Биполярные расстройства: классификация, эпидемиология, диагностика и лечение


А.В. Ушкалова

Рассматривается проблема биполярных расстройств (БР) - достаточно распространенных тяжелых хронических расстройств настроения, ассоциирующихся с повышенным уровнем смертности, высокой частотой самоубийств, снижением качества жизни больных и членов их семей. Приводится классификация БР, обсуждаются их этиология и эпидемиология, проблемы диагностики. Подробно рассматриваются подходы к лечению различных форм БР. Отмечается, что соли лития, бывшие основным средством для лечения БР на протяжении ряда десятилетий, во многих случаях уступают по эффективности и безопасности противосудорожным средствам, среди которых наибольшую доказательную базу имеет вальпроат, а также атипичным нейролептикам.

Литература






  1. Access Economics and SANE Australia. Bipolar disorder: costs. An analysis of the burden of bipolar disorder and related suicide in Australia. Melbourne: SANE Australia, 2003.

  2. Mitchell PB, Ball JR, Best JA, et al. The management of bipolar disorder in general practice. MJA 2006;184(11):566–70.

  3. Angst J, Sellaro R. Historical perspectives and natural history of bipolar disorder. Biol Psychiatry 2000;48(6):445–57.

  4. Manning JS, Haykal RF, Connor PD, et al. On the nature of depressive and anxious states in a family practice setting: the high prevalence of bipolar II and related disorders in a cohort followed longitudinally. Compr Psychiatry 1997; 38(2):102–08.

  5. Michalak EE, Yatham LN, Lam RW. Quality of life in bipolar disorder: a review of the literature. Health Qual Life Outcomes 2005;3:72.

  6. Dean BB, Gerner D, Gerner RH. A systematic review evaluating health-related quality of life, work impairment, and healthcare costs and utilization in bipolar disorder. Curr Med Res Opin 2004;20(2):139–54.

  7. Peele PB, Xu Y, Kupfer DJ. Insurance expenditures on bipolar disorder: clinical and parity implications. Am J Psychiatry 2003;160(7):1286–90.

  8. Wyatt RJ, Henter I. An economic evaluation of manic-depressive illness – 1991. Soc Psychiatry Psychiatr Epidemiol 1995;30(5):213–19.

  9. Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. 4th ed. Washington, DC: American Psychiatric Assoc 1994:327.

  10. Мосолов С.Н., Костюкова Е.Г. Современные подходы к диагностике и фармакотерапии биполярного аффективного расстройства // Трудный пациент. 2005. № 12.

  11. Post RM. The impact of bipolar depression. J Clin Psychiatry 2005;66(Suppl. 5):5–10.

  12. Judd LL, Akiskal HS, Schettler PJ, et al. The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry 2002;59:530–37.

  13. CalabreseJR, Shelton MD, Rapport DJ, et al. Current research on rapid cycling bipolar disorder and its treatment. J Affect Disord 2001;67 (1–3):241–55.

  14. Vieta E. Managing Bipolar Disorder in Clinical Practice. Published by Current medicine group Ltd, Porters South, London, UK, 2006.

  15. Kendler KS, Pedersen NL, Neal NK, et al. A pilot Swedish twin study of affective illnesse including hospital- and population – ascertained subsamples: results of model fitting. Behav Genet 1995;25:217–32.

  16. Kidd PM. Bipolar disorder and cell membrane dysfunction. Progress toward integrative management. Altern Med Rev 2004;9(2):107–35.

  17. Kessler RC, Berlund P, Dernler O, et al. Lifetime prevalence and age-of-onset distributions of DSM disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62:593–602.

  18. Hirshfewld RM, Calabrese JR, Weissman MM, et al. Screening for bipolar disorder in the community. J Clin Psychiatry 2003;64:53–59.

  19. Amsterdam JD, Brunswick DJ. Antidepressant monotherapy for bipolar type II major depression. Bipolar Disord 2003;5:388–95.

  20. Handtouche EG, Adiskal HS, Lancrenon S, et al. Systematic clinical methodology for validating bipolar – II disorder:data in mild-stream from a French national multi – site study (EPIDEP). J Affect Disord 1998;50:163–73.

