| Part Ⅰ Efficacy of Lithium Combined with Second Generation Antipsychotics for the Treatment of Maniac Episode of Bipolar DisorderObjective: To explore the differences across lithium combined with different second generation antipsychotics(quetiapine,clozapine,olanzapine or risperidone)in the efficacy for the treatment of maniac episode of bipolar disorder,so as to provide evidences for rational clinical selection of medications for maniac episode of bipolar disorder.Methods: Clinical data were collected from patients with maniac episode of bipolar disorder who received treatment at a third-level psychiatric hospital in Anhui province from January 2015 to October 2019 for evaluation of the pretreatment and posttreatment Bech-Rafaelsen Mania Rating Scale(BRMS)scores and occurrence of adverse reactions.Results: Data from the 182 patients showed significant differences across the groups of lithium combined with quetiapine,clozapine,olanzapine or risperidone in BRMS score at admission and BRMS score at discharge(P<0.001).All of the four treatments can effectively relieve manic symptoms.Chi-square test showed no significant differences across these groups(P= 0.146);however there were differences across the four groups in the remission rate of maniac state(P=0.017).Logistic regression analysis showed occurrence of adverse reactions,length of hospital stay,treatment regimen and years since onset to be the factors that could affect the remission rate at 2 weeks of treatment.Conclusion: Lithium combined with any second generation antipsychotic(quetiapine,clozapine,olanzapine or risperidone)could effectively improve the symptoms of maniac episode of bipolar disorder.In addition,the remission rate of maniac state at 2 weeks of treatment could be associated with the combined treatment regimen,occurrence of adverse reactions,older age at onset and longer length of hospital stay.Part Ⅱ Pharmacoeconomics Evaluation of Lithium Combined with Quetiapine versus Clozapine in the Treatment of Maniac Episode of Bipolar DisorderObjective:To evaluate the pharmacoeconomics of the treatment regimens of lithium combined with the second generation antipsychotic quetiapine or clozapine,so as to provide evidences for rational clinical drug use for maniac episode of bipolar disorder.Methods:This was a retrospective study collecting clinical data from patients with maniac episode of bipolar disorder who received treatment at a third-level psychiatric hospital in Anhui province from January 2015 to October 2019.Based on comprehensive consideration of the pretreatment and posttreatment Bech-Rafaelsen Mania Rating Scale(BRMS)scores and the occurrence of adverse reactions,cost-effective analysis was performed to evaluate the economical efficiency of the two most commonly used treatment regimens.Results:Lithium combined with quetiapine group included a total of 88 valid subjects;lithium combined with clozapine group included a total of 43 valid subjects.There was no significant difference between the two groups in the remission rate at discharge(97.7%vs 93.0%,P=0.198);the incidence of adverse reactions was lower in lithium combined with quetiapine group than in lithium combined with clozapine group(50%vs 76.7%,P=0.003).The medication cost during hospitalization was significantly higher in lithium combined with quetiapine group than in lithium combined with clozapine group($72.91±29.19 vs$18.07±8.76,P<0.001);however the total hospitalization cost was lower in lithium combined with quetiapine group($1360.23±473.72 vs$1630.62±626.50,P=0.022).By analyzing the cost-effectiveness ratio,it was noted that the incremental cost-effectiveness ratio(ΔC/ΔE)between lithium combined with quetiapine group and lithium combined with clozapine group was$-57.53,indicating that lithium combined with quetiapine group would cost$57.53 less for each unit’s increase of effectiveness.Results of the sensitivity analysis were consistent with the fundamental analysis.Conclusion:Lithium combined with quetiapine and lithium combined with clozapine could provide comparable clinical efficacy for the treatment of maniac episode of bipolar disorder;however the incidence of adverse reactions would be lower with lithium combined with quetiapine.Pharmacoeconomics study showed that while the medication cost would be lower with lithium combined with clozapine,the hospitalization cost and examination cost were significantly higher than with lithium combined with quetiapine,leading to higher total hospitalization cost with lithium combined with clozapine,indicating that lithium combined with quetiapine would be more economically efficient for the treatment of maniac episode of bipolar disorder. |
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