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Important clinical features of atypical antipsychotics in acute bipolar depression that inform routine clinical care: a review of pivotal studies with number needed to treat

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Neuroscience Bulletin 2015年第5期31卷 572-588页

作者： Keming Gao Chengmei Yuan Renrong Wu Jun Chen Zuowei Wang Yiru Fang Joseph R.Calabrese Department of Psychiatry Case Western Reserve University School of Medicine and Mood Disorders Program University Hospitals Case Medical Center Division of Mood Disorders Shanghai Mental Health Center Shanghai Jiao Tong University School of Medicine Institute of Mental Health of Second Xiangya Hospital of Central South University mood disorders Program of Hongkou District Mental Health Center of Shanghai

English-language literature cited in MEDLINE from January,1980 to October 30,2014 was searched by using terms of antipsychotic,generic and brand names of atypical antipsychotics, ＂bipolar depression/bipolar disorder＂, ＂placebo＂,and ＂trial＂.The parameters of response（≥50%improvement on MADRS,Montgomery-Asberg Depression Rating Scale total score）,remission（either ≤12 or 8 on MADRS total score at endpoint）,discontinuation due to adverse events（DAEs）,somnolence,≥7%weight gain,overall extrapyramidal side-effects（EPSs）,and akathisia,were extracted from originally published primary outcome papers.The number needed to treat to benefit（NNT） for response and remission or harm（NNH） for DAEs or other side effects relative to placebo were estimated and presented with the estimate and 95%confidence interval.Olanzapine monotherapy,olanzapine-fluoxetine combination（OFC）,quetiapine-IR monotherapy,quetiapine-XR monotherapy,lurasidone monotherapy,and lurasidone adjunctive therapy were superior to placebo with NNTs for responses of 11-12,4,7-8,4,4-5,and 7,and NNTs for remission of 11-12,4,5-11,7,6-7,and 6,respectively.There was no significant difference between OFC and lamotrigine,and between aripiprazole or ziprasidone and placebo in response and remission.Olanzapine monotherapy,quetiapine-IR,quetiapine-XR,aripiprazole,and ziprasidone 120-160 mg/day had significantly increased risk for DAEs with NNHs of 24,8-14,9,12,and 10,respectively.For somnolence,quetiapine-XR had the smallest NNH of 4.For ≥7%weight gain,olanzapine monotherapy and OFC had the smallest NNHs with both of 5.For akathisia,aripiprazole had the smallest NNH of 5.These findings suggest that among the FDA-approved agents including OFC,quetiapine-IR and-XR,lurasidone monotherapy and adjunctive therapy to a mood stabilizer,the differences in the NNTs for response and remission are small,but the differences in NNHs for DAEs and common side-effects are large.Therefore,the selection of an FDA-approved atypical antipsychotic for bipolar depression should be based upon safety

关键词： bipolar depression atypical antipsychotic number needed to treat efficacy tolerability weight gain somnolence extrapyramidal side-effects akathisia

抑郁障碍共患焦虑:诊断与评估之挑战(英文)

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上海精神医学 2014年第4期26卷 227-231页

作者：吴志国方贻儒 Division of Mood Disorders Shanghai Mental Health CenterShanghai Jiao Tong University School of Medicine

抑郁障碍共患焦虑是常见的精神病理现象。该现象使抑郁障碍临床表现复杂化,并导致治疗困难。通过评定符合抑郁症诊断标准患者的焦虑症状严重程度或者通过确定抑郁症患者是否同时符合焦虑症诊断标准,临床医生评估抑郁症状和焦虑症状之间... 详细信息

抑郁障碍共患焦虑是常见的精神病理现象。该现象使抑郁障碍临床表现复杂化,并导致治疗困难。通过评定符合抑郁症诊断标准患者的焦虑症状严重程度或者通过确定抑郁症患者是否同时符合焦虑症诊断标准,临床医生评估抑郁症状和焦虑症状之间的重叠程度。然而,中国临床医疗中存在很多因素,往往难以准确评估患者的共患情况。在中国对于这种最常见的精神病理共患现象——抑郁障碍共患焦虑——的诊断缺乏严重削弱了国内对常见精神障碍治疗的有效性。我们认为,中国临床广泛使用有效可靠的评估工具将有助于对许多同时存在抑郁症状和焦虑症状的患者的诊断与治疗。