  21. Angst J, Gamma A, Benazzi F, et al. Diagnostic issues in bipolar disorder. Europ Neuropsychopharm 2003;13:S43–S50.

  22. Practice guideline for the treatment of patients with bipolar disorder. American Psychiatric Association. Am J Psychiatry 1994;151(Suppl. 1): 1–36.

  23. Mitchell PB, Ball JR, Best JA, et al. The management of bipolar disorder in general practice. MJA 2006;184(11):566–70.

  24. Barnes C, Mitchell P. Considerations in the management of bipolar disorder in women. Aust N Z J Psychiatry 2005;39(8):662–73.

  25. Papadimitriou GN, Calabrese JR, Dikeos DG, et al. Rapid cycling bipolar disorder: biology and pathogenesis. Int J Neuropsychopharmacol 2005;8(2):281–92.

  26. Akiskal HS, Hantouche EG, Bourgeois ML, et al. Gender, temperament, and the clinical picture in dysphoric mixed mania: findings from a French national study (EPIMAN). J Affect Disord 1998;50(2–3):175–86.

  27. Hirschfeld RMA, Lewis L, Vornik LA. Perceptions and impact of bipolar disorder: How far have we really come? Results of the National Depressive and Manic-Depressive Association 2000 survey of individuals with bipolar disorder. J Clin Psychiatry 2003;64:161–74.

  28. Hudson JI, Pope HG, Jonas PM, et al. Phenomenologic relationship of eating disorders to major affective disorders. Psychiatric Res 1983; 9:435–54.

  29. Ghaemi SN, Boiman EE, Goodwin FK. Diagnosing bipolar disorder and the effect of antidepressants: a naturalistic study. J Clin Psychiatry 2000;61(10):804–08.

  30. Thase ME. Bipolar depression: diagnostic and treatment considerations. Dev Psychopathol 2006;18(4):1213–30.

  31. Suppes T, Kelly DI, Perla JM. Challenges in the management of bipolar depression. J Clin Psychiatry 2005;66(Suppl. 5):11–16.

  32. Altshuler L. Bipolar disorder: are repeated episodes associated with neuroanatomic and cognitive change? Biol Psychiatry 1993;33:563–65.

  33. Ketter TA, Nasrallah HA. Mood Stabilizers and Atypical Antipsychotics: Bimodal Treatments for Bipolar Disorder. Psychopharmacol Bull 2006;39(1):120–46.

  34. Vestergaard P. Guidelines for maintenance treatment of bipolar disorder: are there discrepancies between European and North American recommendations? Bipolar Disord 2004;6: 519–22.

  35. Glick ID, Suppes T, DeBattista С, et al. Psychopharmacologic Treatment Strategies for Depression,Bipolar Disorder, and Schizophrenia. Ann Intern Med 2001;134:47–60.

  36. Gijsman HJ, Geddes JR, Rendell JM, et al. Antidepressants for bipolar depression: a systematic review of randomized, controlled trials. Am J Psychiatry 2004;161:1537–47.

  37. Leverich GS, Altshuler LL, Frye MA, et al. Risk of switching in mood polarity to hypomania and mania in patients with bipolar depression during acute and continuation trials of venlafaxine, sertraline, and bupropion as adjuncts to mood stabilizers. Am J Psychiatry 2006;163:232–39.

  38. Vieta E, Martinez-Aran A, Goikolea JM. A randomized trial comparing paroxetine and venlafaxine in the treatment of bipolar depressed patients taking mood stabilizers. J Clin Psychiatry 2002;63(6):508–12.

  39. Post RM, Altshuler LL, Frye MA, et al. New findings from the Bipolar Collaborative Network: clinical implications for therapeutics. Curr Psychiatry Rep 2006;8(6):489–97.

  40. Post RM, Altshuler LL, Leverich GS, et al. Mood switch in bipolar depression: comparison of adjunctive venlafaxine, bupropion and sertraline. Br J Psychiatry 2006;189:124–31.

