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1、2019/11/27,.,1,双相情感障碍 合并物质依赖的诊治,2019/11/27,.,2,Frist,Second,Third,双相障碍合并物质依赖特别是酒依赖常见,双相障碍合并物质依赖的治疗难度加大,依从性差,双相障碍合并物质依赖的治疗,Content,2019/11/27,.,3,精神障碍合并物质依赖,一项来自丹麦的研究表明:在一生中双相障碍患者患有物质依赖的患病率为32%,其中酒依赖的患病率占物质依赖中的27%。,Toftdahl NG, Nordentoft M, Hjorthoj C. Prevalence of substance use disorders in psychi
2、atric patients: a nationwide Danish population-based study. Social Psychiatry Psychiatric Epidemiol 2016;51:129140.,2019/11/27,.,4,双相障碍合并物质依赖发病率高,在澳大利亚和新西兰皇家医师协会关于情感障碍的指南中指出:双相障碍合并物质依赖的患病率可高达67%。,Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorder
3、s Australian 2(9):801-8,2019/11/27,.,7,双相障碍合并物质依赖的治疗,美国药物和酒依赖杂志的文章报道:丙戊酸和纳曲酮也许可以减少酒精的使用。,Ihsan M. Salloum 60(2):87-95 2. Adrin Secades-lvarez, Concepcin Fernndez-Rodrguez Review of the efficacy of treatments for bipolar disorder and substance abuse Rev Psiquiatr Salud Ment (Barc.). 2017;10(2):113-12
4、4,2019/11/27,.,11,双相障碍合并物质依赖的治疗,一项来自意大利的研究发现在控制酒精的复饮方面其实丙戊酸的血液浓度在30-50 g/ml时的疗效跟之前普遍认为的50-100 g/ml时的疗效没有明显的区别。,Vincenzo De Iuliis, Raimondo Gelormini, Mariarosaria Flacco, Comparison of Serum Total Valproic Acid Levels and %CDT Values in Chronic Alcohol Addictive Patients in an Italian Clinic:A Retr
5、ospective Study Drugs - Real World Outcomes (2016) 3:712,2019/11/27,.,12,双相情感障碍合并酒依赖的预防,戒酒硫和纳曲酮对于酒精的复饮具有预防作用。,BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP Journal of Psychopharmacology 26(7) 899952 2012,2019/11/27,.,13,Frist,Second,Third,双相障碍合并酒依赖发病率可达可达27%-67%,双相障碍合并酒依赖的情绪稳定剂首选丙戊酸盐,丙戊酸盐用于预防酒精复饮 的血药浓度可在普通的浓度(30-50 g/ml ),Summary,