关键词：抑郁障碍焦虑障碍共病诊断评估中国

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为什么诊断抑郁症是一个挑战?（英文）

上海精神医学 2016年第6期28卷 343-345页

作者：刘晓华江开达 Division of Mood Disorders Department of PsychiatryShanghai Mental Health CenterShanghai Jiao Tong University School of Medicine

概述:抑郁症非常普遍,也是全球范围导致残疾的主要原因之一。然而,DSM-5现场测试发现诊断抑郁症(major depressive disorder,MDD)的评估者间信度是很差的。为什么诊断MDD如此具有挑战性?本文尝试阐明为什么抑郁症发病机制的不确定性和... 详细信息

概述:抑郁症非常普遍,也是全球范围导致残疾的主要原因之一。然而,DSM-5现场测试发现诊断抑郁症(major depressive disorder,MDD)的评估者间信度是很差的。为什么诊断MDD如此具有挑战性?本文尝试阐明为什么抑郁症发病机制的不确定性和表现形式的复杂性会使诊断变得困难。然而,将来仍然需要其他的生物标志物和转化医学研究来帮助临床医生筛选和诊断抑郁症,而不是单纯依靠目前的主观性诊断标准。

关键词：抑郁症诊断发病机制表型生物标志物

抗抑郁药联合用药以及其他干预策略治疗难治性抑郁症的评价(英文)

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上海精神医学 2014年第6期26卷 365-367页

作者：彭代辉方贻儒 Division of Mood Disorders Shanghai Mental Health Center Shanghai Jiao Tong University School of Medicine Shanghai China

有关难治性抑郁症(treatment-resistant depression,TRD)的定义及其亚类一直有争议,从而难以评估治疗这种慢性致残性病症的不同方案的疗效。根据TRD的症状严重程度等临床特征以及人口学特征方面进行分类可能有助于对同一亚类TRD的识别,... 详细信息

有关难治性抑郁症(treatment-resistant depression,TRD)的定义及其亚类一直有争议,从而难以评估治疗这种慢性致残性病症的不同方案的疗效。根据TRD的症状严重程度等临床特征以及人口学特征方面进行分类可能有助于对同一亚类TRD的识别,并有助于制定针对特定亚类的干预措施。

关键词：难治性抑郁症分类辅助治疗联合治疗

Are subsyndromal symptomatic depression and major depressive disorder distinct disorders？

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上海精神医学 2012年第5期24卷 286-287页

作者： Zhenghui YI Yiru FANG Division of Mood Disorders Shanghai Mental Health CenterShanghai Jiao Tong University School of Medicine

Depressive conditions that do not meet full symptomatic or duration criteria for a major depressive disorder(MDD) are of considerable interest to both clinicians and researchers.[1-4]The fourth edition of the American Psychiatric Association Diagnostic and Statistical Manual of Mental disorders (DSM-IV) provides descriptions of several types of subthreshold depressive states including dysthymia, minor depression and recurrent brief depression;

关键词：抑郁症症状综合征疾病精神障碍研究人员临床医生时间标准

Clinical features and treatment outcomes of major depressive disorder with genital symptoms

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Chinese Medical Journal 2024年第5期137卷 622-624页

作者： Xiaohui Wu Yuncheng Zhu Ping Sun Shuo Wang Zhiguo Wu Jia Huang Lan Cao Yun Wang Yousong Su Zhijian Yao Zuowei Wang Fan Wang Yong Wang Daihui Peng Jun Chen Yiru Fang Department of Clinical Research Center&Division of Mood Disorders Shanghai Mental Health CenterShanghai Jiao Tong University School of MedicineShanghai 200030China Department of mood disorders Shanghai Hongkou Mental Health CenterShanghai 200083China Department of Psychiatry Nanjing Medical University Affiliated Brain HospitalNanjingJiangsu 210029China Department of Psychiatry&Affective disorders Center Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghai 200025China CAS Center for Excellence in Brain Science and Intelligence Technology Shanghai 200031China Shanghai Key Laboratory of Psychotic disorders Shanghai 200118China

To the Editor:Major depressive disorder(MDD)is a mood disorder characterized by complex patterns of emotional,cognitive,and behavioral symptomology and deficits in daily functioning.Genital symptoms,including a reduction in libido and menstrual disturbances,have been considered to be a classic symptom of MDD for many decades.Previous evidence has reached a broad consensus that the incidence of genital symptoms is higher in patients with MDD than in the general population.A systematic review and meta-analysis found a bidirectional association between MDD and genital symptoms,with patients with MDD showing a 50–70%increased risk of developing genital symptoms,while individuals with genital symptoms had a 130–210%increased risk of developing MDD.^([1])As previously reported,50–70%of people with MDD experience sexual dysfunction.^([2])To date,few studies have focused on the comparison of clinical features between patients with MDD with and without genital symptoms,and the longitudinal prognosis.