  41. Altshuler L, Suppes T, Black D, et al. Impact of antidepressant discontinuation after acute bipolar depression remission on rates of depressive relapse at 1-year follow-up. Am J Psychiatry 2003;160:1252–62.

  42. Goldstein TR, Frye MA, Denicoff KD, et al. Antidepressant discontinuation-related mania: critical prospective observation and theoretical implications in bipolar disorder. J Clin Psychiatry 1999;60(8):563–67.

  43. Fountoulakis KN, Vieta E, Sanchez-Moreno J, et al. Treatment guidelines for bipolar disorder: a critical review. J Affect Disord 2005;86(1):1–10.

  44. Sachs GS, Nierenberg AA, Calabrese JR, et al. Effectiveness of Adjunctive Antidepressant Treatment for Bipolar Depression. www.nejm.org March 28, 2007.

  45. Malhi GS, Mitchell PB, Salim S. Bipolar depression: management options. CNS Drugs 2003; 17(1):9–25.

  46. Ahrens B, Muller-Oerlinghausen B. Does lithium exert an independent antisuicidal effect? Pharmacopsychiatry 2001;34(4):132–36.

  47. Kalinin VV. Suicidality and Antiepileptic Drugs: Is there a Link? Drug Saf 2007;30(2):123–42.

  48. Winsberg ME, DeGolia SG, Strong CM, et al. Divalproex therapy in medication-naive and mood-stabilizer-naive bipolar II depression. J Affect Disord 2001;67(1–3):207–12.

  49. Lambert PA. Acute and prophylactic therapies of patients with affective disorders using valpromide (dypropylaetamide). In: Anticonvulsants in affective disorders Edited by HE Emrich, T Okuma, AA Muller. Elsevier Science Publishers, Amsterdam, Oxford, Princeton 1984.

  50. Sachs GS, Altshuler LL, Ketter TA, et al. Divalproex versus placebo for the treatment of bipolar depression. American College of Neuropsychopharmacology Abstracts 2001.

  51. Keck PE, McElroy SL. Divalproex in the Treatmentof Bipolar Disorder. Psychopharmacology Bulletin 2003;37(Suppl. 2):67–73.

  52. Davis LL, Bartolucci A, Petty F. Divalproex in the treatment of bipolar depression: a placebo-controlled study. J Affect Disord 2005;85(3): 259–66.

  53. Calabrese JR, Suppes T, Bowden CL, et al. A double-blind, placebo-controlled, prophylaxis study of lamotrigine in rapid-cycling bipolar disorder. Lamictal 614 Study Group. J Clin Psychiatry. 2000;61(11):841–50.

  54. Frye MA, Ketter TA, Kimbrell TA, et al. A placebo-controlled study of lamotrigine and gabapentin monotherapy in refractory mood disorders. J Clin Psychopharmacol 2000;20(6): 607–14.

  55. Ballenger JC. The clinical use of carbamazepine in affective disorders. J Clin Psychiatry 1988; 49(Suppl.):13–21.

  56. Small JG. Anticonvulsants in affective disorders. Psychopharmacol Bull 1990;26:25–36.

  57. Yatham LN, Kennedy SH, O'Donovan C, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of patients with bipolar disorder: update 2007. Bipolar Disord 2006;8(6):721–39.

  58. Emrich HM, von Zerssen D, Kissling W, et al. Effect of sodium valproate on mania: the GABA hypothesis of affective disorders. Arch Psychiatr Nervenkr 1980;229:1–16.

  59. Brennan M, Sandyk R, Borsook D. Use of sodium valproate in the management of affective disorders. Basic and clinical aspects. In: Emrich HM, et al., eds. Anticonvulsants in Affective Disorders. Amsterdam, The Netherlands: Elsevier Science Publishers 1984:56–65.

  60. Pope HG, McElroy SL, Keck PE, et al. Valproate in the treatment of acute mania: a placebo-controlled trial. Arch Gen Psychiatry 1991;48: 62–68.

  61. Bowden CL, Brugger AM, Swann AC, et al. Efficacy of divalproex sodium versus lithium and placebo in the treatment of acute mania. JAMA 1994;271:918–24.

