Evolución prospectiva del trastorno bipolar con ciclos rápidos: resultados del STEP-BD

Am J Psychiatry 2008; 165:370-377
(published online January 15, 2008; doi: 10.1176/appi.ajp.2007.05081484)
© 2008 American Psychiatric Association

The Prospective Course of Rapid-Cycling Bipolar Disorder: Findings From the STEP-BD
Christopher D. Schneck, M.D., David J. Miklowitz, Ph.D., Sachiko Miyahara, M.S., Mako Araga, M.S., Stephen Wisniewski, Ph.D., Laszlo Gyulai, M.D., Michael H. Allen, M.D., Michael E. Thase, M.D., and Gary S. Sachs, M.D.


OBJECTIVE: In a naturalistic follow-up of adult bipolar patients, the authors examined the contributions of demographic, phenomenological, and clinical variables, including antidepressant use, to prospectively observed mood episode frequency.
METHOD: For 1,742 bipolar I and II patients in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), episodes of mood disorders were evaluated for up to 1 year of treatment.
RESULTS: At entry, 32% of the patients met the DSM-IV criteria for rapid cycling in the prestudy year. Of the 1,742 patients, 551 (32%) did not complete 1 year of treatment. Among the 1,191 patients remaining, those with prior rapid cycling (N=356) were more likely to have further recurrences, although not necessarily more than four episodes per year. At the end of 12 months, only 5% (N=58) of the patients could be classified as rapid cyclers; 34% (N=409) had no further mood episodes, 34% (N=402) experienced one episode, and 27% (N=322) had two or three episodes. Patients who entered the study with earlier illness onset and greater severity were more likely to have one or more episodes in the prospective study year. Antidepressant use during follow-up was associated with more frequent mood episodes.
CONCLUSIONS: While DSM-IV rapid cycling was prospectively observed in only a small percentage of patients, the majority of these patients had continued recurrences at lower but clinically significant rates. This suggests that cycling is on a continuum and that prevention of recurrences may require early intervention and restricted use of antidepressants.

Notas básicas para recordar sobre el uso de las Benzodiazepinas.

Programa REMEDIAR
Ministerio de Salud. Presidencia de la Nación. Republica Argentina


> Las BZD son fármacos de indicación sintomática, no modifican el curso ni el pronóstico de las enfermedades (Nota de la Rosa de los Vientos: Las modifican en forma negativa)

> Las BZD estan indicadas por cortos lapsos (entre 2 y 4 semanas) cuando la ansiedad y/o el insomnio son severo y predisponen al paciente a un sufrimiento intolerable

> El uso de BZD para la ansiedad leve es inapropiado e inutil

> Todas la BZD pueden producir dependencia y sindrome de abstinencia

> Los factores no farmacológicos deben constituir uno de los pilares del tratamiento

> La modificación del modo y el estilo de vida del paciente es fundamental, ya que contribuye a la estabilidad clínica y a mejorar su calidad de vida

Autores: Valsecia Mabel, Dos Santos Lorena.
Fuente: Modulo IV: Uso racional de medicamentos, enfoque racional de la terapéutica de otras patologías en APS/Valsecia Mabel, ed: Graciela Ventura. 1 Ed. Buenos Aires. Ministerio de Salud de la Nación. Presidencia de la Nación. 2007