Filiz Dere YİLMAZ, Kaasım Fatih YAVUZ, Kürşat ALTINBAŞ, Dilek Yesilbas LORDOGLU, Erhan KURT

Tek ve ikili duygudurum dengeleyici ile koruma altındaki iki uçlu bozukluk tip 1 tanılı hastaların sosyodemografik ve klinik özelliklerinin karşılaştırılması

Amaç: Bu çalışmada İki Uçlu Bozukluk tanısıyla tek bir duygudurum dengeleyici kullanan hastalar ile ikili duygudurum dengeleyici kullanan hastaların demografik ve klinik özellikleri ile hastalık seyri ve dönem özelliklerinin karşılaştırılması amaçlanmıştır. Yöntem: İki Uçlu Bozukluk Tip 1 tanısıyla takip edilen 167 hastanın ayaktan takip dosyaları geriye dönük olarak incelenmiştir. Hastaların 136'sı tek duygudurum dengeleyici ve 31'i çift duygudurum dengeleyici kullanmaktaydı. Grupların sosyodemografik ve klinik özellikleri kayıtlanmış, elde edilen veriler SPSS (Statistical Package for Social Sciences) 17.0 programı kullanılarak analiz edilmiştir. Veriler değerlendirilirken Ki kare ve t testi kullanılmıştır.Bulgular: Tek ilaçla koruma tedavisi alan hastalarda anlamlı olarak kadınlar daha fazlaydı. İkili ilaç kullanan hastaların toplam dönem sayısı ve hastaneye yatış sayısı, tek ilaç kullananlara kıyasla yüksekti. Tek ilaç grupları kendi aralarında karşılaştırıldıklarında lityum alan hastaların toplam dönem sayısı ve hastaneye yatış sayısı valproat kullanan hastalara kıyasla anlamlı derecede düşük bulundu.Sonuç: İkili duygudurum dengeleyici ile koruma altındaki hastalarda hastane yatış ve dönem sayısı yüksekliği bu hastaların daha zor tedavi edilen, daha kötü seyirli bir grup olduğuna işaret edebilir. Tek ilaç kullanan hastalarda kadın cinsiyet oranlarının yüksekliği kadınlarda hastalık seyrinin daha iyi olduğuna işaret edebilir. Ancak araştırmamızın kesitsel olması ve görece düşük örneklem sayısı nedeniyle daha fazla yorum yapmak güçleşmektedir. Bu nedenle bu alanda özellikle tek ilaç kullanan hasta sayısının daha fazla olduğu uzunlamasına izlem çalışmalarına gereksinim vardır

Comparison of Sociodemographic and Clinical Characteristics of Bipolar Type 1 Patients on Single or Double Mood Stabilizer Treatment

Comparison of sociodemographic and clinical characteristics of bipolar type 1 patients on single or double mood stabilizer treatmentObjective: Purpose of the current study is to compare the demographic and clinical characteristics, prognoses and episode characteristics between patients on a single mood stabilizer treatment and those on double mood stabilizer treatment. Methods: The follow-up files of 167 patients who met DSM-IV-TR criteria for bipolar-I disorder were examined retrospectively. Patients were divided into two groups, with 136 patients on a single mood stabilizer and 31 patients on double mood stabilizer treatment. Sociodemographic and clinical characteristics of the groups were evaluated. The data derived from the study were analyzed with SPSS (Statistical Package for Social Sciences) for Windows 17.0. The data were evaluated with chi-square and t test. Results: The number of women was significantly higher in the single mood stabilizer group. The total number of episodes and hospitalizations were higher in patients on double mood stabilizer treatment compared to the single mood stabilizer group. When comparing within the single medication group, the total number of episodes and hospitalizations in patients using Lithium were significantly lower than in patients on valproat. Conclusion: Patients medicated with double mood stabilizer may be more difficult to treat and have a poorer prognosis than patients medicated with a single mood stabilizer. The number of female patients was greater in the single mood stabilizer group, which may indicate a generally more positive outcome in women. However, this research was cross-sectional and had a relatively low sample size, making it rather difficult to come to a more definite conclusion. Therefore, follow-up studies with a greater number of patients on a single mood stabilizer over an extended period of time are required