  62. Oluboka OJ, Bird DC, Kutcher S, et al. A pilot study of loading versus titration of valproate in the treatment of acute mania. Bipolar Disord 2002;4:341–45.

  63. Keck PE, McElroy SL, Tugrul KC, et al. Valproate oral loading in the treatment of acute mania. J Clin Psychiatry 1993;54:305–08.

  64. Goodwin GM. Recurrence of mania after lithium withdrawal. Implications for the use of lithium in the treatment of bipolar affective disorder. Br J Psychiatry 1994;164(2):149–52.

  65. Jacobsen FM. Low-dose valproate: a new treatment for cyclothymia, mild rapid-cycling disorders, and premenstrual syndrome. J Clin Psychiatry 1993;54:229–34.

  66. Freeman TW, Clothier JL, Pazzaglia P, et al. A double-blind comparison of valproate and lithium in the treatment of acute mania. Am J Psychiatry 1992;149:108–11.

  67. Hirschfeld RMA, Allen MH, McEvoy JP, et al. Safety and tolerability of oral loading divalproex sodium in acutely manic bipolar patients. J Clin Psychiatry 1999;60:815–18.

  68. Zajecka JM, Weisler R, Sachs G, et al. A comparison of the efficacy, safety, and tolerability of divalproex sodium and olanzapine in the treatment of bipolar disorder. J Clin Psychiatry 2002;63(12):1148–55.

  69. Vieta E. Divalproex versus olanzapine in mania. J Clin Psychiatry 2003;64(10):1266.

  70. Tohen M, Baker RW, Altshuler LL, et al. Olanzapine versus divalproex in the treatment of acute mania. Am J Psychiatry 2002;159(6):1011–17.

  71. Macritchie K, Geddes JR, Scott J, et al. Valproate for acute mood episodes in bipolar disorder. Cochrane Database Syst Rev 2003;(1): CD004052.

  72. Keck PE, McElroy SL, Strakowski SM. Anticonvulsants and antipsychotics in the treatment of bipolar disorder. J Clin Psychiatry 1998;59 (Suppl. 6):74–81.

  73. Goodwin FK. Rationale for using lithium in combination with other mood stabilizers in the management of bipolar disorder. J Clin Psychiatry 2003;64(Suppl. 5):18–24.

  74. Swann AC, Bowden CL, Calabrese JR, et al. Differential effect of number of previous episodes of affective disorder on response to lithium or divalproex in acute mania. Am J Psychiatry 1999;156:1264–66.

  75. Kosten TR, Kosten TA. New medication strategies for comorbid substance use and bipolar affective disorders. Biol Psychiatry 2004;56 (10):771–77.

  76. Prien RF, Himmelhoch JM, Kupfer DJ. Treatment of mixed mania. J Affect Disord 1988; 15:391–93.

  77. Akiskal HS, Bourgeois ML, Angst J, et al. Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders. J Affect Disord 2000;59(Suppl. 1): S5–S30.

  78. Mitchell PB, Slade T, Andrews G. Twelve-month prevalence and disability of DSM-IV bipolar disorder in an Australian population survey. Psychol Med 2004;34:777–85.

  79. Muller-Oerlinghausen B, Retzow A, Henn F, et al. Valproate as an adjunct to neuroleptic medication for the treatment of acute episodes of mania: a prospective, randomized, double-blind, placebo-controlled, multicenter study. J Clin Psychopharmacol 2000;20:195–203.

  80. McElroy SL, Keck PE, Pope HG, et al. Valproate in the treatment of rapid-cycling bipolar disorder. J Clin Psychopharmacol 1998;8:275–79.

  81. Keck PE, McElroy SL, Vuckovic A, et al. Combined valproate and carbamazepine treatment of bipolar disorder. J Neuropsychiatry Clin Neurosci 1992;4:319–22.

  82. Sachs GS, Grossman F, Ghaemi SN, et al. Combination of a mood stabilizer with risperidone or haloperidol for treatment of acute mania: a double-blind, placebo-controlled comparison of efficacy and safety. Am J Psychiatry 2002;159: 1146–54.

