population.

Previous studies have identified links between cardiometabolic disorders and psychiatric illness severity suggestive of a genetic and pathophysiologic diathesis that predisposes vulnerable individuals to the concurrent development of mood symptoms and medical conditions, they said.

Participants were adults aged 18 years or older with bipolar I or II disorder and mood symptoms of at least mild severity that warranted a change in treatment. Having symptoms of at least mild severity was defined as a score of 3 or greater on the Clinical Global Impression Scale-Bipolar Version.

The findings reinforce the notion that bipolar disorder is associated with a high burden of comorbid medical illnesses, which appear to influence the course of the illness and psychotropic prescribing patterns, and they “highlight the multisystem involvement in bipolar disorder and the need for improved understanding of the relationships between psychiatric pathology and medical illness,” the investigators concluded.

This study was funded by the U.S. National Institute of Mental Health. The authors had no disclosures.