PDF

___

1. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HU, Kendler KS. Lifetime and 12-month prevalence of DSM-III-R Psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994; 51:8-19. [CrossRef]
2. Angst J. The emerging epidemiology of hypomania and bipolar II disorder. J Affect Disord 1998; 50:143-151. [CrossRef]
3. Szádóczky E, Papp Zs, Vitrai J, Ríhmer Z, Füredi J. The prevalence of major depressive and bipolar disorders in Hungary. Results from a national epidemiologic survey. J Affect Disord 1998; 50:153-162. [CrossRef]
4. Angst J, Sellaro R. Historical perspectives and natural history of bipolar disorder. Biol Psychiatry 2000; 48:445-457. [CrossRef]
5. Morgan VA, Mitchell PB, Jablensky AV. The epidemiology of bipolar disorder: sociodemographic, disability and service utilization data from the Australian National Study of Low Prevalence (Psychotic) Disorders. Bipolar Disord 2005; 7:326-337. [CrossRef]
6. Simpson SG, Jamison KR. The risk of suicide in patients with bipolar disorders. J Clin Psychiatry 1999; 60(Suppl.2):53-56.
7. Bowden CL, Grunze H, Mullen J, Brecher M, Paulsson B, Jones M, Vågerö M, Svensson K. A randomized, double blind, placebo controlled efficacy and safety study of quetiapine or lithium as monotherapy for mania in bipolar disorder. J Clin Psychiatry 2005; 66:111-121. [CrossRef]
8. Suppes T, Liu S, Brecher M, Paulsson B, Lazarus A. Maintenance treatment in bipolar I disorder with quetiapine concomitant with lithium or divalproex: a placebo controlled randomized multicenter trial (trial 1447C00127). Bipolar Disord 2008; 10(Suppl.1):18-24.
9. Vieta E, Suppes T, Eggens I, Persson I, Paulsson B, Brecher M. Efficacy and safety of quetiapine in combination with lithium or divalproex for maintenance of patients with bipolar I disorder (international trial 126). J Affect Disord 2008; 109:251-263. [CrossRef]
10. Fountoulakis KN, Vieta E. Treatment of bipolar disorder: a systematic review of available data and clinical perspectives. Int J Neuropsychopharmacol 2008; 11:999-1029. [CrossRef]
11. Jefferson JM, Greist JH. Lithium. In Comprehensive Textbook of Psychiatry: BJSadock, V Sadock eds. Baltimore, USA, Lippincott William Wilkins, 2000; 2377-2390. [CrossRef]
12. Rapoport SI, Basselin M, Kim HW, Rao JS. Bipolar disorder and mechanisms of action of mood stabilizers. Brain Res Rev 2009; 61:185-209. [CrossRef]
13. Schou M. Forty years of lithium treatment. Arch Gen Psychiatry 1997; 54:9-13. [CrossRef]
14. Pope HG Jr, McElroy SL, Keck PE Jr, Hudson JI. Valproate in the treatment of acute mania: a placebo-controlled study. Arch Gen Psychiatry 1991; 48:62-68. [CrossRef]
15. Emrich HM, Wolf R. Valproate treatment of mania. Prog Neuropsychopharmacol Biol Psychiatry 1992; 16:691-701. [CrossRef]
16. Calabrase JR, Woyshville MJ, Kimmel SE, Rapport DJ. Predictors of valproate response in bipolar rapid cycling. J Clin Psychopharmacol 1993; 13:280-283. [CrossRef]
17. Denicoff KD, Smith-Jackson EE, Disney ER, Ali SO, Leverich GS, Post RM. Comparative prophylactic efficacy of lithium, carbamazepine, and the combination in bipolar disorder. J Clin Psychiatry 1997; 58:470-478. [CrossRef]
18. Coryell W, Scheftner W, Keller MB, Endicott J, Maser J, Klerman GL. The enduring psychosocial consequences of mania and depression. Am J Psychiatry 1993; 150:720-727. [CrossRef]
19. Altamura AC, Mundo E, Dell’Osso B, Tacchini G, Buoli M, Calabrese JR. Quetiapine and classical mood stabilizers in the long-term treatment of Bipolar Disorder: a 4-year follow-up naturalistic study. J Affect Disord 2008; 110:135-141. [CrossRef]
20. Masi G, Perugi G, Millepiedi S, Mucci M, Pfanner C, Berloffa S, Pari C, Gagliano A, D’Amico F, Akiskal HS. Pharmacological response in juvenile bipolar disorder subtypes: a naturalistic retrospective examination. Psychiatry Res 2010; 177:192-198. [CrossRef]
21. Levine J, Chengappa KN, Brar JS, Gershon S, Yablonsky E, Stapf D, Kupfer DJ. Psychotropic drug prescription patterns among patients with bipolar I disorder. Bipolar Disord 2000; 2:120-130. [CrossRef]
22. Cole AJ, Scott J, Ferrier IN, Eccleston D. Patterns of treatment resistance in bipolar affective disorder. Acta Psychiatr Scand 1993; 88:121-123. [CrossRef]
23. Wilhelm S, Schacht A, Minarzyk A, Liebeskind A, Grunze H. Preventing bipolar relapse: Which factors are associated with different mood stabilizer therapy? Eur Psychiatry 2007; 22(Suppl.1):262. [CrossRef]
24. Yazici O, Oral ET. 5. Chapter: Preventive Treatment: In Aydemir O, Ulusahin A, Akdeniz F (editors). Treatment Guidelines for Bipolar Disorder. First Ed. Ankara: Psychiatric Association of Turkey Press, 2010; 63-83. (Turkish)