  83. Tohen M, Chengappa KNR, Suppes T, et al. Efficacy of olanzapine in combination with valproate or lithium in the treatment of mania in patients partially nonresponsive to valproate or lithium monotherapy. Arch Gen Psychiatry 2002;59:62–69.

  84. DelBello MP, Schwier M, Rosenberg LS, et al. A double-blind, randomized, placebocontrolled study of quetiapine as adjunctive treatment for adolescent mania. J Am Acad Child Adolesc Psychiatry 2002;41:1216–23.

  85. Lerer B, Moore N, Meyendorff E, et al. Carbamazepine versus lithium in mania: a double-blind study. J Clin Psychiatry 1987;48(3):89–93.

  86. Small JC, Klapper MH, Milstein V, et al. Carbamazepine compared with lithium in the treatment of mania. Arch Gen Psychiatry 1991;48;915–21.

  87. Weisler RH, Kalali AH, Ketter TA; SPD417 Study Group. A multicenter, randomized, double-blind, placebo-controlled trial of extended-release carbamazepine capsules as monotherapy for bipolar disorder patients with manic or mixed episodes. J Clin Psychiatry 2004;65(4): 478–84.

  88. Weisler RH, Keck PE, Swann AC, et al; SPD417 Study Group. Extended-release carbamazepine capsules as monotherapy for acute mania in bipolar disorder: a multicenter, randomized, double-blind, placebo-controlled trial. J Clin Psychiatry 2005;66(3):323–30.

  89. Vieta E. The role of third generation anticonvulsants in the treatment of bipolar disorder. Clin Neuropsichiatry 2004;1:159–64.

  90. Janicak PG, Newman RH, Davis JM. Advances in the treatment of mania and related disorders: a reappraisal. Psychiatr Ann 1992;22:92–103.

  91. Bradwejn J, Shriqui C, Koszycki D, et al. Double-blind comparison of the effects of clonazepam and lorazepam in acute mania. J Clin Psychopharmacol 1990;10(6):403–08.

  92. Swann AC, Bowden CL, Calabrese JR, et al. Pattern of response to divalproex, lithium, or placebo in four naturalistic subtypes of mania. Neuropsychopharmacology 2002; 26(4):530–36.

  93. McElroy SL, Keck PE, Stanton SP, et al. A randomized comparison of divalproex oral loading versu shaloperidol in the initial treatment of acute psychotic mania. J Clin Psychiatry 1996;57:142–46.

  94. Calabrese JR, Rapport DJ, Youngstrom EA, et al. New data on the use of lithium, divalproate, and lamotrigine in rapid cycling bipolar disorder. Eur Psychiatry 2005;20(2):92–95.

  95. Vieta E, Calabrese JR, Hennen J, et al. Comparison of rapid-cycling and non-rapid-cycling bipolar I manic patients during treatment with olanzapine: analysis of pooled data. J Clin Psychiatry 2004;65(10):1420–28.

  96. Vieta E, Parramon G, Padrell E, et al. Quetiapine in the treatment of rapid cycling bipolar disorder. Bipolar Disord 2002;4(5):335–40.

  97. Vieta E, Gasto C, Colom F, et al. Treatment of refractory rapid cycling bipolar disorder with risperidone. J Clin Psychopharmacol 1998;18(2): 172–74.

  98. Frye MA, Altshuler LL, Bitran JA. Clozapine in rapid cycling bipolar disorder. J Clin Psychopharmacol 1996;16(1):87–90.

  99. Martinez-Aran A, Vieta E, Colom F, et al. Do cognitive complaints in euthymic bipolar patients reflect objective cognitive impairment? Psychother Psychosom 2005;74(5):295–302.

  100. Burgess S, Geddes J, Hawton K, et al. Lithium for maintenance treatment of mood disorders. Cochrane Database Syst Rev 2001;(3): CD003013–64.

  101. Davis JM, Janicak PG, Hogan DM. Mood stabilizers in the prevention of recurrent affective disorders: a meta-analysis. Acta Psychiatr Scand 1999;100(6):406–17.