关键词： symptoms Clinical features

Atypical features and bipolar disorder

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上海精神医学 2016年第3期28卷 166-168页

作者： Daihui PENG Yueqi HUANG Kaida JIANG Division of Mood Disorders Shanghai Mental Health Center Shanghai Jiao Tong University School of Medicine Shanghai China

双相障碍(Bipolar Disorder,BD)临床症状多样,容易被误诊为抑郁症(Major depressive disorder,MDD)。非典型症状(Atypical Features,ATFs)是一个有用的指标,可以从抑郁状态中识别出双相障碍,有助于双相障碍与抑郁症的鉴别诊断。本文就... 详细信息

双相障碍(Bipolar Disorder,BD)临床症状多样,容易被误诊为抑郁症(Major depressive disorder,MDD)。非典型症状(Atypical Features,ATFs)是一个有用的指标,可以从抑郁状态中识别出双相障碍,有助于双相障碍与抑郁症的鉴别诊断。本文就非典型症状与双相障碍的相关性问题进行讨论。

关键词：情感障碍典型特征双相鉴别诊断临床症状抑郁症

The Relationship Between Neuroimmunity and Bipolar Disorder:Mechanism and Translational Application

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Neuroscience Bulletin 2019年第4期35卷 595-607页

作者： Zhiang Niu Lu Yang Xiaohui Wu Yuncheng Zhu Jun Chen Yiru Fang Clinical Research Center Division of Mood Disorders Shanghai Mental Health Center Shanghai Jiao Tong University School of Medicine Shanghai 200030 China CAS Center for Excellence in Brain Science and Intelligence Technology Shanghai 200031 China Shanghai Key Laboratory of Psychotic disorders Shanghai 201108 China

Neuroimmune system may be involved in the pathological process of bipolar disorder(BD),but the essential association is not fully understood.Accumulating evidence has shown that BD involves the activation of immune cells and the release of inflammatory substances in the central nerve system(CNS).Meanwhile,neuroimmune responses also interact with other hypothesis of the etiology of BD that are widely recognized,such as neurotransmitter systems,neuroendocrine systems,neurotrophic factors,and oxidative stress.Simultaneously,related genes and immune changes in peripheral blood vary with it.Overall,neuroimmunity may play an important role in the pathogenesis of BD,and the inflammatory cytokines,especially interleukin-6 and tumor necrosis factor-alpha,have potential value for the clinical diagnosis and prognosis of BD,as well as predicting the therapeutic effects of drugs.Large-scale studies are needed to extend the evidence on neuroimmunity in BD,and to examine its clinical value for applications such as early prediction and treatment.

关键词： Neuroimmunity Inflammation Cytokines Bipolar disorder Translational application

Role of biological rhythm dysfunction in the development and management of bipolar disorders: a review

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General Psychiatry 2020年第1期33卷 8-19页

作者： Yiming Chen Wu Hong Yiru Fang Clinical Research Center&Division of Mood Disorders Shanghai Mental Health CenterShanghai Jiao Tong University School of MedicineShanghaiChina Shanghai Key Laboratory of Psychotic disorders ShanghaiChina CAS Center for Excellence in Brain Science and Intelligence Technology ShanghaiChina

Disturbance of biological rhythms contributes to the onset of bipolar disorders and is an important clinical feature of the condition.To further explore the role of biological rhythms in bipolar disorders,95 English articles published between 1968 and 2019 were retrieved from the PubMed database and analysed.We herein review the outcomes of studies on biological rhythm disturbance in bipolar disorders,including the epidemiology,aetiology,clinical features(eg,sleep,feeding and eating disorders)and treatment of the condition evaluated by patients*selfreport and biological indicators such as melatonin.Our report supports the characterisation of biological rhythm disturbance as a significant clinical feature affecting the onset and development of bipolar disorders and reviews classical and novel treatments,such as chronotherapy,that can be applied in the clinical practice.Our analysis indicates that a more comprehensive study of the pathophysiology,clinical phenomenology and treatment of biological rhythm disturbance is required.

关键词： epidemiology bipolar disturbance