ANTICONVULSANTS IN LITHIUM-REFRACTORY BIPOLAR PATIENTS

锂难治性双相情感障碍患者的抗惊厥药

• 批准号: 3880995
• 负责人: R M POST
• 金额: --
• 依托单位: NATIONAL INSTITUTE OF MENTAL HEALTH
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/3880995
• 关键词: anticonvulsants; biomarker; bipolar depression manic phase; carbamazepine; clonazepam; drug tolerance; human subject; human therapy evaluation; lithium; mental disorder chemotherapy; phenytoin; sleep disorders; valproate

Using the anticonvulsant carbamazepine, we have documented acute response in approximately two-thirds of acutely manic patients and one-third of acutely depressed patients. Lithium augmentation of inadequate response is also observed, in spite of greater decrements in T3 and T4 than with either agent alone. Long-term prophylaxis has also been documented with carbamazepine, although a subgroup of patients show loss of efficacy over time. This may represent the development of tolerance and appears to occur in patients with the most rapidly deteriorating prior course of illness. Patients who are inadequately responsive to carbamazepine may respond to valproate and vice versa. Thus, carbamazepine and valproate appear to be important clinical options in treatment-refractory bipolar illness. Good responses have not been observed to the anticonvulsant phenytoin, while clonazepam may be useful for breakthrough manic episodes and their associated insomnia. A clinical trial of the anticonvulsant calcium channel blocker nimodipine has been instituted. We are attempting to discern clini- cal and biological markers of differential response to lithium and different anticonvulsant agents.

使用抗惊厥药卡马西平，我们记录了急性反应 在大约三分之二的急性躁狂患者中，三分之一 急性抑郁的患者。锂的反应不足是 同样观察到，尽管T3和T4的减少比这都比这两个 独自一人。还记录了长期预防 卡马西平，尽管一组患者显示出疗效的丧失 时间。这可能代表宽容的发展，似乎发生了 对于先前病程最快恶化的患者。 对卡马西平反应不足的患者可能会反应 瓣膜酸盐，反之亦然。因此，卡马西平和丙丙酸酯似乎是 治疗恐怖症的重要临床选择。好的 尚未观察到抗惊厥苯妥英的反应，而 氯硝西am可能对突破性的躁狂情节及其 相关的失眠。抗惊厥钙通道的临床试验 已建立了阻滞剂nimodipine。我们试图辨别临床 对锂和差异反应的生物标志物和生物标记 不同的抗惊厥药。