  102. Geddes JR, Burgess S, Hawton K, et al. Long-term lithium therapy for bipolar disorder: systematic review and meta-analysis of randomized controlled trials. Am J Psychiatry 2004;161(2):217–22.

  103. Bowden CL, Calabrese JR, McElroy SL, et al. A randomized, placebo-controlled 12-month trial of divalproex and lithium in treatment of outpatients with bipolar I disorder. Divalproex Maintenance Study Group. Arch Gen Psychiatry 2000;57(5):481–89.

  104. Goodwin GM. Recurrence of mania after lithium withdrawal. Implications for the use of lithium in the treatment of bipolar affective disorder. Br J Psychiatry 1994;164(2):149–52.

  105. Post RM, Leverich GS, Altshuler L, et al. Lithium-discontinuation-induced refractoriness: preliminary observations. Am J Psychiatry 1992;149(12): 1727–29.

  106. Jensen HV, Plenge P, Mellerup ET, et al. Lithium prophylaxis of manic-depressive disorder: daily lithium dosing schedule versus every second day. Acta Psychiatr Scand 1995;92(1):69–74.

  107. Bowden CL. Acute and maintenance treatment with mood stabilizers. Int J Neuropsychopharmacol 2003;6:269–75.

  108. Vacheron-Trystram MN, Braitman A, Cheref S, et al. Antipsychotics in bipolar disorders. Encephale 2004;30(5):417–24.

  109. Abou-Saleh MT. Who responds to prophylactic lithium therapy? Br J Psychiatry 1993;21(Suppl.): 20–26.

  110. Calabrese JR, Shelton MD, Rapport DJ. A 20-month, double-blind, maintenance trial of lithium versus divalproex in rapid-cycling bipolar disorder. Am J Psychiatry 2005;162(11): 2152–61.

  111. Lambert P, Venaud G. Comparative study of valpromide versus lithium in treatment of affective disorders. Nervure 1992;5:57–62.

  112. Tohen M, Ketter TA, Zarate CA, et al. Olanzapine versus divalproex sodium for the treatment of acute mania and maintenance of remission: a 47-week study. Am J Psychiatry 2003;160(7): 1263–71.

  113. Bowden CL, Calabrese JR, McElroy SL, et al. Efficacy of divalproex versus lithium and placebo in the maintenance treatment of bipolar disorder. Arch Gen Psychiatry 2000;57:481–89.

  114. Keck PE, Meinhold JM, Prihoda TJ, et al. Relation of serum valproate and lithium concentrations toefficacy and tolerability in maintenance therapy for bipolar disorder. Abstracts of the American College of Neuropsychopharmacology Annual Meeting 2002.

  115. Calabrese JR, Bowden CL, Sachs G, et al. A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently depressed patients with bipolar I disorder. J Clin Psychiatry 2003;64(9):1013–24.

  116. Bowden CL, Calabrese JR, Sachs G, et al. A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently manic or hypomanic patients with bipolar I disorder. Arch Gen Psychiatry 2003;60(4): 392–400.

  117. Okuma T, Inanaga K, Otsuki S, et al. A preliminary double-blind study on the efficacy of carbamazepine in prophylaxis of manic-depressive illness. Psychopharmacology (Berl) 1981;73(1): 95–96.

  118. Dardennes R, Even C, Bange Psychiatry 1995; 166(3):378–81.

  119. Tohen M, Greil W, Calabrese JR, et al. Olanzapine's efficacy for relapse prevention in bipolar disorder: A randomised double-blind controlled 12 month clinical trial. World J Biol Psychiatry 2004;5:51.

  120. Tohen M, Greil W, Calabrese JR, et al. Olanzapine versus lithium in the maintenance treatment of bipolar disorder: a 12-month, randomized, double-blind, controlled clinical trial. Am J Psychiatry 2005;162(7):1281–90.

  121. Keck PE, Calabrese JR, McQuade RD, et al. A randomized, double blind, placebo-controlled 26-week trial of aripiprazole in recently manic patients with bipolar I disorder. J Clin Pychiatry 2006;67:626–37.




Бионика Медиа