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首页> 外文期刊>The Australian and New Zealand journal of psychiatry >Mood stabilizer loading versus titration in acute mania: audit of clinical practice.
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Mood stabilizer loading versus titration in acute mania: audit of clinical practice.

机译：急性躁狂症患者情绪稳定剂负荷与滴定度的比较：临床实践的审核。

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OBJECTIVE: The aim of the present study was to investigate whether the use of a loading strategy with lithium or valproate followed recommended practice and second, whether this had any impact on indicators of outcome in acutely manic inpatients. METHOD: A 12 month retrospective review of admissions to two adult psychiatric units in Auckland, New Zealand, was conducted. Demographic, legal status, psychiatric admissions, outcome indicators (length of stay, intensive care and seclusion use) and medication data were collected for all patients with a diagnosis of acute bipolar mania who started mood stabilizer treatment within 3 days of admission (n=93). Serum levels and adverse effects were also recorded. RESULTS: In 46.2% of admissions a loading strategy was prescribed, and lithium was the treatment choice in two-thirds of admissions. Serum levels were taken inconsistently, particularly for valproate. No difference was found between loading and titrating for the assessed outcomes in routine practice; average length of stay was 30.2 days; most patients (71.0%) spent time in intensive care (average 8.4 days) and 33.3% spent time in seclusion. More adverse effects occurred with loading (51.2%) compared to titrating (36.0%), particularly with lithium. CONCLUSION: The literature supports a strong link between rapidly attained high serum levels and positive outcomes. The present study found inconsistent and infrequent measurement of levels, which was not in accord with recommended practice. Frequent monitoring of serum levels to support dosing decisions is important to inform better clinical decision making, especially when a loading strategy is used. This may explain the less than optimal outcomes (with respect to rapid resolution of mania and hospital discharge) that were found, irrespective of dosing strategy.
机译：目的：本研究的目的是调查是否遵循推荐的做法使用锂或丙戊酸负荷策略，其次，这是否对急性躁狂住院患者的预后指标有影响。方法：对新西兰奥克兰市两个成人精神病科住院患者进行了为期12个月的回顾性审查。收集所有诊断为急性双相性躁狂症的患者的人口统计学，法律地位，精神病学入院，结局指标（住院时间，重症监护和隔离使用）和用药数据，这些患者在入院后三天内开始进行情绪稳定剂治疗（n = 93） ）。还记录了血清水平和不良反应。结果：在46.2％的入院者中，制定了负荷策略，而锂是三分之二入院者的治疗选择。血清水平不一致，尤其是丙戊酸盐。在常规实践中，加载和滴定评估结果之间没有差异;平均住院时间为30.2天;大多数患者（71.0％）将时间用于重症监护（平均8.4天），而33.3％的时间则用于隔离。与滴定（36.0％）相比，加样（51.2％）发生的不利影响更大，尤其是锂。结论：文献支持快速达到高血清水平与阳性结果之间的紧密联系。本研究发现水平的测量不一致且不频繁，这与推荐的做法不符。经常监测血清水平以支持剂量决策对于更好地制定临床决策至关重要，尤其是在采用加药策略时。这可以解释所发现的与给药策略无关的次优结果（关于快速解决躁狂症和出院）。

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