双相情感障碍药物治疗的全球趋势。

IF 5.5 2区 医学 Q1 PSYCHIATRY
Anastasia K Yocum, Balwinder Singh
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引用次数: 0

摘要

双相情感障碍(BD)是一种以显著的情绪波动为特征的慢性精神健康状况,包括躁狂或轻躁狂和抑郁期。影响全球约1-2%的人口,双相障碍与社会功能受损、生活质量下降和自杀风险增加有关。这种疾病给卫生保健系统带来了沉重的负担,由于生产力损失和对广泛治疗和支持服务的需求,造成了巨大的经济成本。本综述综合了过去1 - 3年双相障碍药物治疗的全球趋势,重点关注新兴药物、新治疗方案和该领域内正在进行的争论。此外,该综述探讨了发达国家和发展中国家处方模式的差异,介绍了药物基因组学和个性化医疗对治疗结果的影响。综述的目的:本综述的主要目的是对过去1 - 3年治疗双相障碍的药物使用的全球趋势提供一个全面和最新的综合。本文旨在概述与双相障碍药物治疗相关的最新研究、临床试验和荟萃分析,重点介绍新的发现和进展。此外,本文将对该领域正在进行的争论和争议进行综述,如抗抑郁药在双相障碍治疗中的作用和抗精神病药物的长期使用,旨在弥合知识空白,指导未来的研究方向。最近的研究发现:尽管出于安全考虑,锂的使用正在减少,但研究继续强调锂在情绪稳定和减少自杀行为方面的功效。稳定情绪的抗惊厥药物,如丙戊酸钠和卡马西平,仍然是重要的替代药物,每种药物都有不同的副作用,需要仔细监测患者。新型非典型抗精神病药物,如鲁拉西酮(2013年)和卡吡嗪(2015年)的批准和越来越多的使用,扩大了治疗选择,在双相障碍的不同阶段提供了疗效,但副作用相对较好。抗抑郁药仍然存在争议,有证据表明,它们的益处主要是在与情绪稳定剂联合使用时产生的。新兴药物如lumateperone(2021年12月)和es氯胺酮显示出希望,而药物基因组学研究正在为更个性化的治疗铺平道路。双相障碍药物治疗的前景是显著的进步和持续的挑战。锂和稳定情绪的抗惊厥药仍然是基础治疗,尽管有坚持的挑战和副作用的担忧。新的非典型抗精神病药和新型药物的出现提供了有希望的治疗选择,而抗抑郁药仍在争论中。个性化医疗和药物基因组学可能成为变革性的方法,允许更有针对性和更有效的治疗。然而,发达国家和发展中国家在药物可及性方面的差异突出了全球合作优化双相障碍管理的必要性。持续的研究和创新对于解决BD的复杂性和改善全球患者的治疗效果至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Global Trends in the Use of Pharmacotherapy for the Treatment of Bipolar Disorder.

Bipolar Disorder (BD) is a chronic mental health condition characterized by significant mood swings, including periods of mania or hypomania and depression. Affecting approximately 1-2% of the global population, BD is associated with impaired social functioning, decreased quality of life, and an increased risk of suicide. The disorder presents a substantial burden on healthcare systems and imposes significant economic costs due to lost productivity and the need for extensive treatment and support services. This comprehensive review synthesizes global trends in BD pharmacotherapy over the past 1 to 3 years, focusing on emerging medications, novel treatment protocols, and ongoing debates within the field. Additionally, the review explores differences in prescribing patterns across developed and developing countries, introduces the impact of pharmacogenomics and personalized medicine on treatment outcomes. PURPOSE OF REVIEW: The primary purpose of this review is to provide a comprehensive and up-to-date synthesis of the global trends in the use of medications for the treatment of BD over the past 1 to 3 years. This review aims to outline the latest studies, clinical trials, and meta-analyses relevant to BD pharmacotherapy, highlighting new discoveries and advancements. Furthermore, this review will address ongoing debates and controversies in the field, such as the role of antidepressants in BD treatment and the long-term use of antipsychotics, aiming to bridge knowledge gaps and guide future research directions. RECENT FINDINGS: Studies continue to reinforce the efficacy of lithium in mood stabilization and reduction of suicidal behavior, despite its declining use due to safety concerns. Mood stabilizing anticonvulsants like valproate and carbamazepine continue to be vital alternatives, each with distinct side effect profiles necessitating careful patient monitoring. The approval and increasing use of novel atypical antipsychotics, such as lurasidone (2013) and cariprazine (2015), has expanded treatment options, offering efficacy in different phases of BD with relatively favorable side effect profiles. Antidepressants remain contentious, with evidence suggesting their benefits primarily when used in combination with mood stabilizers. Emerging agents like lumateperone (Dec 2021) and esketamine show promise, while pharmacogenomic research is paving the way for more personalized treatments. The landscape of BD pharmacotherapy is marked by significant advancements and ongoing challenges. Lithium and mood stabilizing anticonvulsants remain foundational treatments, albeit with adherence challenges and side effect concerns. The advent of new atypical antipsychotics and novel agents offers promising therapeutic options, while antidepressants continue to be debated. Personalized medicine and pharmacogenomics could emerge as transformative approaches, allowing for more tailored and effective treatments. However, disparities in medication accessibility between developed and developing countries highlight the need for global collaboration to optimize BD management. Continued research and innovation are essential to addressing the complexities of BD and improving patient outcomes worldwide.

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来源期刊
CiteScore
11.30
自引率
3.00%
发文量
68
审稿时长
6-12 weeks
期刊介绍: This journal aims to review the most important, recently published research in psychiatry. By providing clear, insightful, balanced contributions by international experts, the journal intends to serve all those involved in the care of those affected by psychiatric disorders. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as anxiety, medicopsychiatric disorders, and schizophrenia and other related psychotic disorders. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.
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